8/21 Introduction, Grace & Jacques

[grace//jacques]

Hi, my name is grace and my sweet 9 year old boy Jacques was diagnosed yesterday morning. Brought him in because of weight loss & increased urination thinking it was hyperthyroidism & i was totally not expecting diabetes. I’m struggling really hard with the diagnosis but i want to everything i can to help him. I’ve been scouring the internet doing research because we had never seen the vet who diagnosed him before and there are so many red flags with this guy already as far as seeming generally disinterested and not explaining anything to me after we waited over an hour past our appointment time to see him. Right now im supposed to check his BG 3 times a day, call the vet to report the result and then administer insulin based on what the doctor says after the morning and night checks

I checked his BG last night and this morning, last night it was at 450 and this morning it was at 417. I administered 1 unit of insulin each time. The vet is having me do mid day checks between 12-2 pm. We tested just after 12 and it came up 89. I called the vet and he said to test again. I used the calibration solution on my ipet glucometer and made sure it was on the right code. I tested again and it came up at 50. Doctor had me give honey and food and is making me wait/observe for now.

I’m making sure to prick a hairless part of the ear and making sure to get enough blood to where it travels up the stick. You can see blood on the stick and i tested an even smaller amount of control solution and got an accurate result. I’m absolutely positive he received no more than 1 unit of insulin this morning per the vet.

Right now he’s acting normal and I made sure to give the honey and food as instructed, he gobbled up the food no problem.

What is going on? I’m so lost and scared and my vet is being majorly unhelpful.

 

[Red & Rover (GA)]

Welcome, Grace. A whole slew of questions so that we can help you better.

Anything below 68 on a pet meter means taken action.

What insulin are you using? And what syringes?

Have you tested since you got the 50? And if so, what was the reading?

If you have not tested, can you test now?

 

[grace//jacques]

Welcome, Grace. A whole slew of questions so that we can help you better.

Anything below 68 on a pet meter means taken action.

What insulin are you using? And what syringes?

Have you tested since you got the 50? And if so, what was the reading?

If you have not tested, can you test now?

The insulin is NPH Novolin which I now know is not the best option but it is the only one the vet recommended. I’m using u-100 and I’m using a supply of u-100 syringes from the vets office.

i haven’t tested again per the vet telling me to just give food/honey and monitor. I feel so bad because I’m still learning and each time I’ve had to get a sample has taken at least 2-3 attempts before I poke deep enough to draw blood. I’m freehanding the lancet for more control. Giving him the shots is a breeze but I’m really struggling with the glucose tests. He ate a small meal about an hour ago, should I try again now?

 

[Red & Rover (GA)]

Yes, take another test. The 50 is in hypo territory and a hypo can go bad very quickly.

 

[Red & Rover (GA)]

How long after the injection was the 89 and the 50? And how long has it been now since the injection?

 

[grace//jacques]

How long after the injection was the 89 and the 50? And how long has it been now since the injection?

I just tested again. 307.

The 89 and the 50 were one after another at 5 hours post injection

 

[Noah & me (GA)]

generally disinterested and not explaining anything to me

You should start looking for a new vet.

and then administer 1 unit insulin after the morning and night checks

The amount of insulin you give is not set in stone like an antibiotic, it's always based on the cat's last reading.

I made sure to give the honey

Honey is only given when the readings are so low your cat is approaching hypoglycemia. It's definitely NOT part of a diabetic cat's daily diet and if not needed makes everything worse.

The vet is having me do mid day checks between 12-2 pm

At this point you should be doing curves to see how effective the insulin is. One midday test is not enough.
It's obvious you care and have educated yourself and you've come to the right place. We might not be vets but thousands of diabetic cats and the practical experience we've gained from that lets us undo the damage uninformed vets have done.

 

[Red & Rover (GA)]

And just to double check, here is a diagram showing 1 unit:

 

[grace//jacques]

I’m going to start looking for a new vet immediately. He is having me call after glucose tests and before giving insulin to make sure the dose is ok though. I will try to test as frequently as I can during the day. And I am absolutely positive he got only one unit.

He straight up told me he had no idea why I got those low numbers.

I’m also going to ask about a prescription for Lantus. It shocks me that they didn’t even bring up other types of insulin at the appointment. Told me to just get the cheap stuff from Walmart. ‍I guess it’s better than nothing for now.

 

[Red & Rover (GA)]

I just tested again. 307.

The 89 and the 50 were one after another at 5 hours post injection

Phew! Glad you caught those numbers. And welcome to the best place you never, ever thought you would be. There are years and years of knowledge and experience here. We've all been there and we have done the research.

As you know, NPH is not the best insulin for cats. The better insulins are Lantus and Prozinc. Lantus generics are smeglee and basilgar, available at any pharmacy. Or you can order Lantus (with a vet's prescription from Canada – a lot of people here do.

