New member 10/10/20- Please help- Possible to go off insulin in very early stages?

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Great job starting on the testing! It does take time, and there will be lots of stops and starts at first, but hang in there, it will come. Are you using lancets that came with the meter? Those tend to be thinner (30 or 31 gauge) than what you want when starting out, so it's worth trying to track down some thicker (26 or 28 gauge) when next you go shopping. Later on, when the ears have grown some extra capillaries, you can use the thinner ones.

\But the good news is he's really really hungry at the moment so he didn't care after like 5 seconds when he got his bit of tuna.

How long since his last injection? Was it 4U then?
 
So when it comes to the injection. 1 unit then?
Try again and see if you can get a reading before you shoot.
We really don't have any idea what his BG is to give you guidance with the dose.......even if it is safe to shoot.....I certainly wouldn't go above 1 unit if you are shooting blind though.
I can't give you the advice to shoot without seeing a BG number. You might be better skipping until you can get a BG tomorrow as we don't know if he has come up enough to shoot after the 4 units this morning

Doesn't the lancet box say the gauge size on it?
There should be a number there.
If you have no luck tonight I would go out and buy some 26 gauge lancets tomorrow.

You will need to make sure he eats well tonight before the shot and give him a snack at +2 and +4 and +6 tonight . That is 2, 4 and 6 hours after the dose if you decide to go ahead and shoot.
 
Yeah it's the default lancets. I have no idea how to find the thicker ones, I don't know if I'm missing something because I can never find sizing on any of them, I'm gonna need help figuring out what to look for. I mean it's got a number on it but I assume that's the number of lancets in the box, which is 24. Otherwise I've got 0.3mm, 30G whatever that means. And yep, 4 units this morning.

I usually let him free feed overnight if that's ok? He tends to nibble. I'll quickly try again but doubt I'll get anything
 
Otherwise I've got 0.3mm, 30G whatever that means. And yep, 4 units this morning.

That's the size there-- 30 gauge. So definitely a bit thinner than you'd like right now-- they'll work (you did get a blood drop!), it's just harder to get a large enough droplet for the meter.

I was asking about how long ago the dose was because extreme hunger can be one of the signs that a cat is going low, and I was wondering how close he was to the typical nadir time.

I would definitely shoot less than 4U tonight if you shoot. Fingers crossed that you're able to get a test before then so we can give more informed opinions on that!
 
Nothing. I decided not to shoot. He's stressed, it's late. I think his glucose is back up again though, he's fairly normal again, so idk maybe I could get away with something. I'll monitor his urine in the meantime as best I can.

AH thanks! That's the number I was looking for! I didn't realise they went to 30 and it just didn't occur in my head. Still running on 2 hours sleep so, whoops.

So next question, he's obviously due for his dose next morning. What do I do there? I can't get the right lancets before he's due. Is it ok to skip that too? Or give a small dose?

Oh also, he's probably just hungry because it's over an hour past his usual feeding time and it's thrown him off
 
Nothing. I decided not to shoot. He's stressed, it's late. I think his glucose is back up again though, he's fairly normal again, so idk maybe I could get away with something. I'll monitor his urine in the meantime as best I can.
If he was showing early signs of a hypo such as being spaced out, lethargic, unsteady his feet or very sleepy his BG was probably low. You mentioned he wasn't quite right this morning. If you see him like this please feed him some food. Once the BG is out of the hypo range he will appear normal But the BG may not be nearly high enough to give the dose. That is why testing is so important.
I agree with Nan, try and get a good night's sleep. It will all get sorted out. It is always a steep learning curve in the beginning but you are doing really well.
Team Bruce will see you tomorrow!
 
Yeah that'll be helpful to change the time back a bit.

And thanks. Phew. I don't want to throw myself a pity party or anything but I really struggle with in-store shopping and looking at all the products, I'm autistic and have to calm myself from having massive anxiety/panic when I'm in the store. Just picking up my order today was rough. Is there any chance you can please point me in the right direction of the name of a product for the lancets to buy? It's completely fine if you can't, just trying to take a shortcut if I can. I can get to Chemist Warehouse again, but I can also look for a specific product online and try to track it down. I just can't seem to find the size in online descriptions which is super annoying.

Don't worry, I'll be in bed at a reasonable time and calming myself down from the mess lol. He was doing ok before the insulin started so he'll cope. Seriously I can't thank everyone enough for your help. Everyone here is so helpful. I'm so glad I came here.
 
