Sick Kitty - Please Help

[soupsquad]

Hi all,

I'm new here and could really use some help. My sweet girl (Molly) turns 15 next week and we've been having some issues with her diabetes.

A few months ago she started peeing everywhere and we took her to the vet where she was diagnosed with diabetes and a UTI. They prescribed 2.5 units of Caninsulin morning and night and pills for her UTI. We gave both (albeit unwillingly for the pills) but she lost her appetite and lost lots of weight rapidly. The vet had not told us at the time to at-home test and I knew nothing about diabetes so I would just make sure she ate, then give insulin. Because she stopped eating, I couldn't give it for a bit but we finally got her to start eating again so I gave 2.5 units. She went very low and ended up at an emergency vet where they said they believe because she lost so much weight so quickly that 2.5 units was way too much and she had gone low. She gave us an at-home tester and recommended we adjust her dose based on that. When we got home she was pretty consistently sitting around 6-12 mmol which we were told was perfect and she didn't need insulin. That was about 3 months ago.

Now, about a week ago she suddenly started getting high blood glucose level again. We've been testing morning and night before eating, exactly 12 hours apart. So, I started giving her 0.5 units to see how she would react. She did well, so we upped to 1.0 as her mmol went higher (27 is the highest I've seen). Now this morning I woke up and there's puke and diarrhea everywhere. She's on a diet of half Gastrointestinal fiber response hard food and half soft food of the same kind from royal canin. Based on what I've read, this isn't ideal since diabetic cats shouldn't have hard food or anything with a high carb level which I think this has but unfortunately she's a pretty heavily disabled rescue and we haven't been able to change her food. Before we got her, she inhumanely lost her tail and got spinal cord damage and has always had a very bad stomach because of that. Any time we've swapped her food, she's gotten diarrhea. This is the first time she's ever gotten it out of nowhere but I know diabetes can cause it when they're consistently high for a long time. I thought I'd been controlling it pretty well this last week but now I don't know what's happening.

Another somewhat unrelated issue is that every vet I've taken her to has either made things worse, tried to drain my bank account or gave bad advice. (we've been to 3, one gave very bad advice (put her down), one prescribed 2.5 units with no testing and one tried to charge me $5k when her blood sugar went low and wouldn't let me see her and when I got her back, they had broken her toe). So now I'm somewhat afraid of taking her to the vet since every vet nearby has made me and her uncomfortable in some way.

This morning she was 20.5, I couldn't give insulin because she won't eat. Please help, I don't know what to do and I don't want my baby to suffer or be in pain, I love her more than anything.

 

[Chris & China (GA)]

This morning she was 20.5, I couldn't give insulin because she won't eat. Please help, I don't know what to do and I don't want my baby to suffer or be in pain, I love her more than anything.

As long as you're able to home test, there's absolutely no reason not to shoot, especially at numbers over 10. Here's a great post on Why not eating does NOT mean no insulin

If you're new to numbers under 10 or don't have much data, we suggest if they are below 10, you should stall, DON'T feed and test again in 20-30 minutes to see which way their blood glucose is going. Use that time to post here with a strong subject line like "STALLING! NEED HELP!". Once you have somebody's attention, you can go back and edit the subject line to the usual one.

One thing you need to learn more about is your insulin. Caninsulin is no longer recommended for cats. It has a tendency to hit hard and fast and then wear off long before the next shot is due. It's a good insulin for dogs (thus the "canin" prefix) but treating a cat like a small dog usually doesn't work very well (although we have had cats do OK on it).

Insulin's like Glargine (brand names Lantus, Basaglar, Semglee), Prozinc and Levemir are all much gentler and longer lasting. Glargine and Levemir are both human insulins that work very well in cats and are available at any human pharmacy/chemist. Prozinc is a veterinary-only insulin.

You don't say where you live so we can't offer too much in the way of advice but if you read this "How you can help us to help you" post it will make it a lot easier for us to give you the best advice.

 

[soupsquad]

Thank you so much for your help, I'll definitely be sure to give insulin in the future even if she doesn't eat. She has started eating again, I think she just had an upset stomach. In the future, I'll look at stalling.

I did notice with caninsulin that she seemed to stay a bit high for the first couple of hours, then go down to about 7-9 for 4 or so hours, then go back up quite quickly which I did think was weird.

I'm in Alberta, Canada and they're very strict about insulin here so I don't think I could get human insulin, so I'll ask the vet I've been purchasing from about using something else like Prozinc. On that note, in Canada our Walmarts don't have ReliOn so the cheapest test strips I've been able to find are the OneTouch Verio strips which is what I've been using.

Would anyone have any advice for helping on the financial side in Canada as well? Luckily my employer is fantastic and just rolled out a company paid $500 per year to help with pet costs so I'll have a bit of help but given how much I've had to test lately and the fact that Verio strips are still $45/ 50 strips, it won't last long alongside the needles and lancers. Tips for this would be appreciated as well.

 

[Ale & Bobo & Minnie (GA)]

I believe so is Chris and Lantus is easy to buy in Canada or so I thought. I ordered mine from there and I’m in the us

 

[Red & Rover (GA)]

Waving from Ontario. Welcome.

