01/08/21 New Member - Kitty struggling to regulate

[RachelG]

Hi there,

I'm relieved and hopeful to have found this forum, and hope that some experienced cat parents can help us. Fortune (14) has IBD/Lymphosarcoma since 01/2017 and recently developed diabetes, we suspect from being on prednisolone for 2.5 years.

After his initial diagnosis on 05/28/20, we first made diet changes to lower carb (he was on rabbit for IBD/lymphosarcoma which is high carb) and took him off prednisolone which caused his IBD symptoms to flare and his weight to drop dramatically, so we started insulin on 07/01/20. We started testing his BG using urine dips at the direction of our vet.

His BG was between 300-500 from July-August, and his weight dropped from 15.6 to 13. We went up to 3 units, 2x/daily by 08/05/20. After one month, his dips showed negative, so we began to back off his dosage gradually until eventually the vet told us to stop completely on 10/16. We thought he was in remission.

However, his weight kept dropping. From October 3 to November 5 his weight dropped .7lbs, and we brought Fortune to the vet and restarted insulin. His BG was back to 250. We were reminded that Fortune is several years into his cancer diagnosis and overall "looks good."

He keeps dropping weight. We called and emailed updates, and increased insulin on our own, but we very scared to see Fortune become skinnier and weaker. We finally brought our boy back into the vet and his weight was down another 1.3 lbs to 11.6. The vet sent us off after doing lab work which showed BG at 676, but his fructosamine (sp?) level which indicates BG levels over the past few weeks was normal. He has suggested we do an in-office glucose curve. We are currently at 1 unit/2xday

The office is not staffed 24 hours, and Fortune will be alone overnight.

I am at a loss. Our boy is still himself (thank G-d) and happy, but so weak and clearly not feeling himself. He has "clicking" in his back right foot, and has had trouble jumping lately which I think is related to the weight loss. He drinks more frequently that he ever has before. His coat is thin and sparse, and he seems cold. And of course, despite having a voracious appetite, he is not gaining weight.

I am very hesitant to leave him over night when he is clearly not well, and will be alone. I am also concerned that diabetes is supposed to be "very treatable," yet since initially being diagnosed on 05/28/20, he has lost 3.9lb! Gosh, just writing those numbers makes me tear up. Fortune has always been a larger cat, but now his spine is palpable and he is so weak. He is so loving and affectionate, and such a good boy. He has so much more life and love left in him, and I want to make sure he is getting absolutely the best care possible.

Any advice on how to proceed is welcome - I am reading on this forum about BG testing at home to create curves instead of urine dips, and I just ordered a monitor. I would like to try doing it at home before we deal with the in-office ordeal if possible; at the same time I don't want to put off getting him well as fast as possible. Just at a loss.

Thank you,

Rachel & Fortune xo

 

[Diane Tyler's Mom GA]

Welcome Rachel and Fortune
I'm so sorry he's not feeling well, poor baby.
Poor baby looks so thin like you said
I see on your profile he's on Lantus which is a good insulin.

It is great you want to home test and ordered a monitor
Which one did you get
Most of us use human meters from Walmart Relion Prime
It's 9 dollars
17.88 for 100 strips
Don't know if you ordered a pet meter (Alpha Trak )
The strips are very expensive like 48.00 for 50 strips
You will be going thru a lot of strips

You will need either 26 or 28 gauge lancets
Cotton rounds to put behind the ear in case you prick yourself
After you get the ear to bleed press gently to stop the bleeding like 10-20 seconds

I don't use the lancing device to prick the ear, a lot of us test freehand, just hold the lancet and
prick the ear, I think you can see where you are aiming better

Neosporin Ointment with pain relief / NOT the cream
If you see his ears look sore, apply a thin layer
Has your vet tested for ketones
Pick up some ketostix to test his urine





I will post more below

 

[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

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

 

[Diane Tyler's Mom GA]

Start rubbing his ears to get him used to it, give him a treat after testing
even if you don't get blood the first. Soon he will associate after testing he will get a treat.

 

[Diane Tyler's Mom GA]

VIDEO: How to test your cat's blood sugarsugar

Here is a video that one of our members testing her cat

 

[Diane Tyler's Mom GA]

• when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first .
• It appears after each post in gray, look at mine,

• On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
• • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • 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.


tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people
You can also add where you live in your profile, not your signature

This is at the bottom of every ones post in grey
Please make sure you list his health issues

 

[Diane Tyler's Mom GA]

Also set up a spreadsheet and post the numbers you have, that's the only way members here can give you any advice about dosing



We don't increase or decrease by full units, we increase or decrease by 0.25 units at a time. We use syringes with half unit markings.