I couldn’t find an accuchek fastclix 28 gauge at all.
But you can use a Abbott freestyle Lancet 28 gauge if you buy the lancing device to go with it. I would imagine you could buy the device at the store that sells the lancets.
A lot of chemists sell the Abbott lancets.
Here is a link to what you are looking for. I couldn’t see that chemist warehouse sold them.
You may be able to ring around a few chemists to see if they have them before going in to buy them.
I used this device and lancets and they are very user friendly.
https://discountchemist.com.au/product/freestyle-28-gauge-sterile-lancets-100pk/?dTribesID=793d5797a6a4797fccfe046b334a682d|adtribes|96508&utm_source=Google Shopping&utm_campaign=DiscountChemist&utm_medium=cpc&utm_term=96508&gclid=EAIaIQobChMIj96N04Cq7AIVRKqWCh1-TAKxEAQYAyABEgIMWfD_BwE
 
Back again with some general info and comments.

Ideally, I'd like to keep the new diet (seeing as he's currently fine), go off insulin, and monitor his blood levels to get good starting readings, but I know there can be serious problems going off insulin.
If a diabetic cat that needs insulin doesn't receive any at all, there is a risk that the cat's body may start breaking down fats for energy. This results in ketone production and puts the cat at risk of developing diabetic ketoacidosis, a life-threatening complication of diabetes. By way of general information, routine ketone monitoring is a wise safety precaution, particularly if a cat is running in high BG numbers (greater risk of metabolic dysfunction). Ketones may be monitored via urine (urinalysis strips) or blood testing (ketone meter, similar to glucometer). I see other members have already given you some pointers. Here are some useful resources for you to bookmark:

Tips for Collecting Urine Samples

Diabetic Ketoacidosis Information


Well, he hated the injections (He took the first one fine, then realised it was coming and freaked out every time) and is very stressed, so when he was a bit wonky I just assumed he was dealing with a lot of anxiety and stress. I asked the vet what signs to look for for hypoglycemia and he told me, but reassured me it was very unlikely. Bruce kept getting more and more "upset" as injections went on, and then today I was trying to pet him and he was out of it. I asked the vet if I could skip tonight's dose and he said "ok, but we need to be careful not to do that too often". The difference is night and day, he's so much more alert, he's purring, being a cheeky bugger, back to his normal self. I feel terrible that I might have been overdosing his insulin or managing his diet wrong or something. I'm second guessing myself that it could be stress, but he was just weak and glaring off into the distance while trying to get a scritch out of me earlier today, so surely not (usually he would've been crushing my hand demanding harder skritching, lol). What a mess.

With regard to some of the clinical signs you've observed in Bruce, it is valid for you to be concerned, to wit:

* OK on first injection, intent on avoiding subsequent injections, stress increasing with each successive injection. [Depot building, more insulin in system with each successive injection.]

* After administration of 7th dose, Bruce "out of it", "weak and glaring off into the distance". [Depot getting closer to 'full', greater risk of hypo.]

* Behaviour returns to normal when 8th dose skipped. [Possibly due to body no longer needing to 'fight' the insulin dose - speculating here.]​

By way of general information, sometimes a cat may become lethargic or 'seem a bit off':

* for part of the time over the first few days of treatment with insulin as the body may take a little time to acclimatise. (Should be self-limiting, usually resolves after a few days.)

* when blood glucose levels drop too low, possibly accompanied by other symptoms like 'spaciness'. (BG testing will enable you to check whether BG is in hypo territory.)

* when blood glucose levels go through a steep drop into still-safe lower numbers from a much higher preshot BG. (With a Lantus kitty, likely cause would too high a dose. Again, home testing will help with this.)

* if the current insulin just plain doesn't agree with the particular cat. (Cat may 'seem more itself' when insulin dose is wearing off; usually resolved by switching to a different insulin).

* if it is throwing ketones or going into DKA. (Regular monitoring for ketones is best preventative measure. Extra caution needed if general BG level is high, or appetite is poor.)​

If the insulin dose is set wrong or if the particular insulin doesn't agree with the cat, the cat may try hard to avoid subsequent injections. Bruce's behaviour with respect to receiving injections is definitely something to keep an eye on.

Conversely, some cats may initially be resistant to BG testing. However, when the insulin dose is set to a safe and effective level and they start feeling better, they recognise that the testing is somehow connected with that and they become much more compliant and accepting of the procedure. Some even start sitting in their testing spots of their own volition, waiting for their caregiver to check their BG levels and give them a treat!


Maybe also switch to a new vet? Honestly I'm so new to this and my vet is downplaying all the info I'm finding online and confusing me, so I'm just so lost.
Impression of current vet's performance:

* Based on the research-based dosing protocols we use here, the starting dose was set too high.

The above is poor but...

