Introducing Romeo and Questions

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Renee McBride

Member Since 2022
Hi,

My 15 yo Romeo aaa diagnosed on Thursday. I am an experienced pet owner (plus an experienced cat rescue volunteer) who has dealt with many medical situations for my fur babies (kidney disease, thyroid, urinary tract disease, FIV etc) but diabetes is completely new for me and frankly has me on anxiety overdrive! I am not afraid of the injections/needles since I am experienced administering them but I am most afraid of pushing Romeo into hypo. Another diabetes group has mentioned my vet has started him on way too high of a dose and I am struggling with how to question that since it’s difficult to act like an online group knows more than a vet! Ugh.

Romeo’s story:

-We lost one of our fur family members (Julius) in March very unexpectedly. Juju and Roro were very close so when Romeo was acting depressed, I assumed it related. In April, I took him to the vet because his breathing/nose sounded like a tea kettle. Xrays showed a URI and the bloodwork also showed major inflammation and infection. He was started on antibiotics and a short dose of prednisone. Looking back at his labs, I suspect he was already trending to diabetes (Glucose 398) but the vet said it was probably stress. If he was heading to diabetes, I know the steroids didn’t help.

This week, I took him in because he just seemed off. My gut told me something wasn’t right. He has been a big drinker for awhile but he was hovering over his water. He was sleeping a lot and he wasn’t eating well. He was super dehydrated even after I did 2 back to back days of subq fluids.

The glucose Was 326 and urine confirmed sugar. He also has a UTI and the bloodwork showed probable pancreatitis.

He was given amoxicillin, continued subq for a couple more days and Prozinc. His vet wants him on 3U (he is down 1.5 lbs since April and currently at 14). I know this is high but I don’t know how to ask for less.

I picked up the home meter Friday and have struggled to get blood out of him but have gotten a few tests. Yesterday am 146, pm 186. This am 336 (I did have to poke and mess with him A LOT so stress could factor in). Tonight pre poke check was 159. Another group says not to inject if less than 200? So I waited an hour and he was only 169.

I have NOT given any insulin tonight and just fed him his dinner. I’m worried if I made the right choice or if I am messing with regulating him but I am terrified of hypo or killing my baby. I’m guessing these “normal” readings are because he is on such a high dose and may need a smaller one to start?

Hugs and purrs,
Renee , Romeo and the rest of the fur crew
 
@FrostD
Welcome Renee and Romeo
I am not a prozinc user but I will tag a member who is but I would like to tell you that you couldn't have found a better group to join.
There are many experienced members here and if it wasn't for their advice Tyler wouldn't be in remission today knock on wood
Can you first please fill out what we call our signature , information about Romeo
It's at the end of every ones post in light gray
I'll give you the info
click on your name up top and then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

We also use a spreadsheet to track the BG readings to see how the insulin is working and how low it's dropping. We also test during each 12 hour cycle just not the pre shots to see if a decrease or increase is needed. We adjust the dose by how low the BG number is
We also adjust by 0.25 increments, not whole units, so having the U-40 syringes with half unit markings is helpful. Take a look at Tyler's spreadsheet to get an idea how it works
Look at my 2020 and 2021 tabs up top ,there is more testing I did, my 2022 there isn't that much because he's in remission

I'll give you the link to create one but if you need help setting I can tag Bhooma
@Bandit's Mom to set it up for you, just ask

We need to look at your spreadsheet so we can give you advice
3 units does seem like a high dose to start with, but I am not that experienced when it comes to dosing
Here is the link for the spreadsheet it will also explain out it works
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
You can call them and they will contact your vet to fax a script over, ask for refills and give the vets office a heads up
If you don't have the syringes with half unit markings you can get them here
https://www.adwdiabetes.com/product...MI6Pi__pG7-AIV6idMCh1qAQPBEAQYAyABEgK5DfD_BwE
DIA10
adw-coupon-dia10.jpg



@FrostD
 
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Renee McBride said:
Hi,

My 15 yo Romeo aaa diagnosed on Thursday. I am an experienced pet owner (plus an experienced cat rescue volunteer) who has dealt with many medical situations for my fur babies (kidney disease, thyroid, urinary tract disease, FIV etc) but diabetes is completely new for me and frankly has me on anxiety overdrive! I am not afraid of the injections/needles since I am experienced administering them but I am most afraid of pushing Romeo into hypo. Another diabetes group has mentioned my vet has started him on way too high of a dose and I am struggling with how to question that since it’s difficult to act like an online group knows more than a vet! Ugh.

Romeo’s story:

-We lost one of our fur family members (Julius) in March very unexpectedly. Juju and Roro were very close so when Romeo was acting depressed, I assumed it related. In April, I took him to the vet because his breathing/nose sounded like a tea kettle. Xrays showed a URI and the bloodwork also showed major inflammation and infection. He was started on antibiotics and a short dose of prednisone. Looking back at his labs, I suspect he was already trending to diabetes (Glucose 398) but the vet said it was probably stress. If he was heading to diabetes, I know the steroids didn’t help.

