New - just started insulin

[MinnerPip]

Hi, I’m Laura and my almost 5 year old female orange kitty is Minner. Minner was a csection kitten in Sept 2019 , and after 2 weeks old she had to be syringe fed and raised w/o siblings and her mom initially. Her mom returned after a serious illness a month later but we lost her mom 9 mths ago. Minner has never been sick, ever, not even a sniffle, until 2.5 mths ago she started sneezing about 100x a day, which resolved in several days but I took her to vet and got blood drawn for 1st time as baseline. Totally normal. Urinalysis also normal according to my vet.

In early-mid June I started noticing increased urination and water drinking. I measured. 300-350ml urine per day in about 6 litter box visits. It was 2-2.5x her normal. I took her back to vet and her blood glucose was over 200. Tried getting her to eat better food (she loves dry and has never been willing to eat any kind of wet food and I have tried dozens). She is stubborn and holds out for dry and I give in b/c she’s 16-17 pounds and I fear hepatic lipidosis. I did try to be firm and then a week later took her back to vet b/c she vomited and she was dehydrated and her glucose was then over 300. The vet suggested Libre2. Put first one on her Jun27, lasted less than 24 hours. Put 2nd one on Jun 28, lasted 48 hours. Put 3rd one on July 2nd. At this moment it’s still on, but she HATES it and constantly tries to get at it with mouth and back leg. I find it to be a blessing and a curse. I am/was terrified about starting insulin so having the monitor gives me some relief as I can check her.

I had wanted to start with Lantus pen as I was afraid of using a needle and I had read glargine had best chance of remission. My vet has never used glargine so that made me nervous so I asked him what he thought we should start with and he said Humulin N. This was this past Monday. So Tues morning gave 1U in AM. It got her from 270 at time of injection to below 80 in 2-3 hrs but then rebounded. We did 1U in am and pm on Wed/Thu/Fri but the glucose curve is like a mountain range and hardly gets into normal range. Today I did a 2nd 1U injection mid day b/c she was over 400 (never been that high). Yes she is grazing on food b/c she eats so little at one time and barely ate yesterday so I let her eat her dry “high protein” purina today.
Today I also got vet to switch her to glargine. I pick it up Sunday and will start her on glargine Monday AM. I am afraid to start a new insulin when vet offices are closed and I only have access to ER.

I have ordered the young again dry food and some other dry food with less than 7% carbs. I have tried various wet foods, even raw (smalls). The only wet food she will eat consistently is hartz delectables bisque which is a treat. She licks at fancy feast Florentine a little.

I am glad I found feline diabetes.com and this forum. I am terrified of all of this and freaking out b/c Minner is so stubborn about food and hates the monitor. Sigh.

thank you for support … any and all suggestions welcomed and appreciated.

Laura and Minner

 

[Diane Tyler's Mom GA]

Welcome Laura and Minner.You couldn't have found a better group to join. There are a lot of experienced members here.
I am going to tag some experienced members for you about how many units to start with when you give glargine

If it wasn't for them giving me their advice I don't think Tyler would be in remission for 3 years and 4 months today.
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 blue link will also explain how to create our spreadsheet and how to use it, it's really easy. If you should need help setting it up just ask , we have a member here who will be happy to set it up for you.
You can tap on any members spreadsheet to have a look at it
We don't use times when telling us what a cats BG is since we are all in different time zones. We would say +2 which means 2 hours after giving insulin , if you do another test 4 hours later you would say +4 and so on

Can you add a little more information to your signature that's not there

• 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)
  • Bexacat or Senvelgo (if applicable) and dates
  • 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.

Glargine is a great insulin, I'm glad you are switching to it
Do you have the U-100 syringes with the half unit markings?
We use these because we increase or decrease the dose by 0.25 units at a time

If not you can get them here without a vets script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

As far about the Freestyle Libre which I never have used I found this posted by some members and copied it for you
The freestyle libre is not reliable under 100.
Do you have a manual human glucose meter you could also use if the BGs drops under 100?
We have found that if the BG drops to say 70 in the libre, when tested on a manual human meter, the BG is often over 100. That is why it is a good idea to have a second meter to double check.

Since the libre is considered a human meter . Plus the strips are so much cheaper.

Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197

Testing
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

Try putting a thin layer of Vaseline on theear so theblood will bead up

Here is a video that one of our members did ,ignore the coding because she is using a pet meter, with a human meter no coding needed
VIDEO: How to test your cat's blood sugar


More
Here is a link to Hometesting tips and links

You may want to read all about Lantus/Glargine here please read all the yellow stickys. You will see there are 2 dosing methods to chose one. You would need to follow the SLGS method since Minner is eating kibble

• Full and half-unit syringe scales:

If Minner isn't crazy about the Young Again
these are about 5 or 6% carbs

Dr Elseys you can buy on chewey site
https://www.chewy.com/dr-elseys-cleanprotein-chicken/dp/146269?utm_source=google-product&utm_medium=cpc&utm_campaign=12791446238&utm_content=Dr. Elsey's&utm_term=&show-search=1&gclid=EAIaIQobChMI0PvU2Zj79wIVRIdbCh3JawEkEAQYASABEgIInfD_Bw


Dr Elsey's also at Walmart
https://www.walmart.com/ip/Dr-Elsey...ViI3ICh0suwO_EAQYAiABEgJrOPD_BwE&gclsrc=aw.ds

Dr Elsey's Amazon
https://www.amazon.com/dp/B07FCJHDPR/ref=twister_B09GHFJY65?_encoding=UTF8&psc=1

From what I have read on our site they are 5 or 6% carbs so that's ok
I have read The Young Again Kibble can cause stinky poops

Dr Elsey's will send you a sample . You can see if Callie likes them before buying them ,get the chicken flavor. Dr Elsey's Clean Protein

Dr Elsey's web site
https://www.drelseys.com

I think this is there phone number
Phone: 877-311-2287


Here is a video that one of our members made , ignore the coding , she is using a pet meter, with a human there is no coding needed
VIDEO: How to test your cat's blood sugar


With hometesting you test first, feed a meal and then give the dose of insulin. Because you are using Lantus, you can give the insulin straight after the meal or while she is eating it…if you know she will eat it for you.
The onset of insulin (Lantus) is about 2 hours after the dose is given so you have time to make sure she eats well.

One other thing you withhold feeding 2 hours prior to testing first thing in the AM and PM because you don't want the BG to be influenced by food
Here is a link for some abbreviations we use
https://www.felinediabetes.com/FDMB/threads/lantus-levemir-biosimilars-isg-slang-dictionary.1903/

Maybe you can find a low carb wet food Minner might like , I know you said you have tried many. You want to feed under 10% carbs but most feed 6% and under
link:http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



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.

Even if Minner won't eat the med or high carb food , Minner can just lick up the gravy, that's where the higher carbs are anyway. Just cover the can with the lid and squeeze out the gravy into a dish

I hope you are not overwhelmed with the information I gave you , just trying to help

 

[Diane Tyler's Mom GA]

Hi, I’m Laura and my almost 5 year old female orange kitty is Minner. Minner was a csection kitten in Sept 2019 , and after 2 weeks old she had to be syringe fed and raised w/o siblings and her mom initially. Her mom returned after a serious illness a month later but we lost her mom 9 mths ago. Minner has never been sick, ever, not even a sniffle, until 2.5 mths ago she started sneezing about 100x a day, which resolved in several days but I took her to vet and got blood drawn for 1st time as baseline. Totally normal. Urinalysis also normal according to my vet.

In early-mid June I started noticing increased urination and water drinking. I measured. 300-350ml urine per day in about 6 litter box visits. It was 2-2.5x her normal. I took her back to vet and her blood glucose was over 200. Tried getting her to eat better food (she loves dry and has never been willing to eat any kind of wet food and I have tried dozens). She is stubborn and holds out for dry and I give in b/c she’s 16-17 pounds and I fear hepatic lipidosis. I did try to be firm and then a week later took her back to vet b/c she vomited and she was dehydrated and her glucose was then over 300. The vet suggested Libre2. Put first one on her Jun27, lasted less than 24 hours. Put 2nd one on Jun 28, lasted 48 hours. Put 3rd one on July 2nd. At this moment it’s still on, but she HATES it and constantly tries to get at it with mouth and back leg. I find it to be a blessing and a curse. I am/was terrified about starting insulin so having the monitor gives me some relief as I can check her.

