10/25 - NEED ADVICE - newly dx not eating much low bg

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Lola

Lola

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hi, I am new to the forum but I have been reading lots of great advice from the site. thanks! So my cat was diagnosed the other day, he has lost several pounds in the past 2 months, has neuropathy in his hind legs, and when the vet tested his bg it was 430. Also his urine tested high for glucose. So the vet prescribed 4u bid humulin n. I bought a glucose meter and gave him his first dose of insulin at 8:30 last night about an hour after he ate. I couldn't manage to get a drop of blood from his ear until about an hour after his shot, (I am new to this) so I don't know what his pre-shot level was, but an hour after the shot it was 190. I checked ever hour and at 4 hours he was down to 30. I gave him treats and honey and checked an hour later and it was back up to 50. Then I went to bed (this was 2 am). I checked his bg at 7:30 am, planning to keep him on a 12 hour feeding/insulin schedule. His bg was 100. He didn't want food. It is 11am, he just hate about a Tbsp of canned food (low carb canned food from Natural Balance). I don't want to give him more insulin with such low bg/not eating. I don't understand why I have the only diabetic cat who doesn't eat much. he was also drinking a lot of water last night even though his bg were levels were low/insulin was peaking. Can anyone give me advice? I must say I didn't want to start him on such a high dose of insulin but I decided to follow my vet's advice. I am not sure how much experience he has treating feline diabetes (he didn't prescribe on of the newer 'better' insulins and has never had a patient do home glucose testing). But he has been a vet for many years and I have just read stuff online obsessively for the past 4 days.

I also just want to add that he has been on low carb/grain free canned food for the past several years (Wellness and Natural Balance) but has also been overweight and ravenous his whole life, but only recently he eats less, lost weight, has neuropathy, and had high bg at the vet on 2 occasions 2 days apart. He doesn't seem to be having the usual symptoms (eating a lot) so I am confused.

any advice would be great. thank you!
-Lola
 
Re: newly diagnosed cat not eating

Hi and welcome to fdmb.

I'm glad you found us. Wow glad you are testing at home. That is GREAT!!! and thank good ness because you saved your kitty's life. Also glad you are feeding a lo carb grain free food. THAT is great also.

First off - Humulin N is not the greatest insulin to use for diabetic cats. But seeing that's what you have for now. I would decrease the dose to 1 unit ONLY 2x/day but continue testing before each dose and even do checks thruout the day if you can. With your kitty's blood glucose being so high he probably does not feel good at all.

Have you offered anything like baby food, bites of boiled or grilled chicken or lunch meat? What about canned tuna in water and the water from the tuna?

Also you can give pepcid ac - NOT pepcid complete. The generic name is famotidine. You want to give 1/4 tablet and you can give it 2x/day.

This is just to get you started. There will be more info to follow
 
Re: newly diagnosed cat not eating

Hi,

Thank you for your reply. I know that humulin n is not the greatest, and I know the dose that the vet started me off with is too high, but I feel conflicted in going against his advice as he is the expert. I also live in the Bronx with no car and not much money so I feel limited in going to another vet for another opinion. It is hard to get good reviews on vets to find a good one.

Does insulin upset their stomach? Is that why you suggested Pepci AC?

He just ate a bit, but he only eats about a Tbsp or a 1/4 of a 6 oz can at a time. I will check is BG levels in a few and make a decision.If it is still low (100) I do not want to give him insulin, esp since I am using humulin. I think I need to call the vet and get his advice. I just wish I was more confident in it.


He is eating so little it is very out of character for him. I am going to get the Wellness food that he used to eat and see if he likes that (I had to switch to a hypoallergenic food for my other cat but perhaps I have to just separate them at feeding time - fun!).


And yes I am managing to do the glucose testing but I feel so awful pricking his ear and esp since I feel like I have to do it painfully in order to get enough blood. I hope my technique gets better but in the meantime I feel awful about it. At least he is a docile cat.

thank you,
Lola
 
Re: newly diagnosed cat not eating

so abit more info - The neuropathy is due to the hi blood glucoses (BG's). You can give methyl B12 or xobaline to help with that. It's a little pill that you can get on line or at a store like Super Supps. Giving that and getting the BG's lower will help with this.

With the insulin - it would be best if your vet would consider switching Lantus but I know how difficult that is to convince your vet. But remember too this is for the life of your kitty. Your vet is doing the best he can but he is like a general practitioner. Many vets have little experience with diabetic cats. YOU have done tons of research already. What happens is you have to be an advocate for your boy too. YOu could say something like "I'm not comfortable giving so much insulin with such a low blood glucose."

Oftentimes when BG's are so high - the cats don't feel good - they have an upset stomach - so they don't want to eat. The pepccid can help with this.

Can you get strips to test his urine for ketones? They are sold in any pharmacy or in a grocery store where diabetic strips are sold? Have you been able to smell his urine or breath at all? Does it smell like nailpolish remover???