Tagging @Christie & Maverick who lives in Alberta.

I used the FreeStyle Lite. I think they are only marginally cheaper than the Verio strips $80/100.
I used my PC points to cut the cost. (Also, if you have a senior human handy, take advantage of Seniors Days at Shoppers.)

There is also the Bravo meter. It takes a larger drop of blood than the FreeStyle.
The upside is the cost of the strips.
The downside is - and it's a big downside - the strips are not in stores and have to be ordered. This means you should have 200 to 300 strips (100 in your hypo kit) at any given time. During a low numbers event you'll be surprised just how quickly you will go through strips.
https://diabetesexpress.ca/products/bravo-meter
https://diabetesexpress.ca/collections/test-strips/products/bravo-test-strips

 

[Red & Rover (GA)]

p.s. If you live near the border, strips are much cheaper in the US.

 

[Chris & China (GA)]

I'm in Alberta, Canada and they're very strict about insulin here so I don't think I could get human insulin, so I'll ask the vet I've been purchasing from about using something else like Prozinc

Glargine insulin is a human insulin that is OTC in Canada. You just find the best price at the pharmacies near you and go in and ask for it. You're not asking for them to run it through your national health insurance. A 5 pack of Lantus pens is about $125 last time I heard (and you want the pens instead of the vial for several reasons. 1 is that if you drop a pen, you don't end up with an expensive puddle on the floor. 2. each pen only holds 300 units---a vial holds 1000, so unless your cat is on a very high dose, you can't use 1000 units before the insulin starts to lose efficacy. With the pens (or cartridges) only holding 300 units, you can pretty much use every drop. A 5 pack will last most cats at least 1 year and some up to 2 years! That makes it very affordable. If they tell you it has to be thrown away after 28 days, just smile, nod your head and go home. Stick it in the fridge (not the door) and it will be good until the expiration date on the box (usually at least 2 years).

Do NOT buy the special pen needles! We use regular insulin syringes with half unit marks and pull the insulin out of the pen. The pen needles not only allow you to only make changes in whole units, but you're supposed to "prime" it before each shot. That means shooting 2 units into the trash or down the drain before each shot. You also are supposed to hold the needle in for at least 10 seconds. For people that's fine, but our cats are not humans! It doesn't take much movement to have that needle come out. As far as the 28 day thing, in humans, who carry it with them which allows it to get warm may need to dispose at 28 days (IF they haven't used it all which would be unusual). As long as it's kept in the fridge, it's good until at least the expiration date unless for some reason it becomes cloudy or has "floaties" in it. It should be absolutely clear.

 

[Ale & Bobo & Minnie (GA)]

Glargine insulin is a human insulin that is OTC in Canada. You just find the best price at the pharmacies near you and go in and ask for it. You're not asking for them to run it through your national health insurance. A 5 pack of Lantus pens is about $125 last time I heard (and you want the pens instead of the vial for several reasons. 1 is that if you drop a pen, you don't end up with an expensive puddle on the floor. 2. each pen only holds 300 units---a vial holds 1000, so unless your cat is on a very high dose, you can't use 1000 units before the insulin starts to lose efficacy. With the pens (or cartridges) only holding 300 units, you can pretty much use every drop. A 5 pack will last most cats at least 1 year and some up to 2 years! That makes it very affordable. If they tell you it has to be thrown away after 28 days, just smile, nod your head and go home. Stick it in the fridge (not the door) and it will be good until the expiration date on the box (usually at least 2 years).

Do NOT buy the special pen needles! We use regular insulin syringes with half unit marks and pull the insulin out of the pen. The pen needles not only allow you to only make changes in whole units, but you're supposed to "prime" it before each shot. That means shooting 2 units into the trash or down the drain before each shot. You also are supposed to hold the needle in for at least 10 seconds. For people that's fine, but our cats are not humans! It doesn't take much movement to have that needle come out. As far as the 28 day thing, in humans, who carry it with them which allows it to get warm may need to dispose at 28 days (IF they haven't used it all which would be unusual). As long as it's kept in the fridge, it's good until at least the expiration date unless for some reason it becomes cloudy or has "floaties" in it. It should be absolutely clear.

That’s what I thought. Wow, otc. Thanks!

 

[Diane Tyler's Mom GA]

Welcome @soupsquad
In regards to the Vetsulin….are you feeding first then waiting 30 minutes before giving the dose of insulin?


Information for Glargine/Lantus
Since you're in Canada you won't need a script for Glargine/Lantus as Chris said
You will need U-100 syringes with half unit markings because we adjust the doses by 0.25 units at a time. We don't adjust the dose on the pre shots , meaning the first test you take in the AM and PM. We adjust the dose by how low the kitties are dropping which is called the nadir ( lowest BG during the cycles)

About the syringes for Glargine
They have half unit markings.
Not all pharmacies carry them (or think they don't). Call around. Ask them to look in the back. Tell them the purple and yellow box.
Do you have a Costco near you, call around and see who has the cheapest price

Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there

 

[Diane Tyler's Mom GA]

Tap on the blue link
Here is the link so you can set up your signature and spreadsheet
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

The signature is at the end of everyone's post in gray ,information about our cats

• 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.