* Was aware that there was no initial capacity to monitor BG levels at home.
* Gave instructions to switch to food with over 50% less carbs.
* Does not appear to have given any weight to the effect of the simultaneous filling of the Lantus depot.

The above three constitute the diabetic equivalent of a perfect storm.

These are other concerns:

* Dismissive of client's observations of concerning clinical signs, discouraging attitude towards client's queries and efforts to learn more about feline diabetes.
* Disturbingly blasé attitude to assessment of risk of hypoglycaemia, and to treatment thereof.

Honestly, if this was happening to my cat and my vet wouldn't give proper consideration to very concerning observations about my cat's response to insulin, I would be actively looking for a different vet who had a better handle on feline diabetes fundamentals, and who was willing to work with me as a partner in my cat's care.


Mogs
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I really struggle with in-store shopping and looking at all the products, I'm autistic and have to calm myself from having massive anxiety/panic when I'm in the store.
You hum it, I'll play it. (((Nick)))

I have PTSD and shops affect me pretty much the same way. (Feels like the items on the shelves are screaming at me.) It's overwhelming and horrible to experience. I feel for you.

:bighug:

Just picking up my order today was rough.
The power of love - you got the stuff. :cool:

(((Bruce)))

Tip: When trying to get a blood sample, warm the ear. Then warm it some more. Then when you think it has to be warm enough now, warm it more again.

Once you crack the ear warming, your testing success rate should hugely improve. (I was quite taken aback at how warm I needed to get the ear when I first started testing.)


Mogs
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Here is the home testing method I used. Perhaps it might give you some ideas to add to your own testing technique.

  1. Fold a sheet of kitchen paper in four lengthwise and cut it up into 1" strips. You will use these to cushion and support the ear during the test.

  2. Put a thin film of Vaseline or Neosporin ointment (not the cream!) onto the edge of the ear to help the blood sample bead up instead of wicking away into the fur. (Wipe off any excess with a tissue or cotton pad.)

  3. To get a blood sample you need to increase the blood flow to the ear, so make sure the ear is really, really, really warm (but not hot) - especially in the early days of testing. (Note: With repeated 'poking', more capillaries form in the test area, so it becomes easier to get samples reliably.)

  4. Once you have the testing area of the ear very well warmed, wrap a strip of folded kitchen paper round your index finger then place finger under the sweet spot area of the ear you're testing to support it during the poke.

  5. Use your thumb and middle finger to lightly but firmly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much).

  6. When using a lancet 'freehand', make sure the bevelled side of the lancet is facing upwards. Hold the lancet at a slight angle to the ear similar to the way you hold a pen when writing, not perpendicular (easier to see where you're aiming and also makes skin prick easier).

  7. When it comes to the actual poke, prick the sweet spot on the edge of the ear in a similar way to how you might quickly prick a balloon with the tip of a needle to make it pop.

  8. When using the glucometer, bring the test strip to where it j-u-s-t comes into contact with the blood droplet and hold it there. The strip should then 'sip up' the amount it needs to run a valid test. Most meters beep or give a visual cue to let you know that enough blood has been collected on the strip.

    If your cat is a wriggler, try collecting the blood sample on the back of your (clean) fingernail and test it from there.

  9. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 15-20 seconds to minimise bruising.

  10. Keep praising your cat throughout the process and reward with a favourite diabetic-friendly treat or other favourite activity (e.g. grooming).
With a bit of time and practice you'll be able to work out a technique and a routine that works best for you and for Bruce.


Mogs
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You can also just free-hand the lancet without the device. I actually found that easier to manage (plus there's no clicking noise to startle the cat).

Hi Nick re Nan's comment above. I did mention before that I found this better but it may have been helpful if I said why. Mac didn't mind the click so for me the advantages of freehanding is that it gives me much more space only holding a tiny lancet with one hand rather than the lancing tool. If I need to poke twice I can just do it immediately rather than having to draw back the lancet into the tool again. And best of all I can see exactly where I am aiming - my lancing tool had a white end - why on earth it isn't clear plastic !!! It does take a couple of tries to get used to how hard to poke (the tip I was given was like popping a balloon). I think I delayed trying it for a while because it felt more like I was doing it to his ear whereas the tool made me feel more distanced from it so less guilt - daft I know!
PS if you ever do find you get the vein by accident don't worry - yes you do get quite a bit of blood (don't waste it!) But it soon stops with a bit of pressure using kitchen paper or cotton wool - its not like you've severed his jugular you have not damaged him. Yes been there done that (ear vein not jugular!) and we both survived just fine.
Gill
 
I think I delayed trying [freehanding the poke] for a while because it felt more like I was doing it to his ear whereas the tool made me feel more distanced from it so less guilt
Same here! :oops:

I used to spend the first part of each testing session apologising profusely to Saoirse, and explaining to her at great length why it was necessary and that I was only doing it because I was trying to protect her.