This week, I took him in because he just seemed off. My gut told me something wasn’t right. He has been a big drinker for awhile but he was hovering over his water. He was sleeping a lot and he wasn’t eating well. He was super dehydrated even after I did 2 back to back days of subq fluids.

The glucose Was 326 and urine confirmed sugar. He also has a UTI and the bloodwork showed probable pancreatitis.

He was given amoxicillin, continued subq for a couple more days and Prozinc. His vet wants him on 3U (he is down 1.5 lbs since April and currently at 14). I know this is high but I don’t know how to ask for less.

I picked up the home meter Friday and have struggled to get blood out of him but have gotten a few tests. Yesterday am 146, pm 186. This am 336 (I did have to poke and mess with him A LOT so stress could factor in). Tonight pre poke check was 159. Another group says not to inject if less than 200? So I waited an hour and he was only 169.

I have NOT given any insulin tonight and just fed him his dinner. I’m worried if I made the right choice or if I am messing with regulating him but I am terrified of hypo or killing my baby. I’m guessing these “normal” readings are because he is on such a high dose and may need a smaller one to start?

Hugs and purrs,
Renee , Romeo and the rest of the fur crew
Click to expand...


@tiffmaxee

@Wendy&Neko

@Suzanne & Darcy

@Bandit's Mom
I know you aren't prozinc user's, I did tag Melissa frosty d
but in case she doesn't come on until tomorrow can you take a look at this new members post, I think her vet started her cat on too high a dose of prozinc of 3 units by what numbers she has already stated
Thanks ladies
 
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Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up
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6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
 
Hi Renee and Romeo and welcome to the forum.
I am not sure what other group you were posting on but I agree that the dose is too high.
I know it is hard to get your head around but most vets do not know a lot about feline diabetes and often prescribe too big a dose to start with. This forum has very very experienced people her and we live feline diabetes 24/7.
Do you have a hypo kit set up? Make sure you get one set up asap. I will post a link below that has a hypo kit in it

Please go back to 1 unit twice a day. 3 units is far to high a dose to start with.
Make sure you are testing before every dose and if the BG is under 200 stall, dont feed and test again in 20 minutes to see if the BG is rising. And post here and ask for help. Change to subject line to reflect the problem
I am not a Prozinc user so hopefully @FrostD will be along sometime soon. But probably not for several hours yet as she is probably sleeping.
You made the right choice to skip this dose. See what he is at the start of the next cycle.
Keep posting and asking questions :)
Bron
 
Welcome to FDMB.

You have great instincts and trusting your gut about Romeo's health makes that very clear!!

We follow a method for dosing. The rationale behind the method is to start at a relatively small dose and then increase the dose in a systematic way. The rationale is that if you start with a large dose, there's no way to know if it will drop your cat's numbers into a low range which is not great for your cat and will likely cause you to panic! This is particularly true when you're still learning how to home test. It's especially the case if your vet isn't a fan of home testing. (We're big fans of home testing since it's the best way to keep your cat safe.) So, we advocate for starting at a dose between 0.5u - 1.0u depending on what you're feeding your cat so you don't risk hypoglycemia and so you can master the basics of mastering diabetes management.

We recommend that you feed your cat a low carb canned food or raw diet. We consider low carb as under 10% carbohydrate although most of the members generally give their cat food that's in the 5% range. There are lots of options! You don't need to be feeding Romeo prescription diabetic food. (There's nothing "prescription" about it other than the price.) This is a chart of most of the canned foods available in in the US along with nutritional information. The chart was put together by a vet with an interest in feline nutrition.

Much of what Diane posted is in this link on helping us to help you. We tend to be very numbers driven. We want to be able to follow along with you to see the results of your testing and the effect the insulin is having.

Please let us know if you have questions. We're here to help.
 
How long has he had the UTI, how long has he been on antibiotics, and how much longer does he have left? Did they do a culture?

And those tests you have, they are while he's.on insulin?

The main reason I'm asking all this is because I've seen my fair share of FD misdiagnoses because long-running infections raise BG. More and more UTIs are not responding to antibiotics (especially if culture wasn't done). Recently I've seen cats struggling with them for month or more.

I would also be checking for ketones at least 3 times a week, you can use either a blood meter (more expensive) or urine test strips like Ketostix . Diabetic ketoacidosis (DKA) is a very serious risk for diabetic cats, and the recipe is not enough insulin (such as in an unregulated cat like yours) + inappetence/not enough food + underlying infection/inflammation/stress.
 
Thanks! I think I updated my signature! I will try and address all questions:

Regarding diet, I had always done a high quality, high protein low carb wet food. I also try and keep phosphorus numbers relatively low since all 5 of mine are seniors. Until Friday, he was on premium dry as well (only 1/8 c twice a day) but I have stopped that as of diagnosis last week. I’m now working to try and push enough calories via wet so that’s a challenge.

I can’t do urine testing at home since I have 5 cats sharing litter boxes (Romeo would NOT do well penned up alone). Luckily, he showed no ketones Friday or in January at his annual U/A.