I had wanted to start with Lantus pen as I was afraid of using a needle and I had read glargine had best chance of remission. My vet has never used glargine so that made me nervous so I asked him what he thought we should start with and he said Humulin N. This was this past Monday. So Tues morning gave 1U in AM. It got her from 270 at time of injection to below 80 in 2-3 hrs but then rebounded. We did 1U in am and pm on Wed/Thu/Fri but the glucose curve is like a mountain range and hardly gets into normal range. Today I did a 2nd 1U injection mid day b/c she was over 400 (never been that high). Yes she is grazing on food b/c she eats so little at one time and barely ate yesterday so I let her eat her dry “high protein” purina today.
Today I also got vet to switch her to glargine. I pick it up Sunday and will start her on glargine Monday AM. I am afraid to start a new insulin when vet offices are closed and I only have access to ER.

I have ordered the young again dry food and some other dry food with less than 7% carbs. I have tried various wet foods, even raw (smalls). The only wet food she will eat consistently is hartz delectables bisque which is a treat. She licks at fancy feast Florentine a little.

I am glad I found feline diabetes.com and this forum. I am terrified of all of this and freaking out b/c Minner is so stubborn about food and hates the monitor. Sigh.

thank you for support … any and all suggestions welcomed and appreciated.

Laura and Minner

@Wendy&Neko
@Sienne and Gabby (GA)
@Bron and Sheba (GA)
@Bandit's Mom
@Suzanne & Darcy

 

[Wendy&Neko]

Hello and welcome to the best place you never wanted to be. Sorry about the information overload. I promise it will get easier.

There are 3 things we are strong believers in here. They are a good insulin, a diet appropriate for a diabetic cat, and home testing.

Your instincts are right, Lantus is a much better insulin. The AAHA recommends either Lantus or Prozinc for cats. Definitely not Humulin N which doesn't last long enough in cats. We use syringes here to dose the insulin, as we make changes by 0.25 units at once. Cats are quite sensitive to small changes in insulin dose. You need the 1/2 unit marked syringes - we eyeball the 1/4 units. There are more brands than what Diane listed above, including Relion at Walmart.

Diet is a hard one, lots of people have had kibble heads. Have you ever tried freeze dried or air dried food? Here is a note that might help you with transitioning. It is written by a vet specializing in feline nutrition.

• Transitioning your cat from dry to wet food

And lastly, it's ideal if you can learn to home test with a blood glucose meter. A human meter is just fine. That's what most of us use and the test strips are much cheaper. The Libre is fine to start, but how long it lasts really depends on the cat. Most people end up putting a onesie or other shirt time thing over the Libre. More information here:

• Freestyle Libre for Cats; Tips and Information

As Diane mentioned, you will have to learn to manually test with a meter if he gets into lower numbers anyway.

And last but not least, some information to tuck away, just in case:

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

 

[Sienne and Gabby (GA)]

Welcome to FDMB! And like Wendy said, sorry that Diane went into information overload mode.

Everyone who finds us is overwhelmed at first. You seem to have a wonderful grip on feline health issues so hopefully, some of what you learn here will be familiar. I agree with everything Wendy said. I'm going to add a few details.

The AAHA is the American Animal Hospital Assn. They publish and update guidelines for treating diabetes. Humulin N is a great insulin for dogs; not so much for cats. You can also now purchase the biosimilar/generic for Lantus, glargine, and it's much less expensive.

There is also more information about Lantus in the sticky notes at the top of the Lantus forum here. Once you and Minner have gotten the food situation taken care of and are comfortable with home testing, posting on the Lantus forum would be a good option. We encourage everyone to start here on Health.

We also encourage you to ask questions. The members here are generous with their time and knowledge. We're here to help.