And what about the skin on the back of his neck? If you lift it up - does it go back to normal quickly? or slowly?
 
Re: newly diagnosed cat not eating

Just to clarify....

Pepcid AC (famotidine) dose is 1/4 of a 10mg tablet, twice per day...for nausea.

Sometimes you can only find the 'extra-strength' 20mg tablets...they are hard to cut into
1/8-ths. Try to get the 10mg ones.

Most chain stores (Walmart, Walgreens, etc.) have their own house brand of famotidine.
Ask the pharmacist for their house-brand equivalent of "Pepcid AC" regular strength 10mg.
 
Re: newly diagnosed cat not eating

Sorry I meant to add - have you tried warming his ear when you test him. I PROMISE this will get easier! If you take a sock and put some rice in it - tie it off and warm it up for a few seconds - or even take a warm moist wash cloth and hold it on his ear for a little bit (maybe 30 or so seconds if he'll tolerate it) - it will help increase the blood flow to the area. Eventually the ear will "learn" to bleed more easily for you. I PROMISE!!!

Usually we say if someone is new and doesn't have alot of info on how their cat responds to insulin - we suggest you NOT shoot if they are under 200. 4units bid on a newly diagnosed cat is ALOT of insulin - of any kind of insulin. It is always best to start with 1unit/bid of ANY insulin.

Some vets learn you should base the dose on a cats weight but really that is not the safest
 
Re: newly diagnosed cat not eating

You can always try to change your vet's mind on insulin first since it's difficult for you to see another vet. I've attached an article that shows an 80+% remission rate in newly diagnosed cats on Lantus. Here is a link to the AAHA diabetes guidelines as well: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Note page 218, where it says "Insulin Therapy in the Cat." Humulin N is not even mentioned because it is not appropriate for cats. It works similar to the lente insulin mentioned, where it does not have a duration of action long enough in cats. Humulin N can be very dangerous due to hypoglycemic incidents (as you've already experienced), your cat will not get any better on that insulin. With a slow acting insulin like Lantus, however, your cat has extremely good odds of going remission. The Humulin N may seem a little cheaper now, but in the long run you will pay far more for it in vet bills. Plus, you want your cat to get better, not worse.

Print out those two items and bring them to your vet. Often vets just haven't had the time to stay current with the details for every disease with every animal, and once you bring them the research they will change their treatment recommendations. If your vet refuses to change insulins despite the information you're providing for him, then unfortunately it's time to look for a new vet, even if it's harder to get there.

What Natural Balance food are you feeding? The only one that is appropriate for a diabetic is the Venison & Pea formula. All of the others contain Brown Rice, which will drive up blood sugar. Take a look at this Cat food nutrition list. It contains many kinds of premium foods that are ok to feed a diabetic--you need to feed something under 10% carbs. If you want a less expensive food, check out Binky's list here: http://felinediabetes.com/diabetic-cat-diets.htm.
 

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Re: newly diagnosed cat not eating

Thanks for the info! I will definitely bring it to the vet and switch to Lantus...

Yes I am feeding the venison and pea Natural Balance, my other cat has inflammatory bowel disease and that is the only food she can eat at the moment. Sometimes we have to change but for now this is our food of choice and I think it is working for both of them. And of course now that Boo has diabetes I will not change his food, if I have to change for the other cat I will just separate them. But they both need to be on high protein, grain free food. The other cat just requires unusual protein sources. Fun.

-Lola
 
Re: newly diagnosed cat not eating

The dose of 4u, for ANY insulin, is entirely too much insulin for a cat.
That number you got, the 30, is mighty close to your cat needing to be rushed to the vet.... 30 is a dangerously low number.

Fantastic that you are testing.... if you had not been testing, saw the 30 and given honey, well I don't even want to think about your kitty going even lower.

Wonderful that you are already feeding the perfect food for a diabetic. I just wanted to say that until they are regulated, the hunger will be large, so feed a bit more as the cat needs it.

It's good advice to test before every shot because one day, your cat could be at 30 at shot time, so you sure don't want to shoot insulin blind. Be sure to get a number before giving any shot, and skipping the shot if under 200 is a very good plan until you know how your cat reacts to insulin.

The dose of 4u is way too high, but you already know that by how low your cat dropped, so it would be a good idea to cut that back to 1u twice a day and test a few times to see how long the insulin lasts in your cat and when numbers start to rise.

You would be better to give your cat Lantus or Levemir, so if possible, see if you can print out some info from this site about Lantus and give it to your vet. For one thing, the insulin you are giving now does not last 12 hours so your cat's numbers will be up and down, up and down, up and down. Just imagine being hot then cold, hot then cold, hot then cold. Man, it's rough on the body so it's no wonder kitty does not feel like eating.
After you get off a roller coaster, and are a bit nauseous, you sure don't feel like eating, right?

