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Jennifer and Logan

Jennifer and Logan

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Hi my cat Logan (pronouns she, her ) is 17 years old and has just been diagnosed with diabetes in addition to her pancreatitis, CKD and IBD. She has no weight loss and her only symptoms are excess drinking and peeing (which I assumed was from the CKD) and her back legs have been a bit wobbly the last few weeks. 3 months ago at her last blood test she was not diabetic and I assume this is from the prednisolone she takes every day to control her vomiting from the IBD.

I have the insulin and syringes and a blood glucose meter but have not started giving her the insulin because I’m nervous about having to do all the blood glucose monitoring. Do I need to do it every day before i give the insulin? She’s starting on 1 unit 2x a day.
 
Hi Jennifer!
Welcome here, I’m sorry that your Logan is going through all of these illnesses, kudos for your care!
I’m quite new here myself, so I won’t be telling you the basic things, some more knowledgeable will soon chime in. I just want to tell you that yes, it is scary at the beginning, but it’s actually not that bad. You just have to give it time and you and your cat will eventually fall into a routine.
I think you did the good thing not to start her yet on the insulin, it’s very important to check her blood glucose (BG) before giving it. It’s the only way to avoid a hypoglycaemia, which can be truly dangerous.
Maybe you can start by testing yourself and the people around you, just to see how painful it is (it isn’t that painful!) and to get to know your device.
 
Another thing, I was rereading your post, her back legs are wobbly, could it be low potassium from the CKD? How are her potassium levels? (Lower than 4 on IDEXX is too low already for CKD cats).
My understanding is that, if it is from diabetes, it is secondary to glucose toxicity, where too high levels of glucose have this effect on the nerves. I really don’t know if 3 months is enough time for this condition to develop, this is why I was thinking that it could be potassium. I could be wrong of course!
 
Daphne and Aida said:
Another thing, I was rereading your post, her back legs are wobbly, could it be low potassium from the CKD? How are her potassium levels? (Lower than 4 on IDEXX is too low already for CKD cats).
My understanding is that, if it is from diabetes, it is secondary to glucose toxicity, where too high levels of glucose have this effect on the nerves. I really don’t know if 3 months is enough time for this condition to develop, this is why I was thinking that it could be potassium. I could be wrong of course!
Click to expand...

Welcome Jennifer and Logan, you are in the right place we need a bit more information about Logan so we can help you in this journey a bit easier, the link below will help you and us to get to know Logan. It is important that you learn how to home test, especially before each insulin shot, so, you test, feed, shoot in that order, you do not want to give insulin without knowing his number, also if you make a spreadsheet for Logan, we can see how he develops throughout each dose, link below, not to worry we are always here to help you, try reading the sticky notes in the Main Forum as well, before you know it you will be a pro!:bighug::cat::cat:

https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-
you.216696/
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/


Daphne and Aida said:
Another thing, I was rereading your post, her back legs are wobbly, could it be low potassium from the CKD? How are her potassium levels? (Lower than 4 on IDEXX is too low already for CKD cats).
My understanding is that, if it is from diabetes, it is secondary to glucose toxicity, where too high levels of glucose have this effect on the nerves. I really don’t know if 3 months is enough time for this condition to develop, this is why I was thinking that it could be potassium. I could be wrong of course!
Click to expand...
 
CORKY said:
Welcome Jennifer and Logan, you are in the right place we need a bit more information about Logan so we can help you in this journey a bit easier, the link below will help you and us to get to know Logan. It is important that you learn how to home test, especially before each insulin shot, so, you test, feed, shoot in that order, you do not want to give insulin without knowing his number, also if you make a spreadsheet for Logan, we can see how he develops throughout each dose, link below, not to worry we are always here to help you, try reading the sticky notes in the Main Forum as well, before you know it you will be a pro!:bighug::cat::cat:

https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-
you.216696/
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Click to expand...
Daphne and Aida said:
Another thing, I was rereading your post, her back legs are wobbly, could it be low potassium from the CKD? How are her potassium levels? (Lower than 4 on IDEXX is too low already for CKD cats).
My understanding is that, if it is from diabetes, it is secondary to glucose toxicity, where too high levels of glucose have this effect on the nerves. I really don’t know if 3 months is enough time for this condition to develop, this is why I was thinking that it could be potassium. I could be wrong of course!
Click to expand...

Thank you for the reply Corky. Her potassium level was 4.8 so she’s good there. She is also anemic (HCT is 25 which dropped from 34 in May however we did start giving her LRS fluids for the CKD in this timeframe and my understanding is the extra fluids bring the anemia more into focus). So that worries me as I’ve had 2 cats pass away from anemia.
 
Jennifer Karpyshyn said:
Thank you for the reply Corky. Her potassium level was 4.8 so she’s good there. She is also anemic (HCT is 25 which dropped from 34 in May however we did start giving her LRS fluids for the CKD in this timeframe and my understanding is the extra fluids bring the anemia more into focus). So that worries me as I’ve had 2 cats pass away from anemia.
Click to expand...
@Bron and Sheba (GA)
 
I’m also confused about the feeding schedule. Logan is fed 8 small meals over a 24 hour period because she throws up if she eats too much at once or goes too long without eating. She is fed around 8am, noon, 3pm, 6:30pm, 9pm, 11pm, 1am and 5am. Do I need to change this schedule? I’m thinking about giving the insulin injections around 8:30 am and pm? She gets probiotics mixed in some baby food about 20 minutes before the 8am and 630pm meals.
 