His glucose has been trending upwards since November but the vet attributed it to stress (182 last November, 389 when he had an upper respiratory in April and 326 on Thursday). No culture was done. The U/A was done via cysto. He’s on Amoxicillin which was started Thursday evening and should be continuing the remainder of this week. When he goes for his fruxtosomine check in 2 weeks, I plan to ask for another U/A.

I just learned how to test Saturday so I haven’t done a 12 hour curve yet. I need to find a day when I can actually be home for 12 hours straight! However, given his swings yesterday (336 AMP to 159 PMP, the vet has agreed I can scale it back to 1U from 3U. I was gone most of the day today but his AMP was 289, 4 hours post (attempted to catch nadir) was 284 and PMP is 245 so he’s staying more consistent rather than the huge swing. Obviously we hope for a lower number over time but it seems like he is responding better to the lower dose. Plus he is acting better! Rather than sleeping all day, he was running around with his ball yodeling. =)

I actually started this spreadsheet today from another group. The 2022 tab looks to be the same. I’m still trying to build that up (plus tracking weight, calories and labs). Then I can figure out how to get it into my Google drive!
 
There are meters that test blood for ketones. There is some information on ketones and a link to meters in this post:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

A word of warning on spreadsheets from other groups. The spreadsheet format was started here, but one of the groups made made some minor mods which introduced a problem with the sheet, such that it doesn't open for others on phones or iPads. One you post the link, we can confirm whether you've got a working version.
 
Thanks Wendy! The ketone article is interesting since it describes a lot of what we dealt with at diagnosis (I am still waiting for a copy of his U/A for my files but the vet didn’t mention any ketones). However, I guess those symptoms also align with pancreatitis and his labs did show that (high lipase and GGT).

Since his AMP was high today, I already did a +1 and +2 and it’s falling nicely but I will add a 4/6/8 today (I may not get one between 5 and the 7 pm PMP since I am on duty to run my daughter all over!). I added my sheet to my Google drive under a folder for Romeo and opened access to that folder for anyone with the link. So hopefully this works? I can open the spreadsheet on my own iPhone so fingers crossed! Please let me know if you can see it. Since I am tracking all sorts of data in multiple tabs, hopefully that doesn’t mess with it.

https://docs.google.com/file/d/19Vk...u50vUJ/edit?usp=docslist_api&filetype=msexcel
 
I can see the spreadsheet, and also see that it's the dodgy one from that FB group. I can tell because the "handy reminders" have an error in them. Specifically the optimal range for insulin on a pet meter is quite out of date. You have some comments attached, that we usually just add to the Remarks column on the far right. Also, if the spreadsheet is working, it should be automatically colouring the cells for you. To me, on both the iPad and the computer, the colour tones look off. The reference ones at the top are the correct colour. If fixing this is too much for you, we have a spreadsheet whiz here who can help you. @Bandit's Mom

As for the actual numbers, he dropping a lot at +2. I'm glad you will get a +4 today cause it looks like a very active cycle. Good thing you reduced the dose.
 
Yes! If you have a whiz to fix it, I would love that. I am needing to manually try and match the colors in my excel and it’s a pain! I am trying to get this workbook into my one stop shop document for Romeo to track everything I could possibly need to monitor.

What ranges should I be watching for? I know my vet said he felt I could shoot at 150 versus the 200 mark the spreadsheet says but I obviously don’t have enough data to share the entire sheet with him yet (I plan to send it to him prior to our glucosamine check). I just did the -+4 and he has now dropped to 244. I can tell he certainly feels better in the 200’s versus high 300/low 400s. He was a little hesitant to eat this am (rejected Tiki Cat and Hound and Gatos and finally agreed to eat Fancy Feast classics…I’m glad I had started introducing a broad variety a couple of months ago!).

Also, how often do you have the vet do a U/A? I am a single mom with 5 fur babies on top of my human daughter so money is tight and I don’t want to overreact but I will do what he needs when he needs it. I was debating asking if we should do a U/A in 2 weeks to at least make sure the UTI is actually gone and to be sure we have no ketones. I would love to check his ketone urine every so often at home but can’t think how I would in a shared litter box (can you even check clumped litter or do they have to be willing to pee in an empty box?)
 
You can use a box with something in it that doesn't absorb liquid. So washed lentils, aquarium gravel are two examples. There is also the Breeze litterbox system when the pee falls down below. Depending on the cat, you might find a time he likes to pee. I know one lady who put her cat in the laundry room with the litter box right after breakfast and he'd always pee then. For me, Neko's timing was pretty predictable and I'd see her head to the litterbox and would follow her with Ketostix in hand. Thankfully she wasn't shy about me sticking that stick in her pee stream. Other people use a long handled ladle just for that use.

As for shooting lower, we do suggest starting out as a no shoot of 200, until you get more data. If a cat has ketones, that is the exception as they absolutely need insulin.
 
I've tagged Bhooma above regarding the spreadsheet. She is in India so will be along later today.
 
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