The pepcid is good to settle the stomach ... one of my kitties is 'gassy', so I often give her pepcid am and pm.
The maximum pepcid you can give a cat in a day is 5mg, so that's why you were directed to get the plain simple regular 10mg strength ones with no asa or other kinds of stuff mixed into it as the rest is not good for the cat.
Those pills are small so just imagine trying to cut one into 8 pieces if you get the extra strength 20mg ones.... best to get the 10mg and cut into 4.

For the B12 pills that you can get at any pharmacy, Shoppers Drug Mart or someplace, look at the non medicinal ingredients and make sure there is no XYLITOL in the pills as that ingredient is a danger to cats. I have seen it in some B12 pills so be careful what you buy.
 
Re: newly diagnosed cat not eating

Lola said:
Thanks for the info! I will definitely bring it to the vet and switch to Lantus...

Yes I am feeding the venison and pea Natural Balance, my other cat has inflammatory bowel disease and that is the only food she can eat at the moment. Sometimes we have to change but for now this is our food of choice and I think it is working for both of them. And of course now that Boo has diabetes I will not change his food, if I have to change for the other cat I will just separate them. But they both need to be on high protein, grain free food. The other cat just requires unusual protein sources. Fun.

-Lola
Click to expand...

That's great! Ask for a prescription for the pens. You get 5 3ml pens for about $200 dollars if you use the coupon here: http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=36964. You'll also want to make sure you have U-100 insulin syringes with half unit markings. Do your current syringes have these? You will use syringes to draw insulin out of the pens just like vial. Do not get the needles that come with the pens--the dose adjustments with those are not small enough for a cat.

Even though that seems like a huge cost, it's really not. those 5 pens will last you at least a year (possibly longer) with the proper handling. So that actually works out to be only $16 a month. And you're home testing, so you'll save lots of money on vet testing. You do not need to pay for office curves or fructosamine tests if you are home testing.

The Venison & Pea formula is fine to feed. No need to change as long as that's the only Natural Balance flavor you're feeding. I had one kitty that needed a renal friendly diet and Bandit is diabetic, so I used to feed them their different foods at opposite ends of the kitchen. After a while they were trained to run to their spot. I would have to stand in between them until they finished eating to make sure they didn't try to trade foods, though. :smile:

If you want a little more variety, Nature's Variety Instinct makes some foods with novel protein: http://www.naturesvariety.com/Instinct/cat/can/all. The Lamb or the Rabbit formulas should both be ok to feed. Do NOT feed their Venison formula, though. The phosphorus levels are so high no cat should consume that food. Same with EVO's 95% venison. Here's a link to the store finder on their site: http://www.naturesvariety.com/locator
 
Re: newly diagnosed cat not eating

wow thanks so much. Why are the pens better than a vial? Does lantus not come in a regular vial?

And no my syringes just have 1 unit markings. So I will also have to get new syringes. Good to know. I hope I can donate the ones I have. Also the humulin, it seems like a waste since I only used it once so far. I wish I had done more research and asked for lantus in the first place.
 
Re: newly diagnosed cat not eating

The pens are better than the vial because they are smaller, so you'll be able to use most or all of the insulin before it goes bad. Once you start a vial, with proper handling you have about 2-6 months before it goes bad on you, and with 10ml that means most of the insulin goes to waste. With the 3ml pens, you'll use nearly every drop before the insulin stops working. So even though they're a little more expensive up front (because you're getting 15ml of insulin total instead of 10ml in the one vial), you'll save money because you'll have to ditch that 10ml vial after about 3ml is used anyway.

Ask for 31-33g, .3cc, 5/16 inch need insulin syringes with half unit markings at the pharmacy (I know you don't need a prescription in NY, but I'm not sure if there are different rules in the city. If so just ask your vet to write one for those exact syringes). If there's a Walmart near you, they have them there and they're only about $13 a box.

The reason why you need syringes with half unit markings is because dose changes are made in .25u increments with Lantus, and it's really hard to measure quarter units without them.

I know it hurts to toss the Humulin after you just bought it, but the sooner you do the better. It's all part of the learning process, and it's not your fault your vet prescribed the wrong insulin. Humulin N works very well with dogs, so a log of vets that have experience with diabetes in dogs don't realize that it does not work the same way in cats because cats have much faster metabolisms and need smaller doses. But try not to get angry at your vet--like I said it's hard to keep up with so many different diseases for each type of animal. Plus, you need him to write you that prescription for Lantus. :-D

Once you get that, you're all set. You can come here for dosing advice. There are a ton of incredibly knowledgeable and experienced people on the board that are very familiar with the dosing protocol for Lantus, plus, someone is here 24/7 to answer your questions. Many people here end up doing this if their vets are not giving them the appropriate treatment or dosing recommendations (and I have to say that I would not trust dosing advice from your vet at ALL. 4u is way too high a starting dose, especially with a harsh insulin like Humulin N, and that could kill or cause serious injury to your cat. Thank goodness you were home testing and caught that hypo incident!!!).