Saoirse's response? ---> :rolleyes:


Mogs
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Thank you so much for the tips. Now that I've slept I think I can actually function and work this out lol. I'll be focusing on sorting out a set up to test all of this at home. I don't want to run around trial and error with vets until I'm sure he's ok.

I gave Bruce 1 unit this morning just after 8. After trying to get last night's BG readings, he was fully braced for that, so it was absolutely hilarious seeing his reaction to just a quick jab, like "That's it? That's all it is?! Why was I worried?!"

Urine samples are only slightly working right now? I have a very small amount of non absorbent litter from my vet's kit that I used. He refused on it's own, so I gradually added more and more of his usual litter to it (a recycled newspaper litter). He used his box just a few minutes after his injection. I'm noticing he wants to make sure I'm definitely doing something else and not going anywhere near him, so catching a urine stream seems less likely. Anyway, his litter absorbed most of it, but I still got a few decent drops for my strips. I ran a few tests because I'm not used to using them yet. I'll be looking at tips for this, but I'm sure he'll go if he just gets a good volume of litter in the tray, so aquarium gravel or dried lentils maybe?

Ketone was negative again. It developed into 0.05g/L (the "traces" category) after like, 3 minutes, so I assume that's fine, given it took significantly over 15 seconds to reach that point.
Glucose is hard to read because it develops so fast and guessing a colour isn't the world's most accurate read, but it looked about 9-13 g/L. I'd say definitely not over 15 g/L max. I'm hoping I get these numbers right after my last bungle lol. Do those numbers from urine sample relate directly to BG? I'm very unfamiliar with how that translates.

Additional info on that, last night Bruce was eating a lot of his GlucoSupport food and looking real hungry, so I gave him his Hills Dental in case his BG was low, and he was satisfied after that (he ate it about midnight), so it might have been completely right that he was getting a bit low. I kept 1/4 cup of GlucoSupport in his bowl but looks like he didn't eat much of it overnight. I take it his urine is a snapshot of the results of that.

I'm on a mission today to sort out those lancets. Also I saw a tip to put rice in a sock and warm it in the microwave, and use that to heat kitty's ear (making sure it's not hot, just warm). I think I'll try to give ear massages with that, my hands are kind of cold. I'll try to get a spreadsheet going to at least gather data on dosages and whatever test results I can. The worst part of it is it's happening over the weekend, lol. I can get someone to help run errands during the week, just not now.
 
Its a lot to do. We understand the learning curve is steep. One step at a time!

A trick Ive seen mentioned here is clean the litter box Put a very small amount of litter in the box( enough so he can scratch in it). Prop one end of the bow up slightly Once he "goes" the urine will run down to the end not lifted. Dip in stick.

Once the strip is dipped the longer you wait the darker the strip will turn.
 
Also I saw a tip to put rice in a sock and warm it in the microwave, and use that to heat kitty's ear (making sure it's not hot, just warm)
Hi Nick
If you don't have a rice sock or Bruce doesn't like it then what I do is to soak some folded kitchen paper with hot (not boiling water) from the kettle then put it inside a foodbag ( to keep the ear dry). Test the temp against my hand. Then hold the bag against the ear - I put it against the inside top half of the ear flap as I poke the outside. It also has the advantage that its easy to.mould to whatever shape you want.
I rub the outside of the ear gently with my thumb at the same time. Mac actually seemed to quite like having his ears warmed last time (cold day).
I think there could be a market out there for kitty ear warmers - a bit like mittens or egg cosies maybe ?
 
You are doing well.
Great there were no ketones. The urine sample of the glucose is really a snapshot of all the time since he last peed so he could have been low then high and you wouldn’t know.
That’s why testing the BG is so much better.

If you have any issues with setting up the spreadsheet just tell us and we will get someone to do it for you. No problem!

Good luck with the lancet hunt! Let us know how that goes.

The rice in the sock is a good idea!

Are you feeding between the cycle this morning? Or leaving food out for him?
 
Oh awesome! I'll have to give these a try. I'm lucky to get just enough urine at the moment but really need to figure out a longer term plan. I'll find the solution eventually.

On my first attempt at getting BG from him last night, he seemed quite content with having his ear warmed up. He wants the ear massage, just not the prick, lol. So I'm sure he'll get used to it. A massage and a snack, what's not to love? (Aside from getting pricked)

I leave food out for him to have a go at, he usually leaves it and eats most of it as a small meal at midday and then snacks in the afternoon. With the injection shift back to 8pm, that's closer to how things naturally play out- doesn't eat much for a few hours then wants a meal at 8.
 