 

[MinnerPip]

Thank you so much Diane and Wendy. This is indeed overwhelming and stressful for me. I am so scared of all of this and the time required. I keep telling myself to just stay on it and we'll find a rhythm and balance once the insulin and dose are right. I've been obsessed all week and thankfully have had time off work the past 4 days to focus on this. The initial approach does not seem to be working. The Humulin isn't getting Minner into "normal" range (below 180) except for twice and very briefly. I started the SS this morning so it is available now. Her numbers are terrible and she absolutely will not eat wet food, I have been trying for 2 weeks. I am so afraid that she is just wet food resistant. And the bit of Fancy feast florentine she will kind of eat is probably just lapping up the juice and none of the chunks (so getting all the carbs -- ugh). She will eat Hartz delectable bisque which appears to be very low carb, but it's also not cat food with all the nutrients needed. I tried Cat Man Doo freeze dried chicken (also treats) and she ate them for a couple days and now won't.

The Dr Elsey's food arrives from Amazon here any minute. Dare to dream she will eat it. She is even super picky about dry food. I have read and heard that cats will indeed starve themselves so holding out to "force" them to eat a certain food can be dangerous, especially in overweight cats (hepatic lipidosis). Minner fits that bill -- she was 18lbs a year ago and I got 1 pound off her in a year, but she's dropped more in the past month so she's down to 15-16 pounds now. I also read that it's more important for your cat to eat something in a day, even if it's not the food you want them to eat. Dry foods Minner will eat ... mostly Purina Pro Plan Sensitive Skin & Stomach (lamb and rice), also Purina Healthy Kitten and sometimes if turning nose up to prior two, then Purina One Sensitive Skin & Stomach. The lamb and rice is 27.5% carbs and ~530 kcal/cup. She needs 250 kcal daily so I'm trying to spread out 1/4 cup of the lamb and rice over a day in small amounts and have her get the rest of the calories from what she licks from florentine and the hartz bisque packs. If she would just eat low carb food then all of this would be way less stressful.

I bought the meter Diane recommended and the strips from walmart, should arrive later today. I also ordered the recommended syringes from amazon since the ones I got with the Humulin don't have the half marks. I am pretty sure this Libre2 is going to stop working soon, it appears to be lifting on edges now. I had planned to start the glargine Monday morning, but given how the Humulin is so short acting and at 1U does not get Minner into normal range even at peak, I am wondering if I should pickup the glargine asap today and start it today. I'm just scared the meter will stop working today and I'll have no insight into what her glucose is doing. The ReliOn arrives about 3 hours from now so I can test. Minner is not great about being manipulated so I have no idea if she's going to let me prick her ear. Thank you Diane for the great info on how to do this and the "sweet spot".

Thank you again. Please please please please let there be something positive soon as this is currently a near full time job and I have to go back to work tomorrow. I work from home so that is a huge blessing given the situation, but my schedule is insane.

Do you think I should start the glargine as soon as I can pick it up today?

 

[Sienne and Gabby (GA)]

You are correct -- Minner's numbers are not bad. She's bouncing around but she's seeing lower range numbers. Als0, you're not feeding her a low carb food. Don't expect that your kitty is going to immediately get regulated. It takes time. You'll see a lot of people remind you that managing your cat's diabetes is a marathon, not a sprint! Please don't set your expectations up to a point where you're disappointed.

I'd also strongly encourage you to read over the information in the sticky notes on the Lantus board. Lantus is a very different kind of insulin than Humulin -- or almost any other insulin, for that matter. It is a depot insulin which is why it has a longer duration and a gently mode of action. It will take about 5 - 7 days for the depot to stabilize so you may not see a great deal of response. Even with dose changes, you have to give the depot time to adjust. With Humulin, there is no depot and the response is immediate. It's also very good at dropping numbers fast and hard. Also, if you review the information on dosing methods, you're restricted to Start Low Go Slow since your cat is a dry food junkie!

Whether you start glargine today or tomorrow is up to you. I could argue either way. The biggest advantage of starting today is you'll be home this evening. Tomorrow, you'll need to leave for work.

 

[Wendy&Neko]

We have had lots of people who work full time jobs and have diabetic cats. Sienne who responded above being one, and she had to go into work (medical field). We have tips that can help with caring for a diabetic cat while you have a full time job. You will soon enough get into a routine that makes it easier. But there is that initial learning curve. It does get better. We can help you get there.

I think your first goal today is to try to practice and get comfortable with home testing when the meter arrives. In the mean time, try to find a spot you will use for testing for now, take Minner there and fondle her ears, then give her a treat she likes and let her go. It doesn't have to be a food treat, some people find cuddles or brushing are the treat. Do this a few times so she starts to associate good things with the process.