Lantus really dose work great. My own cat has been in diet controlled remission for over a year due to the excellent dosing advice I received in the Lantus forum. You'll even find after you learn a bit that you may be confident enough to make dosing decisions (following the protocol) on your own. I felt comfortable doing so after about 2 or 3 months of getting advice in the Lantus forum. Speaking of which, here's a link to Lantus Land: http://felinediabetes.com/FDMB/viewforum.php?f=9. When you get a chance, read through the stickies there. There's a lot of information, so work through it as you can. I would recommend reading New to the Group and Proper handling and storage first.

The recommended starting dose for Lantus for most cats is 1u twice a day--if your cat is very large or very small, that may need to be adjusted a little. The starting dose guidelines are in the AAHA document I provided for you, as well as the Lantus article.
 
Re: newly diagnosed cat not eating

Lola

Believe me you do not have the only diabetic cat who will not eat. I have to put food all over the house to get mine to eat and watch to make sure the other cats do not go and eat it.
I think there are a lot of good vets out there but I think when it comes to feline diabetes most of them don`t know. I have had the same vet for 10 years and thought she was great. She actually saved my cats life when she got pancreatitis. But when the same cat became diabetic she did not have a clue. Told me to give her what I thought was to much insulin and insisted that I do not hometest her. She told me they would test her in the office and I was just to go ahead and give her the shots don`t worry what her BG numbers are.
That did not sit right with me. So started testing her myself, not as nuch as I need to but I do test. There is much information here and I know its a lot to process. Good luck and welcome.

Terri
 
Re: newly diagnosed cat not eating

Lola,

Welcome to you and sweet Boo! You certainly have an excellent start for this trip through the land of feline diabetes. You are already feeding good food, testing (a biggie!), you are inclined to ask questions and you found the place where people are always ready to answer those questions. It's is terrifying to get this diagnosis, but it is treatable and many kitties go into remission on the longer lasting insulins.

You can keep the syringes you have for the times when the Boo's dose is a whole unit (or multiples). It's when the dose is at the .5 or .25 unit mark that the syringes with the 1/2 unit markings are important.

I joined this group this summer when my kitty was diagnosed, so I am relatively new to the dance too. This group is literally a life-saver. These folks are knowledgeable and extremely generous with their knowledge and time. There is always someone around to answer questions, give advice, hold your hand through a panic, or just cheer your progress.

I look forward to making this trip with you.
 
Re: newly diagnosed cat not eating

I completely forgot to give advice about the not eating--sometimes switching up foods will help increase appetence. I would try a few different things and see if there's anything he goes for. You can also add some tuna or chicken, and see if that gets him to eat. If he doesn't eat for more than 24 hours, he needs to go to the vet. Hopefully it's not that bad and a result of feeling crappy from the hypo and will improve soon. I agree with the others not to give more than 1u of Humulin N twice a day until you can get him switched over to Lantus.

One thing you also need to pick up is some ketone strips (ketostix). You can get these at any drug store. A very serious, expensive and potentially deadly condition called diabetic ketoacidosis can develop as a complication of high blood sugar. You do have to catch a urine sample, so if you need advice on how to do this there are many different methods people use.
 
Re: newly diagnosed cat not eating

Also, on the eating topic. Sometimes they will eat if the food is mixed with water, soupy. Sometimes sprinkling something on it to attact them, like FortiFlora, bonito flakes, parmesan cheese will work. You could try finger feeding. When they feel so bad with the high blood glucose, sometimes they just need a taste to spark their appetite. That's a lot of "sometimes", but that's how it is with kitties. If all the tempting fails you can assist feed. Here is a video. When my kitty was first diagnosed she wouldn't eat. We tried, and kept trying, all of these things and finally she just started in again. We kept her going for the first couple of days with assisted feeding, not exactly like in the video, but it gives you the basic idea. I was so overjoyed the first time Weezer ate on her own I recorded it on my phone to send to my husband. Good luck! Kitty must eat!!
 
Re: newly diagnosed cat not eating

Thanks so much to all of you. The encouragement is heartwarming ;-) (I also think I am emotional from being up most of the night!).

I will try those tricks to get him to eat. And I will by the ketone strips. But all day (I tested him at 7:30am and at 1:30 pm) so far his BG is 100, so he is not hyperglycemic now. I will check again in the evening and get him to eat more. Perhaps he is just rebounding from the BG levels going so low last night. I never thought I would have a problem getting this cat to eat! he has been obsessed with food his whole life ;-). He is eating about a Tbsp = 1/8 6 oz can every few hours though. So I am not super worried. I just need to watch him and figure out if/when to give him more insulin.
 