 

[Diane Tyler's Mom GA]

Here are the instructions for setting up your spresdsheet if you have trouble with it let us know we have a wonderful member that will do it for you

https://felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

[Diane Tyler's Mom GA]

This explains how the spreadsheet grid works you can look at mine it's at the bottom of my signature and everyone elses

https://felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

 

[Diane Tyler's Mom GA]

if you do get a little blood, try and milk it the ear, press up towards the blood you good gently a couple of times. Try and get those ears as warm as possible.

If you are just using the lancet only, look at it , you will see that one side will point
upward , prick the ear with it facing up.
Good luck

 

[Diane Tyler's Mom GA]

I'm going to tag a few members to read your post , and about his health
issues.

@Wendy&Neko

@Critter Mom

@Sienne and Gabby (GA)

Thanks ladies I feel so bad for her kitty she said he's gotten so thin and keeps dropping weight and is weak
You can see it in the pic she attached, my heart is breaking for him when I look at that pic

Anyone else

 

[Diane Tyler's Mom GA]

I hope I was of some help Rachel, you have found the best support group
in my opinion. We have some very experienced and knowledgeable members
here.
Oh I forgot in your title you have GA that means Gone Ahead when I kitty has passed
so you can remove it.
I'm sure other members will reply
Just keep asking questions
I'm in N.J. also by Giant Stadium

 

[Wendy&Neko]

I would suggest learning to home test and doing that curve at home your self. Not only will it be much cheaper for you, it'll be a lot less stressful for your kitty. A lot of kitties have much higher blood sugars at the vet due to stress, so those numbers aren't very good for determining what needs to be done with the insulin dose. A non diabetic cat of mine tested over 220 at the vet's office, and a nice normal 53 at home the next day.

We have a post that night help you with learning to do blood testing - click on the blue link here: Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos

What type of food are you feeding now? And how many calories per day? There are several low carb commercially available rabbit cat foods.

Has Fortune's B12 levels been tested. May cats with GI issues like IBD have absorption problems due to low B12. The trade off with supplementing is that there is some thought that cancer feeds on B12. Anyway, worth a test and discussion with your vet.

Is Fortune still being treated for Lymphosarcoma and if so, how? IBD is usually treated with novel proteins and probiotics.

 

[RachelG]

Hi @Diane Tyler's Mom - thank you so much for the information! I will look into the meter you suggested, too. I plan to get the meter and supplies today, and start the curve testing the whole day tomorrow. I did order the Alpha Trak 2 before I got your message

I created a signature before I posted along with a spreadsheet, I'm not sure why it didn't show up. I can see it when I'm logged in...I'm afraid my sheet doesn't yet have usable information because we are about to start the BG at-home testing, whereas we were doing the urine dips.

He has his ketones tested at the vet, but I will also get the strips! Thank you, thank you <3

Oh gosh, I did not mean to put GA for that reason! I thought it meant general advice ! It seems to be removed, so I am grateful if a mod helped out. J

Hi @Wendy&Neko – Thank you for replying! Yes, Fortune has had his B12 tested and we give him a B12 shot once a week. He is currently on meds for the lymphosarcoma, a combination treatment with chlorambucil and prednisolone, with ursodiol since 01/2018.

Fortune has had IBD since 2013 and it progressed to lymphosarcoma in late 2016.

We recently added digestive enzymes (Dr. GoodPet Feline Digestive Enzymes) and a probiotic (Proviable-DC by Nutrimax) in November 2020 when he was having diarrhea and vomiting frequently, when I realized that is what doctors put ME on for tummy issues. Vet had no problem, but didn’t make the suggestion. I feel so silly I didn’t look into it sooner.

He was also eating Royal Canin PR Veterinary Diet cans of rabbit prior to the diabetes diagnosis. We had switched him from raw in 2017 after a flare up. I haven’t been able to easily find a low carb rabbit wet food, but will look more on this site. Right now, we are feeding him Fancy Feast Chicken Feast Chunky and Salmon Salmon Pate (3.5-4 cans/day), supplemented with Tiki Cat Born Carnivore Chicken (~.3 cup) and some freeze dried treats. He eats about 500-580 kcal/day.

Fortune is such a sweet love bug and so resilient - he has had to take so many pills the past few years, and takes his insulin shots like a champ. He is also very strong willed and stubborn, and I never thought he would be able to take the treatments, but he has proved me wrong in the best way! I'm lucky that my spouse has taken the lead with administering his meds, and their relationship has gotten so much closer for it. It has been so sweet to watch. (Fortune and I were together 2.5 years before my partner was in the picture )



Grateful for all of the helpful links, and support. I'm so desperate to make sure I am helping him as much as I possibly can! I love our vet, he is very kind and loves what he does, but I'm just no longer confident that he is giving our boy the best care the more I learn about IBD and diabetes.