Have you ever tried freeze dried all meat treats for her? Many cats go nuts over the freeze dried chicken ones. There are also lamb ones if she likes lamb. What you are looking for is single ingredient products.

 

[Diane Tyler's Mom GA]

. I work from home so that is a huge blessing given the situation, but my schedule is insane.

@MinnerPip
Hi Laura, First off sorry for the information overload as Wendy and Sienne pointed out.
That's great you work from home . Things will get easier believe me .
Start rubbing her ears and get her used to you touching them.
Try and bring her to the same spot for testing her, you can even give her a small amount of food to eat as you are testing her .
Try giving her a few pieces of the low carb dry food even .
Sorry again about all the information I gave you.
By the way such a cute pic of Minner
For some reason your spreadsheet doesn't come up it says when I tap on it
We're sorry. You can't access this item because it is in violation of our Terms of Service.

Find out more about this topic at the Google Drive Help Center.

Maybe you have to share it, I'm not sure
To set spreadsheet sharing permission:
* At the top right of the spreadsheet screen click on Share.

* In the pop-up dialog box click on the Get Link section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click Done to save the changes.

 

[MinnerPip]

Thank you Diane, Sienne and Wendy. Whew. Tough day. I did manage to access Minner's spreadsheet and adjust the setting so that anyone with a link can view it. Hoping it works now.

I will start reading the Lantus forum and sticky notes, will do this tonight and start her in the morning. I just gave Minner her 3rd Humulin dose today because after leaving the house for a few hours, upon return, her Libre2 reading was HI, meaning it was above 400 and the device doesn't measure above that, it just says HI. So I gave her a little more than 1U of Humulin, probably 1.25 or so. I don't have the syringes with the half marks, but I did order the ones suggested from Amazon today. I received the Dr Elsey food and Minner ignores it. It feels hopeless with her food situation. She has licked on 3 cans of Fancy Feast florentine today, but I don't think she's eating any of the chunks, just licking all the sauce. She has also been very quiet and hiding today so I'm scared she is getting sick from not eating enough. Yet I gave her 7 Greenies as a treat when giving her this last Humulin injection and she chowed down on those, and licked clean a Hartz Bisque pouch earlier today. Exasperating. I will look for freeze dried meat treats. I bought Cat Man Doo chicken ones a week ago and for a few days she seemed to like them, but now ignores them. I tried the Bonita flakes too from that brand but she refused.

I received the ReliOn today and the test strips, but I forgot to get lancets so I went out to get those. I have not attempted to try this yet as Minner has been quiet today and staying back in the bedroom.

I meet with my vet on Monday afternoon and I hope to talk through this whole Humulin experience, the transition to glargine (lantus) and how to manage the numbers on the Libre given I still need to feed her food that is not optimal from a carb perspective so that she's getting some bare minimum of calories. I think her numbers are bad, but I have no real reference. Never getting into normal range (below 180) seems bad. And it seems they are staying higher longer despite reacting with more frequent Humulin.

I don't know how to cope with these readings in the 300's.

It sounds like Lantus is going to be slow, so if her reading is 350+ in the morning and I feed her and inject her with Lantus, it sounds like it will go higher and may or may not come down anytime soon. I don't know how to know if something is working or if I am doing the right thing. This is very very very stressful. All of it. How do I get relief from this constant worry, stress and questioning on if she is ok, if I am doing the right thing. It's too much. I really need more moral support so thank you all.

 

[Wendy&Neko]

Another annoying, but all too common thing you will see with cats is the effect we call bouncing. Here is the description.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

So high numbers can also be short lived. Which is why we are more interested in how low an insulin dose can take the cat than the high numbers.

A cat's reaction to initially getting insulin, or even switching insulin can be somewhat unpredictable. Some cats do well right away with the switch to Lantus. You are doing the right things. the rest is up to Minner.

 

[MinnerPip]

Thank you Wendy. I may need to hear that a hundred times.

I copied the link to Minner's spreadsheet again and re-did it in my signature. I would appreciate someone letting me know if it is working now. Thanks.

 

[MinnerPip]

I decided to share a pic of Minner's glucose curve today to demonstrate the mountain range effect.