Re: newly diagnosed cat not eating

I've been following along since first giving you some info and know you are now in great hands. Will be eagerly awaiting you updates on your boy!!!
xxx
patti
 
Re: newly diagnosed cat not eating

OK I already have a follow-up question: Boo just ate a bit, a lot more than he has all day, he is way more alert :-), and I just checked his BG and it is 195. Should I give him 1U of humulin? I am not sure I can handle another night of checking his BG levels every hour, but if I give him 1U I wanna do it soon since he just ate, and I would check it 3 or 4 hours post injection.

Any thoughts? I am thinking to not give him anything, honestly.

thanks!
Lola and Boo Kat
 
Re: newly diagnosed cat not eating

How about a scant 1u. Maybe .75 if you can squint that well.

Normally, we say don't shoot if under 200. But this is awfully close.

If you can get a +3 or +4, I think you can give a token dose.
 
Re: newly diagnosed cat not eating

Good luck with your little black Boo, I hope he's on the mend and will get back to a regular eating schedule. My little guy only ate a few Tbsps per day for the first two days of getting insulin, and then for some reason during the third day he was back to a normal amount of food. I hope it's that easy for y'all too. I can't add anything at all to the recommendations the other posters have given about dosing and testing, so I'll just throw in another, "It does get easier!"
 
10/25 need advice - newly diagnosed cat not eating much

update: I didn't end up giving him insulin last night, and this morning he was still at 200. It is confusing because he is eating so little so his numbers are down, so then I don't know if he needs the insulin but I think he does. And since this has happened to others I decided to give him 1U this morning after he ate a bit (he is eating a bit more but not as much as he should be). I checked his BG 4+ post injection and it was 66. I watched him for an hour and he seemed ok. I will check his levels again this evening. This is so confusing.
 
Re: newly diagnosed cat not eating

I think you may need advice I can't give. If you change your subject heading it may draw attention of those qualified to help you. Maybe something like "10/25- newbie needs advice".
 
I don't have much experience with N (Bandit was on Lantus), but if he's above 200 at his dinner preshot, I would give 1u , and make sure I'm testing at +4 (and probably +2 as well). If he's below 200, I would not give insulin. I hope someone who knows N better can chime in.

Is his appetite still getting better?
 
I would reduce your dose - maybe down to .5 - if you get an evening number above 200. If not, retest in 20 minutes without feeding to see if it goes up to 200. If he was 66 at +4, he could have gone lower or he may still be in the low 100s.

I'm sorry that we can't give great advice = no one here that I know of is using your insulin. What are the chances of your getting another type? There are Lantus vials at an excellent price in the supply closet: viewtopic.php?f=15&t=54334
 
First, how was he diagnosed? Was a fructosamine done? What were his symptoms? Does he have any infection anywhere?
I ask because he seems super sensitive to the N and I'm wondering how diabetic he is.

Second, I would give no more than 0.5 if he's at 200 or higher. Just a tad to keep him from going too high. And only if he's got some food in his system.

Third, I'd be syringe feeding if he's not getting at least 3.5 oz a day (and that is very rough, more likely 5oz) to get his calories up.

Diabetic cats feel like crap when first diagnosed and often stop eating. So syringe feeding, insulin, possibly fluids, appetitie stimulants and Pepcid AC and even a B12 shot can help them perk up. Its a delicate balance when they aren't eating...

Fourth, please make sure you test for ketones asap

Good luck and keep posting updates!!!
 
Thanks. He was diagnosed based on 430 BG at the vet, also weight loss and neuropathy (hind legs). two days later I took him back to the vet for urinalysis (his bladder was empty on the first visit) and his glucose was high in his urine. He is gradually eating more, several small meals probably totaling 3 oz today. I got some urine from him today (he peed outside the box I think because of his legs and I was actually happy so I could collect some urine!

I will test for ketones. I assume that he does not have ketones if his BG is low, correct? I might not be understanding that correctly. I am going to check his BG in two hours and I will syringe feed if he doesn't eat before I give him a small shot.
 
Oh I just realized I didn't answer a couple of questions. When he was diagnosed I had full blood work + x-rays done (to see if we could detect anything wrong with his back- he growled during the exam when the vet touched his lower back and as I said he is loosing function in his hind legs). I do not know if the vet checked for fructosamine- is that standard it he full blood work? I still need to go get the results from the vet, I forgot to ask for them and all I know is the BG reading. Something in the liver was high but not very high, I am not sure what that was. The vet didn't mention any sign of infection. Again I know I need to go back to the vet and get the results and get a script for lantus and better syringes.
 
fructosamines should be done as they are more 'like' an average blood glucose level so rule out vet stress (stress can temporarily elevate bgs)
infection can raise bgs
ketones can come from insufficient food/insufficient insulin/infection so he is still at risk

he may be diabetic, but it sounds like he is a candidate for a low dose and possible food control once things are under control

oh, and slightly elevated liver values are normal and should be rectified once his diabetes is under control.
 