It is very important to test throughout the first half of the cycle. The nadir (the lowest point) is usually before mid-cycle because NPH hits hard and fast (like a roller coaster) and rarely lasts the entire 12 hours.

It is very important not to give 1 unit of NPH tonight. It is obviously too high a dose. I'm tagging @FrostD who knows more about NPH than I do. Let's see what she has to say.

 

[Red & Rover (GA)]

Some reading for you and for you vet:

• (2018) Managing Feline Diabetes: Current Perspectives
• (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

And what to do during a low numbers event.

(The blood glucose numbers are those from a human meter. For a pet number, the take action number is 68).

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

 

[grace//jacques]

Phew! Glad you caught those numbers. And welcome to the best place you never, ever thought you would be. There are years and years of knowledge and experience here. We've all been there and we have done the research.

As you know, NPH is not the best insulin for cats. The better insulins are Lantus and Prozinc. Lantus generics are smeglee and basilgar, available at any pharmacy. Or you can order Lantus (with a vet's prescription from Canada – a lot of people here do.

It is very important to test throughout the first half of the cycle. The nadir (the lowest point) is usually before mid-cycle because NPH hits hard and fast (like a roller coaster) and rarely lasts the entire 12 hours.

It is very important not to give 1 unit of NPH tonight. It is obviously too high a dose. I'm tagging @FrostD who knows more about NPH than I do. Let's see what she has to say.

I was already so overwhelmed with the amount of support in this forum before I even posted. I’m very grateful this exists. I already have extreme health anxiety due to a history of serious diseases in my family. Being able to reach out and get credible, up to date information specific to my situation in seconds is invaluable. <3

 

[grace//jacques]

How would I go about switching from the NPH to Lantus?

 

[Red & Rover (GA)]

My apologies for the delays. I'm working online at the moment. Waving to you from Canada.

How would I go about switching from the NPH to Lantus?

You need a prescription from a vet.

Feline diabetes is manageable and the people on this forum can help you every step of the way. We've all been where you are now.

The procedure for shooting NPH is as follows:

(1) test, (2) feed, (3) wait 60 min, (4) shoot. It is important that the cat eats before giving NPH. A snack at +2 (2 hours after shot) helps smooth out the big drop.

See Sticky BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH

It will help us tremendously if you could set up a spreadsheet and signature. These are the first things anyone helping you will look at.

The instructions are here. If you have any problems, just holler. There are people here who can set up a spreadsheet for you in minutes.

• Editing your Signature, Profile, and Preferences

• How to Create a Spreadsheet
• How to Use the Spreadsheet

 

[Red & Rover (GA)]

And to inundate you even more, can you tell us what you are feeding Jacques?

 

[grace//jacques]

And to inundate you even more, can you tell us what you are feeding Jacques?

He used to eat friskies wet food but I put him back on kibble because he was having some gum issues. I was using iams proactive health indoor (cringe) because it actually did help him lose some weight (normal amounts of weight loss well before other beetus symptoms started.) Since yesterday morning I’ve been transitioning back over to wet food. Using tiki cat because it seems like a good high protein/low carb option & he loves it.

 

[Ale & Bobo & Minnie (GA)]

The change from dry to wet could explain the drop.

I’m confused by your vet because he seems to be doing more than most by telling you to home test, but some of his other advice doesn’t track. How was the diabetes diagnosed? Did he do a fructosamine test?

as far as tips to help you get enough blood when you test, it really helps to warm up the ear so enough blood comes out. Most of us use an old sock we fill with some rice, orzo works too, then nuke for 20-30 seconds and hold it against the ear to get it warm. What gauge lancets are you using? In the beginning, it helps to use a larger gauge lancet like 28 and 26. Here’s where you should be aiming:

 

[Red & Rover (GA)]

I was using iams proactive health indoor (cringe)

This dry food comes in at roughly 35% carbs (that's high).

Here is the low carb wet food list. Look for carbs under 10%. It is also wise to have a few cans of food over 15% to use for hypo events. (Some of the Friskies are not low carb.)

• Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)
• List of Low Carb healthy treats

There are very few dry foods that are low carb. If transitioning does not work, (see Transitioning your cat from dry to wet food ), there are a few options.

I'm off for now. Others will come along. I have to finish work and finalize my curbside grocery order.

 

[grace//jacques]

The change from dry to wet could explain the drop.