The times of Humulin injection are denoted by the little icon of a needle at top, times of food with an icon of an apple. I do wonder if the "bouncing effect" that Wendy described could be at play, I just do not think that Minner has had high glucose for very long. I guess "very long" is subjective or relative. I know at start of May she had normal glucose on bloodwork taken in vet office. In mid June, at vet office it was in 200's, and then June 27th at vet office it was 307. So it might appear that Minner has experienced elevated glucose very recently, in past 30 days, and it seems to be getting progressively worse. Praying the glargine will turn this around, hopefully even if she continues to be wet food resistant. I have to admit that it has crossed my mind about using transdermal mirtazipine to make her hungrier, thinking that if she were hungry enough maybe she would give in and start eating any wet food offered, but this "feels" a little inappropriate and I am not sure even that would work.

I just gave her a little Iams sensitive skin/stomach dry just to get more calories in her today. I tried hiding 3 tiny kibbles of Dr Elsey's in it. She 100% knew I had done that and proceeded to stop eating any of it. I have tried the parmesan cheese sprinkles (she thinks it stinks), tried coating low carb food in cat man doo freeze dried sprinkles, no dice. I've tried mixing her Purina with lower carb dry thinking whatever appealing coating is on the Purina would get on the low carb dry, but that didn't work either. I just opened a can of tuna fish, drained the juice and let her drink all the juice which she lapped up eagerly, but she won't touch any pieces of the actual tuna. I thought about trying to let low carb dry soak in tuna juice, but if she won't touch the tuna itself, I doubt she would touch low carb soaked in tuna juice kibble. I've gone so far as considering a feeding tube be placed and feeding her some kind of low carb food through the tube, if they even make such a food that can go through a tube without clogging it. I think that's going over the top though, being a surgery requiring anesthesia which carries risks, plus then dealing with the tube/collar that she would likely go insane over, and in the end it might not work either. Just because she would actually get the low carb food into her stomach doesn't mean she would start being ok eating it through her mouth.

For the love of these precious companions!

 

[Wendy&Neko]

Spreadsheet is working. Don't think I've seen any cat do well on Humulin N. As said above, great insulin for dogs.... Not for the faster metabolisms of our furry masters.

Have you ever tried crumbled favorite dry food on top of wet food, or Fortiflora. It's number 1 ingredient is animal digest which is attractive to cats. Minner ever shown interest in cooked meats? Prawns, steak slices? Freeze dried or air dried food (Ziwipeak) has worked for some. All meat baby food?

I'd say no on the tube or Mirtazapine - the latter of which might create even more food aversions. For now, until (being positive) we figure out how to crack this kibble head, we'll just dose the insulin around her food. Maybe when she's feeling better she'll see the light. If you've read Dr. Lisa's post on transitioning, you'll know this can be a slow process.

 

[MinnerPip]

Thank you Wendy. At the risk of jinxing myself, there were moments today of Minner lapping on Fancy Feast kitten turkey pate. Granted, it had water mixed in so it was a bit soupy, and the bowl sat there for a bit, but twice I caught (heard) her lapping from it tonight. Baby steps. I tried Fortiflora, but not crumbling favorite dry food on top of wet, so that will be next, thanks!! Tried all meat baby food, no dice, but have not tried air dried meats so I will have to look into this, as well as other meats. The other day she did nibble on some pieces of chicken I plucked from my fried chicken after I removed the skin, but then she won't eat the tuna pieces from a can. Strange.

Meanwhile, she has finally done in this 3rd Libre2, it failed a few hours ago, right after giving her Humulin after a 350 reading. I've started reading some of the Lantus forum and sticky notes. It's like starting over with new fear. She's been on Humulin now for 5 days and had the Libre on the entire time. I got past my initial fear because I had constant access to her BG levels. I've learned how spikey and fast acting this insulin is, and therefore in a way "safe" since there's no depot effect where you could be going for days with low BG that you have to boost up with high carb food or honey/karo. So this transition to Lantus is scary, but also seems necessary for Minner to have a chance to become regulated and maybe even go into remission if we're really fortunate.