 

[Diane Tyler's Mom GA]

@RachelG You are very welcome. Sorry I didn't notice you did your signature and SS already. Good job. I hope the curve goes well.
That pic of your spouse and Fortune warms my heart, just look at the way they are looking at each other , so precious. I wish you all the best for Fortune, he is adorable. Have a good day

 

[Diane Tyler's Mom GA]

I would suggest learning to home test and doing that curve at home your self. Not only will it be much cheaper for you, it'll be a lot less stressful for your kitty. A lot of kitties have much higher blood sugars at the vet due to stress, so those numbers aren't very good for determining what needs to be done with the insulin dose. A non diabetic cat of mine tested over 220 at the vet's office, and a nice normal 53 at home the next day.

We have a post that night help you with learning to do blood testing - click on the blue link here: Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos

What type of food are you feeding now? And how many calories per day? There are several low carb commercially available rabbit cat foods.

Has Fortune's B12 levels been tested. May cats with GI issues like IBD have absorption problems due to low B12. The trade off with supplementing is that there is some thought that cancer feeds on B12. Anyway, worth a test and discussion with your vet.

Is Fortune still being treated for Lymphosarcoma and if so, how? IBD is usually treated with novel proteins and probiotics.

Thank you Wendy, Have a good day

 

[Critter Mom]

I'm lucky that my spouse has taken the lead with administering his meds, and their relationship has gotten so much closer for it. It has been so sweet to watch.

Absolutely fabulous picture! Heartwarming, as Diane says above.

Welcome to you all.


Mogs
.

 

[Wendy&Neko]

Fortune has had IBD since 2013 and it progressed to lymphosarcoma in late 2016

I haven't heard of that happening before. I have heard of some cat progressing to small cell lymphoma - actually happened to one of mine. SCL is treated with chlorambucil and prednisolone. If it was actually SCL he had, I would have suggested switching the pred to budesonide, which is a steroid that is locally acting in just the GI system. Budesonide has less impact on blood sugars, it made no different to Neko who was on budesonide because her heart could not handle pred.

Low carb rabbit options by Natures Variety Instinct (their limited ingredient line has just rabbit), Rawz, and Koha. Don't switch to lower carb food until you are home testing, as the difference in carb levels can make a drastic difference in how much insulin is needed.

I removed the GA for you. It causes distress for us to see it and I was glad to see it wasn't true.

 

[RachelG]

I haven't heard of that happening before. I have heard of some cat progressing to small cell lymphoma - actually happened to one of mine. SCL is treated with chlorambucil and prednisolone. If it was actually SCL he had, I would have suggested switching the pred to budesonide, which is a steroid that is locally acting in just the GI system. Budesonide has less impact on blood sugars, it made no different to Neko who was on budesonide because her heart could not handle pred.

I removed the GA for you. It causes distress for us to see it and I was glad to see it wasn't true.

You are right, I misremembered. Which is ironic because both Fortune and my mom have lymphoma! Thank you for the recommendation for budesonide; I will share it with my vet and ask to try it.

Thank you also for removing the GA - it's much appreciated. I feel some kinda way about making that horrible mistake!

And thank you for the low carb rabbit recommendations! We switched to low carb Fancy Feast (salmon and chicken) back in July when Fortune was having a hard time eating. Perhaps that is why his blood sugar dips went to zero so quickly.

The good new is, thank to @Diane Tyler's Mom I have all of the supplies I need to start testing a curve tomorrow! We got the ReliOn meter, strips, etc. and are ready to go. I'm trying to look to see how I can evaluate the results

@Critter Mom Thank you! It melts my heart every time, and I'm lucky enough to see them every day!

 

[Diane Tyler's Mom GA]

You are right, I misremembered. Which is ironic because both Fortune and my mom have lymphoma! Thank you for the recommendation for budesonide; I will share it with my vet and ask to try it.

Thank you also for removing the GA - it's much appreciated. I feel some kinda way about making that horrible mistake!

And thank you for the low carb rabbit recommendations! We switched to low carb Fancy Feast (salmon and chicken) back in July when Fortune was having a hard time eating. Perhaps that is why his blood sugar dips went to zero so quickly.

The good new is, thank to @Diane Tyler's Mom I have all of the supplies I need to start testing a curve tomorrow! We got the ReliOn meter, strips, etc. and are ready to go. I'm trying to look to see how I can evaluate the results

@Critter Mom Thank you! It melts my heart every time, and I'm lucky enough to see them every day!