Just checking back in on you Lola. Nothing new to add but wanted to see how you were doing. I keep meaning to ask how old your precious Boo is. And were you able to get any of the methylcobalamine - that will eventually help with the neuropathy too. Also in time - once you get this diabetes abit more under control - and things settle down more for you and Boo - you mentioned that Boo was growling when the vet examined his hind end. If Boo is an older guy - it may be he is having pain there and could use some pain medicine for the area. Many of our older kitties use a supplement called cosequin or dasequin - which sometimes help - and if not - a medicine called gabapentin. Just a little more to throw into the basket here for you.

Sending many warm thoughts your way.
xx

edited to add - hope the hometesting is going a little easier for both of you too!
 
Patti and Jen: Thanks for checking in. I just went to the pharmacy and got the ketostix, there are no ketones but the glucose came up really high, I think it is wrong b/c it doesn't jive with the glucometer readings. Odd. I also bought B12 but not methlyB12. Shoot! Does it have to be methylcobalamine? I will have to exchange it in that case.

As far as the growling at the vet, it was more when the vet was examining his spine near his hips. The x-ray looks normal so we assumed it is discomfort due to the neruopathy- though I am not sure if that is painful. But thank you for the suggestions. I just got him to eat some more so I will do a glucose test now and decide whether to give him insulin. Meanwhile my other cat is also unhealthy (IBD) and not eating and having diarrhea. I also think she is jealous of all the attention I am giving Boo. Taking care of these two is becoming a full time job!

Oh BTW about the testing, I am managing although I am a bit traumatized by having to poke him. I couldn't manage to get the lancet device to work, so I am just using the lancet myself but I feel like in order to get enough blood I may be poking to harshly or doing too much damage. I feel so badly. I will watch the videos again to make sure I am doing it right. The video with Buddy makes it hard to tell, it seems so easy like he poke it gently straight on from the top/edge of the ear but that doesn't work for me. I almost have to poke through the ear (at the edge) but I do it at an angel. I just feel so badly even though I know it is best for him overall. I will try to improve the technique but I am kind of a wimp/sensitive person so it is hard for me. Thanks again for everyone's support!
 
there are no nerve endings in the edges of the ears, so it is not hurting him. i felt the same way about poking when i first started, then realized that she doesnt even react when she gets poked. i think shes actually just more annoyed at me for touching her ear lol

i find the lancet to be way easier to use. when i tried free handing the poke, i would always hesitate and she could sense that and would shake her head. no hesitation with the lancet

it took me a while to get it right and sometimes i still have problems. the key is finding that 'sweet spot' once you find that and know where it is, you're set!
 
Thanks. I just did a test- I've been using a warming device- an eye pillow thing full of beans or something - and it worked great! His BG is 148 so I am not going to give him insulin. I am going to call my vet in the am. I think he is eating enough, or at least he seems to progressively eating more and more. So as long as I am tracking his BG 2x a day, after meals perhaps? I think he will be fine until something changes. It is just confusing. Maybe he is not diabetic and the hind leg thing is something else, and the 430 BG and high glucose in urinalysis were something else. I don't know. But I will stay on top of this. And he seems to be feeling fine, except for the trouble walking around! Poor guy...
 
Lola said:
Patti and Jen: Thanks for checking in. I just went to the pharmacy and got the ketostix, there are no ketones but the glucose came up really high, I think it is wrong b/c it doesn't jive with the glucometer readings.
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A blood glucose reading tell you what the level is right at that moment.

Glucose builds up in the urine over time until the bladder is emptied. A urine glucose test is not an accurate way to closely monitor blood glucose levels.

I also bought B12 but not methlyB12. Shoot! Does it have to be methylcobalamine? I will have to exchange it in that case.
Click to expand...

Yes, it has to be methyl B12. http://laurieulrich.com/jasper/
 
Yes I have been closely monitoring his BGs with blood tests so that I why I disregarded the glucose reading on the Diastix, it says the glucose is at the highest level (2000) but his BG has not been over 200 in the past 3 days so I don't trust the stick at all. I was just using the stick to check ketones and mentioned the high glucose reading. But my initial problem is that his BG levels (blood test) have been low since his first dose of insulin so I am not really needing to give him more, but I think it is due to his eating so little, so I am just monitoring him twice a day right now. thanks.
 
Lola said:
Yes I have been closely monitoring his BGs with blood tests so that I why I disregarded the glucose reading on the Diastix, it says the glucose is at the highest level (2000) but his BG has not been over 200 in the past 3 days so I don't trust the stick at all. I was just using the stick to check ketones and mentioned the high glucose reading. But my initial problem is that his BG levels (blood test) have been low since his first dose of insulin so I am not really needing to give him more, but I think it is due to his eating so little, so I am just monitoring him twice a day right now. thanks.
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There is no correlation between the glucose reading on the urine stix and the glucose reading
from blood testing...so don't expect them to be the same.

You are doing the right thing by using the BG meter to test BG with.