I could get the lancets but not the device. From what I can tell, they're just available with the full kit and they didn't have those. I can try pricking his ear myself. I think he gets spooked by the big device and the click anyway. So I'll have a thorough look at the advice around that. I discovered cats ears are a very weird to prick lol. I've got some vaseoline petroleum jelly if that might help the blood stay in droplet form.

I'm keeping an eye on him in the meantime and he looks like he's doing just fine so far. I think the drops happen gradually between 1-4pm, it's 1:30 now so early stages. He's napping but he's more alert and lifting his head up when something happens. Usually as he drops I'd notice he just stays in the same spot and barely moves unless it's really necessary. So, good signs so far.

Do we think that just by default (assuming everything remains the same and no signs of hypo) I should stick to 1 unit twice a day? I'll post any readings I get, but there's no guarantee I can draw blood today while I'm learning. I'll get it within a few days though. I've requested the test results from the vet, too. I'll let you know when I get them.
 
Yes I would definitely stay with the 1 unit especially if you are not testing. Make sure he eats well and often especially in the first half of the cycles when the Insulin is usually the strongest.
Unless your testing tells you you need less insulin, you would be best to stay with1 unit for a week. have a look at the Start Low Go Slow method which is at the top of the Lantus page. I will send you the link. It’s a very good method, very reliable especially if you are starting off and getting used to it all. It gives you structure to go by.

if you think this is around the time he drops low, I would give him a good snack now.

Don’t forget to yell if you need help with the SS.

dosing methods
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Thanks! I haven't set up the spreadsheet yet because "people and life". Hopefully will at least be able to look into it today. He's not taking to a snack at the moment unfortunately. I think he ate something about an hour or so ago though.

Attempting to get a reading tonight, so should I restrict his food 3 hours prior? I'm hoping he doesn't end up over-hungry again
 
Gah! So close. I got about half the blood out that I needed so it gave me an error. His ear was nice and warm to the touch. I guess I need to massage it out a bit more? Or longer heat? It took a while for it to come out. I'll only make him go through that once, so I just gave 1 unit.

Also I got another even tinier urine sample right before his injection that looked about 15+. It's all I've got to go on right now, so all I can say is, higher than this morning's sample.

Because I'm leaving his food out overnight, I can't guarantee he hasn't eaten before his morning check. Is that ok? Or shall I leave it for the evenings?
 
Gah! So close. I got about half the blood out that I needed so it gave me an error. His ear was nice and warm to the touch. I guess I need to massage it out a bit more? Or longer heat? It took a while for it to come out. I'll only make him go through that once, so I just gave 1 unit.

Also I got another even tinier urine sample right before his injection that looked about 15+. It's all I've got to go on right now, so all I can say is, higher than this morning's sample.

Because I'm leaving his food out overnight, I can't guarantee he hasn't eaten before his morning check. Is that ok? Or shall I leave it for the evenings?
Are you milking the ear before you prick it?
Were there any ketones in the test?

You need to leave food out for him at night as he’ll need to eat. I would also make sure he has a snack before you go to bed.
A lot of us use automatic timed feeders at night... and you can get it to turn two hours before the am shot to an empty slot. Do you think Bruce would eat from one?

How is the SS coming along?
@Bandit's Mom is online atm and she can help you set up the SS if you like. She will see this tag and answer it.
 
Ah. I was rubbing it and warming it, but not milking it. That makes sense. No ketones, but the sample wasn't great and only covered part of the strip. I couldn't get anything accurate. I'm shopping tomorrow for a better setup including hopefully aquarium gravel. I have someone to help me so I can really look around without getting overwhelmed (hopefully).

I was thinking about getting an auto feeder. I'm not sure he would like it to start off, he doesn't respond to food being put in his bowl unless it's wet. So an auto feeder would likely result in the food sitting there anyway.

And yeah that'd be really helpful to get it set up. Thank you so much! I'm just realising that I'm still really frazzled by everything so any help goes a long way.
 
Thanks for the encouragement! Bandit's Mom has offered help thankfully. My brain completely fried trying to set it up. This might be a job for tomorrow because it's getting late and I realise I didn't eat properly today. A good sleep and a good breakfast and I'll be up for another day of sorting this out. Keep on keepin on and all that ^^
 
Nick -

Welcome to FDMB!

If it's not too much trouble, if you've gotten some of your preliminary questions answered, would you mind starting a new thread? Once a thread gets to be over 50 posts, it's difficult to take the time to wade through all of the information to insure that you've gotten your questions answered.
 
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