Hi Rachel good luck with the curve tomorrow
Just post the numbers on your spreadsheet

 

[RachelG]

So we did a few pricks last night, and that went much easier than this morning! This morning it took a good 30 minutes to get a big enough drop of blood before it got absorbed by his fur. Poor baby - we pricked him so many times! Gave him SO many treats though, lol (freeze dried fish). Did the rice with sock warmed up trick, and went up to a 26 gauge (last night we used 28). Such a trooper - though he did make his complaints known.

Hopefully it goes a bit easier the rest of the day! I have read conflicting things about frequency of testing. Should we go for every hour or every other after insulin?

I updated the numbers and will keep updating through the day.

 

[RachelG]

I just learned that my partner changed the dosing a few days ago - 1 unit in the morning and 2 units in the evening - because Fortune was (and is) clearly suffering from such high BG.
Previously we always gave him even doses - e.g. 1unit in am, 1 unit in pm - but now I'm not sure how to proceed. He got 1 unit this morning - his BG was 155 AMPS.

Now I'm not sure how we adjust. I'm reading Tilly's Tight Regulation Protocol, but because Fortune is no longer "newly diagnosed" and is technically on a higher dose than recommended based on his low weight, I am unclear how to adjust. Our vet always increased in whole unit doses, and decreased as well. We are waiting on the syringes with half unit and quarter unit markings to adjust more gradually, but for right now I'm trying to make a plan to help him.

My boy keeps slipping, on the floor when he runs and yesterday he gave us a fright when he slipped on the stairs (thankfully caught himself). I'm worried he has neuropathy - the vet said it was arthritis when we brought him in on 12/26.

Thanks in advance for guidance. Very scared over here.

 

[Diane Tyler's Mom GA]

@RachelG
The curve would be done every 2 hours
EXAMPLE
Give insulin at 7:00 AM
Test at 9:00 AM. (+2)
Test at 11:00 AM. (+4)
Test at. 1:00 PM. (+6)
Test at. 3:00 PM. (+8)
Test at. 5:00 PM. (+10)
Test at. 7:00 PM. Which would be your PMPS test
You can feed as you normally would


You should be giving the same dose of Lantus in the AM and PM
He is still NEWLY diagnosed, until after a year.
Please fill in your spreadsheet with todays AMPS 155 and how many units you gave and keep the SS up to date

Rachel how old is he
On the lancet you will see that one side points upward
Prick the ear with that side, try milking the ear after you get some blood
With your finger press up toward the blood gently a couple of times



About him slipping it very well could be neuropathy
My cat had it, does he also look like he is walking like a rabbit with his back feet? As if he is walking with the back feet flat rather on his toes?
Yes they do slip all over .
It will get better once you can get him in better numbers, also most if us give Methyl B-12 supplement. I will post it below, you mix it in with their moist food once a day

I am going to tag @Wendy&Neko since I saw she replied to you on your post
You can still eye ball the dose until your half unit marking comes

@Wendy&Neko
Hi Wendy Rachel is doing her first curve this morning, her husband raised last night's dose to 2 units, She gave 1 unit this morning.
She was giving 1 unit in the AM and PM before her husband raised it last night

I gave her some info here
Thanks Wendy
You also asked her what she was feeding she answered this in #14, I don't know if you saw it

Wendy do you think after she does the curve she should move over to the Lantus
Board?
@Wendy&Neko

 

[Diane Tyler's Mom GA]

Will also tag

@Tomlin

@Sienne and Gabby (GA)

@tiffmaxee

@Nan & Amber (GA)

@Bandit's Mom

Anybody else that might help Rachel
Thank you

 

[Critter Mom]

Hi Rachel,

I just learned that my partner changed the dosing a few days ago - 1 unit in the morning and 2 units in the evening - because Fortune was (and is) clearly suffering from such high BG.

this morning - his BG was 155 AMPS

If you're seeing really high numbers and also seeing preshots in the 150s it's possible that Fortune may be experiencing some 'bouncing' (unfamiliarly low/too low BG levels trigger the body's defence mechanisms to release extra blood glucose into the bloodstream). [ETA] It's impossible to say for certain without much data, but as you start gathering BG readings for Fortune you'll be better able to gauge how he's responding to his insulin.

Lantus works better with consistent, identical doses AM and PM. Using different doses at AM and PM messes up the Lantus depot and, as well as making overall response more unpredictable, it may also lead to significant swings in BG.