I’m confused by your vet because he seems to be doing more than most by telling you to home test, but some of his other advice doesn’t track. How was the diabetes diagnosed? Did he do a fructosamine test?

as far as tips to help you get enough blood when you test, it really helps to warm up the ear so enough blood comes out. Most of us use an old sock we fill with some rice, orzo works too, then nuke for 20-30 seconds and hold it against the ear to get it warm. What gauge lancets are you using? In the beginning, it helps to use a larger gauge lancet like 28 and 26. Here’s where you should be aiming:
View attachment 65262

The vet didn’t even go over the diagnostic process he just said they would take blood and urine and came back and said he’s diabetic.
He’s also told me to give the NPH insulin before or with food, not wait til after, which I will never do again especially after the drop this afternoon. I definitely do struggle with getting the blood and I have tried the rice sock and it helps but i think the issue is my confidence. I would like to try to get it from the back of his ear because it looks much easier in videos but he’s all black and I have a poorly lit apartment which makes it even harder for me to catch the blood drip. It’s getting easier each time so far, so I think we just need practice. Any tips for taking BG readings are appreciated though because that’s what is giving us both the most stress right now D: we have 28g lancets, are 26s smaller?

 

[grace//jacques]

This dry food comes in at roughly 35% carbs (that's high).

Here is the low carb wet food list. Look for carbs under 10%. It is also wise to have a few cans of food over 15% to use for hypo events. (Some of the Friskies are not low carb.)

• Cat Food - Nutritional Composition, data compiled by Dr. Lisa Pierson, DVM (2017)
• List of Low Carb healthy treats

There are very few dry foods that are low carb. If transitioning does not work, (see Transitioning your cat from dry to wet food ), there are a few options.

I'm off for now. Others will come along. I have to finish work and finalize my curbside grocery order.

Thanks for all your help!

 

[Sienne and Gabby (GA)]

The width (called "gauge") of lancet and needles is counterintuitive. The lower the number, the wider the lancet. A 28 gauge lancet is thinner than a 26 gauge. The downside of using thicker lancets is that your cat will notice the poke more. However, once you've been testing regularly for a couple of weeks, the capillary bed in your cat's ear will begin to build up and it will be much easier to get blood. I used a 30 gauge lance once my cat was used to getting his ear poked.

By any chance, do you have decent under cabinet lights in your kitchen? I used to get Gabby on the kitchen counter because that's where the lighting was the best. Some members here have gotten a headlamp at a hobby store so they had a good light source for testing.

With NPH, you need to wait after you feed your cat before you give insulin. NPH is a faster acting insulin and it's important to have food on board before giving a shot. Also, remember to roll the insulin vial between your hands to mix it.

Tiki Cat is a great food! You were wise to test since it's much lower in carb than what you were feeding Jacques. A change in diet can have a dramatic effect on blood glucose (BG) numbers.

I'm including a link on helping us to help you. It contains the information that Kel (Red & Rover) provided on how to set up a spreadsheet and your signature and also has several other links you may find useful. We're very numbers driven so being able to track Jacques progress along with you will allow us to give you better information.

 

[Virginie & Chewie (GA)]

I definitely do struggle with getting the blood and I have tried the rice sock and it helps but i think the issue is my confidence. I would like to try to get it from the back of his ear because it looks much easier in videos but he’s all black and I have a poorly lit apartment which makes it even harder for me to catch the blood drip. It’s getting easier each time so far, so I think we just need practice. Any tips for taking BG readings are appreciated though because that’s what is giving us both the most stress right now D: we have 28g lancets, are 26s smaller?

I also have a black (and long haired) kitty and I have been taking the blood drops from the back of the ear since we started about ten days ago. My eyesight isn’t great even with my glasses on and my place is also not very well lit, so I resorted to using my reading light and it’s helped so much! The sides are flexible so you can point it wherever you need and frees up both your hand. I bet a camping headlamp would be even better.

Here’s what my light looks like:

I was also really nervous at first because it felt so cruel to poke Chewie so many times (I couldn’t really get the force needed right at first), but it gets better the more you do it. What really helped me too was to start giving her a super special treat every time right after I give her a shot or test her BG. She is so happy knowing the treat is coming that now she sits in my lap and purrs while I warm up her ear and poke it.

Hope this helps!

 

[Ale & Bobo & Minnie (GA)]

Any type of additional lighting you can get will help tremendously. I used a small flashlight I held in my mouth and aimed at the spot. Another tip is I would always whenever I could, scoop up the blood droplet onto a clean nail and test from there so I didn’t have to worry about Minnie moving her head or flicking her ear.

 

[Virginie & Chewie (GA)]

Oh yes how could I forget that detail! Ever since I saw @Ale & Minnie (GA) give this advice, I have been proceeding that way, and it’s sooooo much easier. And after a few days you can totally estimate how big the drop needs to be before you scoop it with your nail to avoid getting an error message from the reader (that’s always the worst when you have to poke AGAIN). “Milking” the ear gently to push more blood towards the little drop is helpful too.