I've got to practice the lancet on her ear so I can test without a Libre device. I'm debating whether to have one more Libre put on her to help me get started with Lantus. Ugh. I may have to. I'm also questioning the starting dose of Lantus. I've read 0.25-0.5 U/kg q12h. Minner weighs 15-16 lbs (6.8-7.3kg) so based on this guidance I would start with low end of range (.25 * 7kg = 1.75U). Yet the vet put 1U on the prescription. And still yet, I've seen some recent forum members at less than 1U doses approaching hypo levels. Almost makes me want to start Minner at 0.5U twice a day instead of 1.0. Do you have a point of view on this? I also saw in an article from American Association of Feline Practitioners, the following statement --> "Hypoglycemia is unlikely if a cat is started in 1U q12h". And that was a statement about initial treatment using any of the four primary insulin types for cats. I would like to believe that. Minner is a big girl and hitting the 350-400+ BG level during periods of the day as the Humulin wears off, so surely starting 1U Lantus is ok. Oh peach.

Thanks again. So relieved to have found you all and this wonderful forum resource.

 

[Wendy&Neko]

Back in the old days, before the Libre was invented, all we had was blood glucose meters.

We take how the dose of the current insulin is doing into consideration when starting Lantus. Though there isn't a lot of data since Minner is so new to diagnosis. But she wasn't getting into dangerous numbers don 1 unit. Starting at 1.0 units Lantus should be fine with higher carb dry food in the picture. That's what the SLGS (start low go slow) dosing method suggests. The other method of calculation is for people using the Tight Regulation protocol, which requires all low carb wet or raw being fed.

FYI, my girl was a lb smaller than Minner and I switched to 1 unit of Lantus. She needed a max of 8.75 units. Took a LONG time to get there.

 

[MinnerPip]

That made me chuckle — so true on technology. I pricked Minner’s ear for 1st time last night. I was surprised how one little jab and a bubble of blood presented itself pronto. She made a little grunt, but didn’t lurch or try to bolt. Gave her some greenies. This was at about +1 for her 4th humulin dose of day. It was 350 pre-shot based on Libre. ReliOn meter said 305 at +1.

This morning I had a little more trouble getting blood from ear. I must have jabbed 6-8 times. Poor Minner. She was starting to get annoyed. I should have warmed the ear more. I made the rice sock last night but didnt use it today. I just tried rubbing ear vigorously. I should have done that longer or used the rice sock.

I did it twice b/c the first reading was 305 and it seemed coincidental that the 2nd time ever using ReliOn resulted in exact same BG level (last night and this AM). So I did it again a minute later and got 307 instead of 305. Then I gave her the insulin.

How different in general will the ReliOn BG measurement be vs Libre? Any reason to ever question or doubt the integrity of the ReliOn reading? Her AM Libre readings the past 3 days have been higher. But she also just might be eating a little less carbs. Her food intake not consistent, we have to work on this given she is a grazer and I leave a little food out overnight.

I read in another post that regular ear pricking doesn’t cause scarred ears. It’s perplexing as it seems that if you do this multiple times daily then there should be reaction. I saw that it will actually cause more capillaries to form and it will mean easier blood draws. Is this your experience?

Are there any typical behavioral changes that may suggest your kitty is getting below 80? Minner hasn’t even gotten below 180 except for a few times the past 5-6 days since starting humulin, but I am constantly afraid. I check on her repeatedly with laser pen reaction or other toy to make sure she responds as expected. If we start Lantus (likely tomorrow now given I want to get new Libre ) then I’m going to be constantly fearful. Ugh. Scary but necessary (saying this over and over).

Any comments on Libre 2 vs 3? Since Minner was constantly annoyed by the Libre2 (i assume the adhesive is irritating), and since Libre3 is smaller (dime vs quarter size), I wonder if Libre3 will be a little less irritating? I tried rubbing hydrocortisone around the Libre but not sure it did much. Maybe Libre3 smaller size means more likely for her to dislodge it since there’s less area adhering to skin?? I hate having to put this on her but I don’t trust myself and meter testing just yet, and starting Lantus will need a lot of observing. I would need to prick her so many times it seems daunting. ???