The vet sent us off after doing lab work which showed BG at 676, but his fructosamine (sp?) level which indicates BG levels over the past few weeks was normal.

The problem with fructosamine tests is that they only give an average value of the BG over the period which the test covers. While the result is in the normal range, there is no way of telling whether Fortune may have been going very low then bouncing up to higher numbers in response (hence the greater value of information you get by home testing).

I strongly recommend that you start posting daily on the Lantus subforum and ask for help with dosing. There are a number of very experienced Lantus users who post there. The help will be a little generalised at first but, as you gather more data for Fortune, it will become more specific and help you to improve his regulation. When you start your thread on Lantus, please copy/paste the link below to the first post so that members replying to your post will be able to refer back to the information you've posted here:

https://www.felinediabetes.com/FDMB/threads/01-08-21-new-member-kitty-struggling-to-regulate.241217/

If you have any recent test results, it would be helpful to add them to the LABS tab of Fortune's spreadsheet, especially as you're juggling the needs of multiple conditions. Some of the members that post on the Lantus board are good at interpreting lab work and may be able to give you additional suggestions.

I'll post some additional tips for home testing in a minute, but two things spring to mind to suggest to you straight away:

* Smear a thin film of Vaseline or Neosporin ointment over the test site and wipe off the excess before starting to warm the ear. (Makes the blood sample bead up instead of wicking away into the fur.)

* Warm the ear even more than you're doing at the moment.

When you get the hang of the testing down pat, provided you can test enough each day then I suggest you consider following the Tight Regulation dosing method. It's a more aggressive protocol than Start Low, Go Slow, but it provides a faster route to an effective dose. You'll be able to get daily coaching and support from experienced members on the Lantus board, whichever dosing method you choose to follow.

Finally, a general comment. When it comes to treatment choices, first and foremost Fortune needs nourishment. When managing a cat with multiple conditions, much as we might wish for things to be different, sometimes it turns out that a cat may need a food that isn't ideal carb-wise for the diabetes. Should that ever prove to be the case with Fortune, keep in mind that insulin dosing can always be worked around the other diets/treatments a cat may need.

(((Fortune and his humans)))


Mogs
.

 

[Diane Tyler's Mom GA]

Here is the link https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
For the neuropathy

Alot of members use this , I use it myself you can buy it on line from Vitacost
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
Some use Zobaline
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up
The Vitacost brand is a capsule so just open it and pour the powder on the wet food and I always add some water to the wet food.
Has no taste, no need to crush it up
The Zobaline is 33.99 for 60 pills, too expensive
I saw a big improvement I'd say 3 months, could be sooner. One capsule a day.
Once you get your kitty better regulated the B-12 methyl will help


Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

• SKU #: 835003001804
• Shipping Weight: 0.23 lb
• Servings: 100

 

[Critter Mom]

As promised...

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

1. For most meters you can insert a test strip part way without switching it on. Once you've done the poke you can then push the strip the rest of the way into the meter to activate it. (Reduces the likelihood that the meter will time out before you can get the blood sample onto the strip.)
   
   
2. 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.
   
   
3. Apply 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 into the fur. (Wipe off any excess.)
   
   
4. 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.)
   
   
5. Once you have the testing area of the ear 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.
   
   
6. 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).
   
   
7. 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).
   
   
8. 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. If you aim as close to the edge of the ear as possible you are less likely to hit the marginal ear vein.
   
   
9. Keep hold of the ear while you're pushing the test strip into the meter to activate it. (Kitties are prone to shake their heads after a poke, sending your precious blood sample flying across the room. Holding the ear reduces likelihood of this happening.)
   
   Note: As you become more practised in testing, you'll be able to activate the meter just before doing the poke and still have plenty of time to collect the sample on the strip before it times out.
   
   
10. 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.
    
    If a test fails and you still have a lot of blood on the strip from the failed test, don't throw it away. Instead, you could pop another strip into the meter and test using the blood on the strip from the first test. (Saves an additional poke so also helpful for wriggly kitties!)
    
    
11. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 20-30 seconds to minimise bruising.
    
    
12. Keep giving lots of praise throughout the process and reward with a favourite diabetic-friendly treat or favourite activity (e.g. brushing).

With a bit of time and practice you'll be able to work out a technique and a routine that works best for yourselves and Fortune.

See also member @FarmKitty's excellent pictorial tutorial for visuals of some of the techniques described above:

https://www.felinediabetes.com/FDMB/threads/hello-food-and-insulin-questions.240117/#post-2709047

In particular, have a look at the pictures of the backlit ear before and after adequate warming. The difference in blood flow is really striking!


Mogs
.