Also almost all of us use human meters that's what our numbers are based on

Just to show you about the Spreadsheet
Don't be nervous about the spreadsheet
About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers



You can look at any members spreadsheet to see what it looks like, it's at the end of everyone's signature just tap on it

If you need help setting it up I can ask one of our members to set it up for you
Her name is Bhooma
@Bandit's Mom

 

[Diane Tyler's Mom GA]

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

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 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with
Here is a video one of our members made testing her kitty
She's using a pet meter that has to be coded ,with a human meter you don't have to code it.
So ignore that
I have always used a human meter
VIDEO: How to test your cat's blood sugar


Learn how YOUR kitty is responding to insulin:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose
• How to do a Curve - a simple explanation

I suggest you set up your hypo kit in case you need to bring Molly's BG up
For your Hypo kit
Med and High Carb food and some honey/karo



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
from The Official Lantus, Levemir & Biosimilars Slang Dictionary MC =11=15% and HC is usually 16-24%


Just keep asking questions

 

[Diane Tyler's Mom GA]

I have copied this from one of our members post (Wendy and Neko)
In Canada, the test strips are unfortunately more pricey and are what you go through more often. But you can often get a free meter when you buy a package of test strips. Sometimes you can get good prices on test strips on eBay. You want a meter that needs just a small drop of blood. The Freestyle Lite is one many use but there are others. The cheapest meter available is the Bravo (free meter available, link to test strips here). But with online purchases you want to have a good supply on hand.
The Bravo takes a much larger (0.6) drop of blood. (I found it read higher than the FreeStyle
The strips for the Bravo meter are $40/100. The downside (other than the larger drop of blood) is that you cannot buy the strips in stores. You have to order online and would always need to keep a back-up of at least 200 strips on hand for emergencies and shipping delays. You cannot run out in the middle of the night during a crisis to get more strips.
FreeStyle Lite meter. Strips in the $80-90/100 range. It takes a 0.3 drop of blood.

EDIT PLEASE IGNORE MY POST, IT'S AN OLD POST
Chris gave the correct information below

 

[Chris & China (GA)]

The strips for the Bravo meter are $40/100. The downside (other than the larger drop of blood) is that you cannot buy the strips in stores. You have to order online and would always need to keep a back-up of at least 200 strips on hand for emergencies and shipping delays. You cannot run out in the middle of the night during a crisis to get more strips.

I usually suggest buying 400 on your first purchase. Then, when you open the last 100, it's time to order again so you have a little time before you totally run out. You also need to spend at least $200 to get free shipping.

Unfortunately, Diabetes Express no longer offers the free meter with the purchase of 100 strips. The meter itself is $31.49

Just so you have a visual, this chart shows how big a blood drop needs to be.

so 0.6 isn't a terribly large amount. It depends on which option is best for you. To save money but need a larger blood drop or pay more for strips that work with a smaller amount

 

[Diane Tyler's Mom GA]

I usually suggest buying 400 on your first purchase. Then, when you open the last 100, it's time to order again so you have a little time before you totally run out. You also need to spend at least $200 to get free shipping.

Unfortunately, Diabetes Express no longer offers the free meter with the purchase of 100 strips. The meter itself is $31.49

Just so you have a visual, this chart shows how big a blood drop needs to be.
View attachment 67844

so 0.6 isn't a terribly large amount. It depends on which option is best for you. To save money but need a larger blood drop or pay more for strips that work with a smaller amount

Thanks Chris, I better not copy that post anymore
Going to Edit my post

 

[Red & Rover (GA)]

Glargine insulin is a human insulin that is OTC in Canada.

According to @Christie & Maverick Alberta is the one province where Lantus is not OTC.
However, if you live close to the BC or Saskatchewan border …

Nice to see you, Chris. Miss you.

 

[Sienne and Gabby (GA)]

I have a couple of thoughts....

Please pick up Ketostix at a pharmacy. It's a way to test for ketones which can be dangerous. My concern is that you are skipping shots and we don't know if your cat has an underlying infection or inflammation. The Ketostix are a urine test strip.

I suspect that Molly's numbers went back up because of what you're feeding her. Most dry foods are insanely high in carbohydrates. It's like feeding a diabetic child cookies and ice cream. This is a link to a chart that lists out most of the canned foods that are available in the US. Not all are available in Canada -- this is a link to a Canadian food chart. We consider low carb to be under 10%. Most members here feed their cat foods that are in the neighborhood of 5%. Any transition to a low carb food should be done very slowly for several reasons. Many cats experience GI issues if food is changed rapidly. More importantly, if you switch to a low carb food, the amount of insulin could to too much. The carbs counterbalance the insulin. It's also why we strongly encourage members to home test.

If you need to deal with your vet regarding insulin, the American Animal Hospital Assn no longer recommends Caninsulin for treating feline diabetes. They recommend either Lantus (glargine) or Prozinc. Even in the UK, vets are now able to prescribe Prozinc as a first line diabetes treatment.