 

[grace//jacques]

I also have a black (and long haired) kitty and I have been taking the blood drops from the back of the ear since we started about ten days ago. My eyesight isn’t great even with my glasses on and my place is also not very well lit, so I resorted to using my reading light and it’s helped so much! The sides are flexible so you can point it wherever you need and frees up both your hand. I bet a camping headlamp would be even better.

Here’s what my light looks like:
View attachment 65264

I was also really nervous at first because it felt so cruel to poke Chewie so many times (I couldn’t really get the force needed right at first), but it gets better the more you do it. What really helped me too was to start giving her a super special treat every time right after I give her a shot or test her BG. She is so happy knowing the treat is coming that now she sits in my lap and purrs while I warm up her ear and poke it.

Hope this helps!

This is very helpful <3 i think I’ll definitely try a headlamp or light of some kind. And I have been giving him the tiki cat wet treats after any pokes and he goes crazy for em. I feel like he’s already starting to make the association, hopefully soon he takes it as well as Chewie

 

[Ale & Bobo & Minnie (GA)]

Oh yes how could I forget that detail! Ever since I saw @Ale & Minnie (GA) give this advice, I have been proceeding that way, and it’s sooooo much easier. And after a few days you can totally estimate how big the drop needs to be before you scoop it with your nail to avoid getting an error message from the reader (that’s always the worst when you have to poke AGAIN). “Milking” the ear gently to push more blood towards the little drop is helpful too.

Here’s another tip I discovered totally by accident. If I got an error message and needed more blood, before poking again I would hold the still warm sock to the back of her ear right behind where I had just poked and I would literally see more blood starting to form and I would hold the sock there until there was a big enough droplet again. Most of the time, I could get more blood out by doing a combo of that and milking the ear instead of having to poke a second time! I hated having to second poke too

 

[Diane Tyler's Mom GA]

I agree with Red and Rover not to give 1 unit of NPH tonight
Generic lantus don't know where you live but Lantus is expensive in the US , generic Lantus is fine, many members use the generic
Check this out also
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1
The 5 pens will last about a year
Its generic lantus

Or this one
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1

Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens

You will need U-100 syringes with half unit markings for lantus , just insert the syringe into the pen and draw out the insulin.
13.47 for a box of 100 Here is the link to buy them from
If they say you need a script from you vet they will call the vet to fax it over 'ask for refills and give your vets office a heads up . I know that some member didn't need a script at all ,I did I live in N.J. So I guess it depends on where you live

https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct



We use the pens just like a vial , just stick the syringe in the gray rubber stopper and draw out your insulin
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen!

Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

The reason we don't use the needles that would go in the pens is because you can only dial the pens by whole units
With the U-100 syringes with half unit markings we can adjust by 0.25 units at a time

You can even order Basaglar genetic Lantus from Marks Marine in Canada call them and ask the price for 5 pens, they are very nice to deal with.
https://canshipmeds.com/search-3/?drugName=basaglar

 

[Diane Tyler's Mom GA]

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugarsugar
Try the 26 gauge lancets

 

[Diane Tyler's Mom GA]

To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine
The spreadsheet is easier than it looks
Just some info about it look at mine at the end of my signature it says Tyler's spreadsheet to get a look at it, you can look at anyone's spreadsheet

About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

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

+1 same as you do for AM cycle

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


If you want someone to set up your spreadsheet just ask

 

[FrostD]

Welcome!

Firstly, pause the food transition exactly where you're at. Do not continue to transition food while giving NPH. Recipe for hypo, that dry food probably is keeping him alive at the moment.

Secondly, 5 hours post shot is a little unusual for an NPH nadir, usually it's a little earlier. So, if you're able, I would try to test even before the 12-2 window. Realistically what is happening is with those 400s he's bouncing, and then when they come down off the bounce they can nadir a little later. But always best to be sure.

Secondly, as others have mentioned, get a new insulin ASAP. Ideally Lantus or it's generics.

Thirdly, I'm not sure what dose to recommend at the moment since we only have a few tests worth of data. I would try 0.25U *if* you can monitor and intervene if there's a hypo. I am hesitant to say skip due to risk of ketones, but hypo is the more immediately-life-threatening of the two.

Was he checked for UTI?

 

[Hendrick Cuddleclaw]

hi and Welcome to the group! I found a headlamp/lens combo worked great. It is sold as a jewler's headlamp with different magnification lenses which you can swap in and out. In the beginning I just wore a pair of 2X readers and a hiking/backpacking headlamp (as seen in the video in my signature) but then we moved on to the combo unit as it was more convenient.

I think these were the ones we got, or something very close to it

Amazon Link

 

[Ale & Bobo & Minnie (GA)]

@grace//jacques just making sure you saw all the latest replies here