 

[Diane Tyler's Mom GA]

@Critter Mom
Hi Mogs , thanks for helping her out
She just started home testing , is doing a curve right now
See # 21 and #22
I also think it's a good idea for her to head over to the Lantus Board
I told her how to do the curve #23

 

[Diane Tyler's Mom GA]

@RachelG

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Critter Mom]

I'm worried he has neuropathy - the vet said it was arthritis when we brought him in on 12/26.

An X-ray should pick up signs of arthritis.

Here's a video of a cat with quite marked neuropathy (successfully treated over a period of months with methylcobalamin):

With milder cases of neuropathy signs may be less obvious. Examples of clinical signs that could potentially be down to neuropathy include:

- not getting as much traction on smooth floors.
- disinclined/unable to jump to higher surfaces.
- inappropriate urination.
- constipation.

There are other issues that produce clinical signs such as the above. I'm not sure when Fortune last had blood work done, but if it was recent it might be worth having a look at where in the range his potassium and phosphorus levels were sitting. Low potassium and high phosphorus levels may also give rise to hind leg weakness.


Mogs
.

 

[Diane Tyler's Mom GA]

@RachelG
Did you get any more tests done, have you read all the new posts yet?

 

[Diane Tyler's Mom GA]

So we did a few pricks last night, and that went much easier than this morning! This morning it took a good 30 minutes to get a big enough drop of blood before it got absorbed by his fur. Poor baby - we pricked him so many times! Gave him SO many treats though, lol (freeze dried fish). Did the rice with sock warmed up trick, and went up to a 26 gauge (last night we used 28). Such a trooper - though he did make his complaints known.

Hopefully it goes a bit easier the rest of the day! I have read conflicting things about frequency of testing. Should we go for every hour or every other after insulin?

I updated the numbers and will keep updating through the day.

Don't see any numbers at all
@RachelG

 

[RachelG]

Thank you so much everyone for all the incredible tips!

I'm Rachel's husband (and Fortune's other human), Eugene. Tagging in to give Rachel a little break

Rachel how old is he

Fortune is almost 15 (turning 15 next month)

@Diane Tyler's Mom thanks for suggesting a B12, I ordered the Vitacost. He's currently getting a B12 shot weekly, but assuming that might conflict with this... I'll consult our vet to make sure, but ordered the one from the link you sent so we have it on hand. Sounds super promising.

I also updated the sheet link in the signature so should show up now.

@Critter Mom those tips for testing were a great help, thank you! Is there a consensus on coming in from the inside or outside of the ear? We've been pricking a very warmed up sweet spot from the inside of the ear, and barely getting a drop of blood without a ton of rubbing and squeezing. Should we be going at it from the outside of the ear instead? (the furry part)

Also, that video was really helpful – Fortune's walk isn't quite that pronounced, just seeing hints of that for now, so hoping we get this under control and start seeing it reverse.

Once we get this curve together, we'll get a post going on the Lantus board for sure. I checked out the board and seems like an amazing group, thanks for the tip! We'll add labs to the sheet as well.

Thanks again!

Fortune's humans (Rachel & Eugene)


Fortune (right) and Marty (left) chilling on the couch with me between Fortune's BG tests.

 

[Sienne and Gabby (GA)]

Re. testing - it will take probably a few weeks for the capillary bed in Fortunes ear to build up. Once that happens, testing will be easier. If you're currently using a wider gauge lancet (e..g, 26 or so), once you're reliably getting blood, you can switch to a thinner (higher number) lancet which will be more comfortable for Fortune.

Weight - how much is Fortune eating? It may make sense to try and find a food that's low in carbs. but high in calories to help your kitty gain weight. I'm not crazy about the idea but you could always discuss the short term use of an appetite stimulant.

 

[RachelG]

Thanks @Sienne and Gabby (GA), That's good to hear that it'll get easier and we can switch to a higher gauge at some point. Yeah 26 is getting some blood now, but 30 and 28 weren't.

He's eating about 360 calories a day, trying to get him to gain weight. I'm not the biggest fan, but feeding him Fancy Feast Chunky Chicken canned food at the moment. It's fairly low carb from what I've read, but we're definitely on the lookout for a higher quality food option and open to suggestions (e.g. better ingredients, organic, animal got spa treatments before being canned, etc.).

 

[Critter Mom]

Hi Eugene.

Is there a consensus on coming in from the inside or outside of the ear? We've been pricking a very warmed up sweet spot from the inside of the ear, and barely getting a drop of blood without a ton of rubbing and squeezing. Should we be going at it from the outside of the ear instead? (the furry part)

I've always done the poke on the outside of the ear - easier to support and hold the ear ear and see where you're aiming.