KetoStix or KetoDiastix are very useful for testing urine for Keytones.
Diastix do not test for keytones.
 
It's great that the ketones are negative!

A couple things about urine testing vs. blood testing. First, it's very easy to get a false high glucose reading if you don't time the reading correctly because the stick will continue to darken. You have to read the colors at exactly 30 seconds afterwards. Did you time the reading?

Second, the urine glucose reading is an average of what the level of glucose has been over a period of about 5-8 hours, where a blood test tells you what the glucose is at that moment. So if Boo has had both high and low numbers, the urine test is going to show only an average of how high he's been. The strips only detect glucose after a cat has passed the renal threshhold (the point where kidneys spill glucose in the urine), which can be anywhere between 180-270.

My point is, don't worry about the urine glucose test. The ketones are the important thing in the mix, not the glucose. Blood testing is the only accurate way to measure blood glucose, and you're doing a great job at that! A little neosporin + pain relief helps after each test. What gauge lancets are you using? A common difficulty with home testing in the beginning is too small lancets. You should be using 26-28g. It's way harder to try and get blood with the 30-33g lancets.


Sue posted a link earlier to an amazing deal on Lantus for you, so I would snatch that up asap! Switching to Lantus would be so much better for Boo.
 
Just a slight correction

when blood glucose levels reach a certain level (it isn't clear what it is but could be mid 200s), the kidneys filter glucose out of the blood and into the urine. It accumulates in the bladder until the next time the bladder is emptied. So it is not an average at all.
 
Mystery said:
Lola, Is Boo eating more this morning?
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Hi, thanks for checking in! Yes he is eating a bit but still not a lot. I checked his BG and it was 260 so I gave him .5U. He is definitely perkier in the past day.
 
Julia & Bandit said:
It's great that the ketones are negative!

A couple things about urine testing vs. blood testing. First, it's very easy to get a false high glucose reading if you don't time the reading correctly because the stick will continue to darken. You have to read the colors at exactly 30 seconds afterwards. Did you time the reading?

Second, the urine glucose reading is an average of what the level of glucose has been over a period of about 5-8 hours, where a blood test tells you what the glucose is at that moment. So if Boo has had both high and low numbers, the urine test is going to show only an average of how high he's been. The strips only detect glucose after a cat has passed the renal threshhold (the point where kidneys spill glucose in the urine), which can be anywhere between 180-270.

My point is, don't worry about the urine glucose test. The ketones are the important thing in the mix, not the glucose. Blood testing is the only accurate way to measure blood glucose, and you're doing a great job at that! A little neosporin + pain relief helps after each test. What gauge lancets are you using? A common difficulty with home testing in the beginning is too small lancets. You should be using 26-28g. It's way harder to try and get blood with the 30-33g lancets.


Sue posted a link earlier to an amazing deal on Lantus for you, so I would snatch that up asap! Switching to Lantus would be so much better for Boo.
Click to expand...


Thanks for the details. I am not considering the urine glucose results at all, I was really just concerned about ketones and then thought it was odd that the glucose read so high since his BG never went very high in the past few days.

I am using 28 gauge lancets. It is definitely going more smoothly as I get the hang of it. I also got some of the neosporin last night and am using it, but he doesn't really seem to feel it. The funny thing my other cat is getting jealous so when I am done with Boo I have to put her on the table and pretend to do stuff to her afterwards. So cute!

And I am thinking about getting the Lantus (I called my vet to discuss with him but he is not in today!) however since his initial diagnosis and dosing with insulin his BG levels haven't been that high so I was wondering if I will still need to give him insulin? I mean I am afraid to invest in the Lantus until I really know what is going on with him. Maybe I should go ahead and get the lantus anyways, without talking to my vet? And even though his highest pre-shot BG level was today at 260?
 
Jen & Squeak said:
Just a slight correction

when blood glucose levels reach a certain level (it isn't clear what it is but could be mid 200s), the kidneys filter glucose out of the blood and into the urine. It accumulates in the bladder until the next time the bladder is emptied. So it is not an average at all.
Click to expand...

It is an average, because like you said, it's measuring the glucose that has accumulated over a short period of time, from one urination to the next (roughly 5-8 hrs). From the Pet Diabetes Wiki:
Some reasons for preferring testing glucose levels by using blood over urine testing is that the urine used in testing may have been in the bladder for hours. Because of this, it may not be a reliable indicator of what systemic glucose levels are at the time of testing[5]. What's seen when testing urine for glucose is an average of what the level of glucose has been over a period of about 5-8 hours (the time period from last urination)[6].
Click to expand...

http://petdiabetes.wikia.com/wiki/Urine_testing_stix
 
Lola said:
And I am thinking about getting the Lantus (I called my vet to discuss with him but he is not in today!) however since his initial diagnosis and dosing with insulin his BG levels haven't been that high so I was wondering if I will still need to give him insulin? I mean I am afraid to invest in the Lantus until I really know what is going on with him. Maybe I should go ahead and get the lantus anyways, without talking to my vet? And even though his highest pre-shot BG level was today at 260?
Click to expand...