Any suggestions on adhesives? I ordered Torbot skin tac wipes as my vet pointed it out as possible way to get Libre more firmly attached and resistant to her attempts to dislodge. Any suggestions on getting adhesive cleaned from her skin? Torbot also makes Tac Away but it is heavy alcohol smell and this causes very upset run away reaction. I tried using olive oil, not sure how much it helped but I did get the dislodged Libre all the way off of her last night w/o making her skin bleed. She seemed to like the olive oil rubbing.

Thank you for feedback on the ongoing questions!!

 

[Wendy&Neko]

How different in general will the ReliOn BG measurement be vs Libre? Any reason to ever question or doubt the integrity of the ReliOn reading? Her AM Libre readings the past 3 days have been higher.

I would trust the Relion over the Libre, especially in lower numbers. In high numbers it doesn't really matter. At this point of Minner's diabetic journey, don't expect consistent readings. Cats also tend to go lower at night which can cause morning AM bounces.

Are there any typical behavioral changes that may suggest your kitty is getting below 80?

If it's been a while since kitty has been in numbers under 100, they may start looking for food, or mewing. Neko's first greens she hid under the bed. It just felt too odd for her. It was safe greens.

Regarding the Libre, a couple posts that might help:
FreeStyle Libre: video, demonstration, explanations, tips – discussion!
Freestyle Libre for Cats; Tips and Information

 

[Diane Tyler's Mom GA]

@MinnerPip
Hi Laura I see in the remarks section on your spreadsheet for 7-9 you said
Gave first Lantus dose (1U) mid-day today at vet office
I'm confused tomorrow is 7-9
Did you mean 7-8 ?
On your signature can you put the date you started Lantus so members are aware if it.
Also on your spreadsheet we like when members switch to a different insulin to put a blank line above the date you started Lantus and just put Started Glargine and highlight it any color you want so it stands out

 

[MinnerPip]

Thanks Wendy. The Libre is a security blanket for me right now. The Libre3 (knock on wood) seems to bother Minner a little less. It may also be because less adhesive had to be used given smaller size. My goal is to start using ReliOn as long term BG tester once I get past the whole overall fear of unpredictability of using new insulin and what it may do. I am dreaming of a day when she can be checked only once a day or even only once every few days.

Thanks for the catch Diane. I corrected Minner's spreadsheet and added the blank line highlighting switch to Lantus. There are two rows for July 8th separated by the blank "SWITCH TO LANTUS" row. This is because she did get one Humulin dose super early on July 8th, then the first Lantus does mid-day on July 8th. So my current timing is not where I want it for AM and PM, but I'll slowly get there by dosing 30 minutes or so earlier than 12 hour mark each time.

This experience defines a new level of patience for me. I don't like her numbers staying above 300 all the time like they did on July 8th. But I also did not like the spiky curve nature of Humulin and the fact that even though I injected her 4 times July 7th with Humulin, her numbers never got below 200. I am anxious to already increase the Lantus to 1.25U or 1.5U (I got the 1/2 dose marked syringes yesterday), but it also seems wise to be patient for a few days even if her BG numbers stay in 300's.

 

[Diane Tyler's Mom GA]

Morning Laura it will take 5-7 days for the depot to build up , hang in there and try and be patient

 

[MinnerPip]

Thank you Diane. My vet just texted me a few moments ago. He receives Minner's BG numbers via the Libre app that sends to his system. He just advised me to continue at 1 unit again for PM dose but he thinks tomorrow we should increase to 2 units. I certainly want to see lower BG numbers, but the whole depot thing makes me nervous. I want to be able to do what a vet advises, but I also don't know how to calm myself when doing an increase to 2 units given we don't really know how this depot thing will materialize itself.

 

[Wendy&Neko]

If you would like to, I think you are ready to start posting over on the Lantus forum. There are even more people over there who can help you.

but he thinks tomorrow we should increase to 2 units.

Umm, no. Unless Minner is showing you some ketones, I would be patient a couple more days yet. The depot can take 5-7 days to build. And as you can see, the numbers are gradually coming down. And we do dose changes by 0.25 units at a time. When following SLGS for dosing, you increase after 7 days if numbers warrant it.

To test for ketones, you can use ketone test strips for urine, such as the brand Ketostix. Available at pretty much any pharmacy. More info here: Tips to catch and test a urine sample Anything above trace should be a conversation with a vet. It's good to test each day Minner is in higher numbers.