We'll add labs to the sheet as well.

Any time you'd like to get a once-over of lab work, I'd recommend posting a request for review of labs and tagging member 'Marje and Gracie'.

Also, that video was really helpful – Fortune's walk isn't quite that pronounced, just seeing hints of that for now, so hoping we get this under control and start seeing it reverse.

He's currently getting a B12 shot weekly, but assuming that might conflict with this... I'll consult our vet to make sure,

I think that's a good plan. The injected B12 is most likely to be the cyanocobalamin form of B12, as is normally recommended for cats with GI issues, so a check with the vet about using both injected cyanocobalamin and oral methylcobalamin is wise, IMO, from a total dosage perspective.

What makes the greatest difference with neuropathy is better BG regulation and, all going well, the Lantus group will be able to help you with that.

Great photo of your furchilder. Love Marty's legs!


Mogs
.

 

[Sienne and Gabby (GA)]

I'm a big fan of ZiwiPeak. They have novel proteins (e.g.,, venison, a rabbit an lamb combo) which would be good for the IBD. The brand has no gums or carrageenan which can be problematic for IBD and lymphoma.

Have you considered going back to raw? There is an excellent premix from FoodFurLife. It saves you from having to track down supplements to make a raw diet nutritionally complete. If you can source your raw proteins, it's really easy to do. If your cat likes rabbit, Hare Today is a source.

Like Mogs, I poked on the outer ear. However, if your cat has dark fur, sometimes poking from the inside makes it easier to see the drop of blood.

 

[Critter Mom]

if your cat has dark fur, sometimes poking from the inside makes it easier to see the drop of blood.

That reminds me of another tip.

I used an anglepoise lamp to illuminate Saoirse's testing station so I could see the blood droplet OK. I've seen some other members recommend those LED headband lamps to wear when getting BG tests.


Mogs
.

 

[Diane Tyler's Mom GA]

Thank you so much everyone for all the incredible tips!

I'm Rachel's husband (and Fortune's other human), Eugene. Tagging in to give Rachel a little break


Fortune is almost 15 (turning 15 next month)

@Diane Tyler's Mom thanks for suggesting a B12, I ordered the Vitacost. He's currently getting a B12 shot weekly, but assuming that might conflict with this... I'll consult our vet to make sure, but ordered the one from the link you sent so we have it on hand. Sounds super promising.

I also updated the sheet link in the signature so should show up now.

@Critter Mom those tips for testing were a great help, thank you! Is there a consensus on coming in from the inside or outside of the ear? We've been pricking a very warmed up sweet spot from the inside of the ear, and barely getting a drop of blood without a ton of rubbing and squeezing. Should we be going at it from the outside of the ear instead? (the furry part)

Also, that video was really helpful – Fortune's walk isn't quite that pronounced, just seeing hints of that for now, so hoping we get this under control and start seeing it reverse.

Once we get this curve together, we'll get a post going on the Lantus board for sure. I checked out the board and seems like an amazing group, thanks for the tip! We'll add labs to the sheet as well.

Thanks again!

Fortune's humans (Rachel & Eugene)

View attachment 59258
Fortune (right) and Marty (left) chilling on the couch with me between Fortune's BG tests.

Hi Eugene that pose of Marty has me cracking up.
When you do decide to go over to the Lantus forum
For the title it would be like thus
Date Fortune. AMPS
Here is an EXAMPLE
1-7. Fortune AMPS- 145
A new post every day . Copy and paste your thread from the previous day, it's above where the pic of the cat is all the way at the top of the page , and add it to the
new day. We do this so members can go back to the previous day if needed

Take a look at mine
When you go over to the Lantus say you are new and came over from the Feline Health Board
So far the curve doesn't look that bad
You can ask to have members look at your curve, and also tag members


Just remember to get a few tests in after his PMPS , to see how the insulin is working
Cats will usually go lower at night

 

[RachelG]

Hi all,

Thank you so much for all of the feedback and tips. Today has been an ordeal for all of us, and Fortune's ears are pretty sore and bruised (we definitely did not get blood on the first prick), but we did it! We plan on doing one more test +2 PMPS.

I posted on the Lantus board with our numbers - could not have navigated this far without you! Biggest concern is that his "curve" is more of a straight line up, probably due to giving 2 IU last night and only 1 IU this morning which seems like it was insufficient.

https://www.felinediabetes.com/FDMB...153-4-161-6-184-8-263-10-282-pmps-273.241307/

Hi Eugene that pose of Marty has me cracking up.
A new post every day . Copy and paste your thread from the previous day, it's above where the pic of the cat is all the way at the top of the page , and add it to the
new day. We do this so members can go back to the previous day if needed

Does this mean we need to do a curve every day? Would testing AMPS and PMPS with one at +3 or +5 be sufficient for right now? How frequently should we perform the curve?