This is really your call on what to do here. If Boo is showing any spillage into his urine, I would definitely continue insulin therapy, even if it's at a lower dose. It's up to you if you want to wait and see if the Humulin N can actually bring him into remission with the diet change (It's rare, but it has happened). I am just worried that if you wait to get the Lantus, the starting cost for your is going to be $200 (for 5 pens) vs $24 dollars for the one cartridge if you take the offer to get the Lantus now. If it were me, I'd get the Lantus now just in case. If Boo goes into remission on the N that's fantastic and you're only out $24. If he doesn't (and I can't even remember a time I've ever seen a cat on N here go into remission), then you are prepared with the Lantus.

If you do decide to go with the Lantus, I would definitely consult with your vet and give him the articles I attached for you, and let him know that you want to switch. However, if he is against it after you've provided him with the information, I would switch vets and find one that does support the treatment. You really want to have an informed vet on board with you in case of emergencies. If you choose, however, you do not need to consult your vet for dosing advice once you start if you are not confident in their experience with cats on Lantus. There are very experienced people here who can guide you through the process.
 
Lola, I saw that you did decide to get a Lantus cartridge. That's great! When you get it, make sure you put it in the fridge (in a stable place, where it won't get knocked around, frozen, e.g. not in the door or anyplace that gets too cold). When you get time, read up on the handling and storage guidelines I posted for you. Lantus needs to be handled a bit differently than N.
 
Hi, Lola! Some more info on NPH for you:

NPH (Neutral Protamine Hagedorn) is human recombinant insulin, which comes in U100 strength and must be used with U100 syringes. It is very similar to natural canine insulin and is commonly used for dogs and is not the best choice for cats. It is a rather harsh and unpredictable insulin to deal with. It drops the BG fast, has a very short nadir, and leaves the system very quickly. It is not abnormal to see drops from a BG in the 400's (20's) to the 40's (2.0's) and back up to the 400's again within a six hour period. NPH is usually dosed every 6hrs if the bg is greater than 150 and rising. It is highly recommended to do 1-hour curves when using it, starting at +1 after shot through +6 to see how it is working. Onset for NPH occurs between +1 and +2 hours after shot, nadir (when the insulin peaks) is approximately +2 to +4 hours after shot, and it leaves the system usually by +6 hours after the shot. I would test at +2 and +4 and always before dosing (no sooner than +6). If at any point he tests "lo" or below 50, you would give just a little food (1 tsp) and retest until bg is rising and in more normal range (50-80) giving additional tsp food as needed. I would not give a full feeding if he tests low before +6, just a tsp so he will want to eat in case his bg keeps dropping. I would ask vet if he couldn't prescribe another insulin that would stay in his system longer, especially if you are unable to be at home to monitor frequently during those 6hrs that NPH is in his system. Hopefully your vet will prescribe a longer acting, more predictable insulin that will be easier for you to work with. Fingers crossed!

Because of its harsh properties and it being quick and short acting, as a nurse, I would use a conservative scale to dose it. It would be a good insulin to use if a cat had a very high bg and was at risk of DKA to get the bg down quickly. Know you are considering lantus and it is a much better insulin for a cat. Meanwhile, I would use the following conservative scale to dose NPH if it were me:

BG

US(mg/dl)--- Metric(mmol/L)--- Dose

151-170 8.3- 9.4 0.25u

171-185 9.5-10.2 0.50u

186-200 10.3-11.1 0.75u

201-250 11.2-13.8 1.0u

251-350 13.9-19.4 1.25u

351-410 19.5-22.0 1.5U

Also, I would be very cautious about dosing NPH if he wasn't eating. You would need to be prepared to syringe feed. The 1/4 tablet of pepcid AC twice a day made a tremendous difference in my cat's appetite.
 
Thank you for the info. That sounds pretty much like what I have been doing. His pre-shot BGs have ranged from 150-260 so I have been giving him 0.5U twice a day. I always test his BG pre-shot. I got him to eat more by switching foods. I had both cats on Natural Balance Venison and green pea canned food (my other cat has IBD and needs limited ingredient/hypoallergenic food) but with the last case of food I bought they both stopped eating that food. So I am feeding Boo (the diabetic cat) the Wellness food he used to eat (I have to lock him in the bathroom because my IBD cat will get sick if she eats that and she really wants to!). So he is eating about 5-6oz of food a day. I also spoke to my vet about Lantus and he said I can stop by and get a prescription from him. So I will switch Boo to Lantus next week. For now he seems to be doing well.

Now I need to figure out why they both stopped eating the Natural Balance food (Boo has never turned food away in the past) and get a new hypoallergenic food for my other cat. I am afraid something is wrong with the Natural Balance. I contacted the company and I am waiting to hear back.
 
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