That reminds me of another tip.

I used an anglepoise lamp to illuminate Saoirse's testing station so I could see the blood droplet OK. I've seen some other members recommend those LED headband lamps to wear when getting BG tests.

We definitely just ordered this on Amazon after blinding ourselves with a flashlight.

I'm a big fan of ZiwiPeak. They have novel proteins (e.g.,, venison, a rabbit an lamb combo) which would be good for the IBD. The brand has no gums or carrageenan which can be problematic for IBD and lymphoma.

We checked out ZiwiPeak - it looks great!

Have you considered going back to raw? There is an excellent premix from FoodFurLife. It saves you from having to track down supplements to make a raw diet nutritionally complete. If you can source your raw proteins, it's really easy to do. If your cat likes rabbit, Hare Today is a source.

Fortune was vomiting a lot more frequently with raw, and our vet discouraged it. I am tempted to try becuse it is such better quality, but concerned about giving him an IBD flare up with the diabetes so poorly controlled too. Even though his is very skinny and dropping weight, right now he is still eating. With raw it has been a toss up - we would have to warm it up which may have defeated the purpose, lol. So I think sticking with the canned for now and dabbling with raw once he is feeling a bit better. I'm encouraged to see there are so many more options from when we were doing it back in '16!

Lantus works better with consistent, identical doses AM and PM. Using different doses at AM and PM messes up the Lantus depot and, as well as making overall response more unpredictable, it may also lead to significant swings in BG.


The problem with fructosamine tests is that they only give an average value of the BG over the period which the test covers. While the result is in the normal range, there is no way of telling whether Fortune may have been going very low then bouncing up to higher numbers in response (hence the greater value of information you get by home testing).

We definitely were not very strict with the 12 hour rule. Discussed this today and going to slowly adjust the time over 15 minute increments to get back to a time that works better. This sounds exactly like what is happening based on the "curve" we saw today. This makes perfect sense to me! Poor boy.

If you have any recent test results, it would be helpful to add them to the LABS tab of Fortune's spreadsheet, especially as you're juggling the needs of multiple conditions. Some of the members that post on the Lantus board are good at interpreting lab work and may be able to give you additional suggestions.

We will be following up with the vet in the am to get the latest.

When you get the hang of the testing down pat, provided you can test enough each day then I suggest you consider following the Tight Regulation dosing method. It's a more aggressive protocol than Start Low, Go Slow, but it provides a faster route to an effective dose. You'll be able to get daily coaching and support from experienced members on the Lantus board, whichever dosing method you choose to follow.

Thank you! We are encouraged that he is still considered "newly diagnosed" even though he has been on insulin since July (dx in May). Trying to get a grasp on the TR protocol. I (Rachel) have pretty bad "brain fog" from chronic illness and am so nervous about messing it up for him!

I I would have suggested switching the pred to budesonide, which is a steroid that is locally acting in just the GI system. Budesonide has less impact on blood sugars, it made no different to Neko who was on budesonide because her heart could not handle pred.

We will be discussing with the vet on Wednesday - thank you! He suspects the pred caused the diabetes, but when we took him off it in May, he wasn't eating and the vet believed it was due to the cancer, so we put him back on it and started insulin. We wonder now if it was because of the pred/cancer, or high BG...

Fortune was scheduled to go into the vet all day Tuesday through Wednesday with an unsupervised (!) overnight stay, but because of the forum we feel like we may be able to cancel. We did not feel comfortable leaving him knowing no one would be there for at least 6+ hours when he is unwell. The vet wants to do a U/S to check the situation of his lymphoma because Fortune has been so unwell, but it seems like all of his symptoms are consistent with diabetes. He just had a U/S on November 5 that showed no progression, so I am disinclined to put him through it again especially when I cannot comfort him due to COVID. Trying to figure out how to get the vet to continue consulting without necessarily following all of his advice to a T...

 

[Critter Mom]

after blinding ourselves with a flashlight.

Well done! That takes skill.


Mogs
.

 

[Diane Tyler's Mom GA]

Morning Rachel no you do not have to do a curve every day.
I think the testing @+3 and @+5 would be ok for now.
You can then try and test at other times
Try to fill in different test times on different days.
@RachelG
Glad to see you over in the Lantus forum
As for how often to do a curve, I would ask that question
over in the Lantus forum.