Hi and welcome to the forum.
Please do start giving Logan the insulin. And I also recommend you hometest the blood glucose (BG). It is the only way you will know if you are giving the best dose and it will keep her safe. Can be a bit scary in the beginning but very soon it will become routine. We can help you.
The routine is test the BG, feed, and give the dose of insulin.
I don’t know a lot about anaemia in cats so I will tag @Suzanne & Darcy

What is the dry food you are feeding Logan?
Do you have any lab results you can post here for us to see. To do that you need to copy and paste the results into this page.
 
Jennifer Karpyshyn said:
I’m also confused about the feeding schedule. Logan is fed 8 small meals over a 24 hour period because she throws up if she eats too much at once or goes too long without eating. She is fed around 8am, noon, 3pm, 6:30pm, 9pm, 11pm, 1am and 5am. Do I need to change this schedule? I’m thinking about giving the insulin injections around 8:30 am and pm? She gets probiotics mixed in some baby food about 20 minutes before the 8am and 630pm meals.
Click to expand...
You don’t need to change that schedule. Just don’t feed for the 2 hours preshots as we don’t want the preshots to be food influenced. You can feed and give the shots straight after the food so you might just have to tweak the times around the shot time. Does that make sense?
 
Jennifer Karpyshyn said:
Hi my cat Logan (pronouns she, her ) is 17 years old and has just been diagnosed with diabetes in addition to her pancreatitis, CKD and IBD. She has no weight loss and her only symptoms are excess drinking and peeing (which I assumed was from the CKD) and her back legs have been a bit wobbly the last few weeks. 3 months ago at her last blood test she was not diabetic and I assume this is from the prednisolone she takes every day to control her vomiting from the IBD.

I have the insulin and syringes and a blood glucose meter but have not started giving her the insulin because I’m nervous about having to do all the blood glucose monitoring. Do I need to do it every day before i give the insulin? She’s starting on 1 unit 2x a day.
Click to expand...
2 units a day is a very high starting dose. What was the result of the Fructosamine test that was hopefully used to diagnose her diabetes. Do you have copies of bloodwork? Fructosamine gives an average of blood glucose over approximately the previous two weeks from when the blood was drawn. I would not start at 2 units. Please try not to stress out too much about the testing. I understand because I cried a lot in the beginning. I told myself that I was never going to be able to do it and my poor baby would probably just hypo. But I loved him so much that I would not give up. It took a little while to get good at it, but not as long as I thought. Within two weeks I was consistently getting blood to test.
 
Now, about the anemia… are you giving B-complex vitamins daily. The body needs these vitamins to produce red blood cells. If the HCT drops to below 20 then you can use erythropoietin stimulating agents (ESAs). Are you familiar with them? Epogen? Darbepoietin? These stimulate the bone marrow to produce more red blood cells. Anemia is common in chronic kidney disease, but until the HCT drops below 20, most vets will not give ESA injections. There is another oral medication called Varenzin which is used to increase red blood cell production in CLD cats, but some cats do not respond well to it. Are you familiar with the felinecrf.org site? I highly recommend that you read as much as you can. It’s full of very well-documented information on kidney disease and other health conditions.
 
High blood phosphorus levels are a possible cause of limb weakness and instability in cats. It’s not uncommon in CKD cats. The high phosphorus levels are damaging to the kidneys and need to be maintained at about 4.5. It is important to feed low phosphorus food and to use phosphorus binders if the food doesn’t lower the phosphorus enough. Here is a list of low carb (for the diabetes) and low phosphorus (for the kidneys) foods.
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf
 
Bron and Sheba (GA) said:
Hi and welcome to the forum.
Please do start giving Logan the insulin. And I also recommend you hometest the blood glucose (BG). It is the only way you will know if you are giving the best dose and it will keep her safe. Can be a bit scary in the beginning but very soon it will become routine. We can help you.
The routine is test the BG, feed, and give the dose of insulin.
I don’t know a lot about anaemia in cats so I will tag @Suzanne & Darcy

What is the dry food you are feeding Logan?
Do you have any lab results you can post here for us to see. To do that you need to copy and paste the results into this page.
Click to expand...

She is eating Purina indoor cat chow. She throws up if I try to switch her food due to the IBD.

Trying to figure out how to copy and paste her bloodwork results. It's a pdf file.
 
Suzanne & Darcy said:
2 units a day is a very high starting dose. What was the result of the Fructosamine test that was hopefully used to diagnose her diabetes. Do you have copies of bloodwork? Fructosamine gives an average of blood glucose over approximately the previous two weeks from when the blood was drawn. I would not start at 2 units. Please try not to stress out too much about the testing. I understand because I cried a lot in the beginning. I told myself that I was never going to be able to do it and my poor baby would probably just hypo. But I loved him so much that I would not give up. It took a little while to get good at it, but not as long as I thought. Within two weeks I was consistently getting blood to test.
Click to expand...

I tried 3 times this morning to test her and couldn't get enough blood out. I think I'll try and get a bigger lancer.

I don't see a fructosamine test result. We did repeat the urinalysis to see if there was blood in the urine a second time after sampling at home and there was.
 
Suzanne & Darcy said:
Now, about the anemia… are you giving B-complex vitamins daily. The body needs these vitamins to produce red blood cells. If the HCT drops to below 20 then you can use erythropoietin stimulating agents (ESAs). Are you familiar with them? Epogen? Darbepoietin? These stimulate the bone marrow to produce more red blood cells. Anemia is common in chronic kidney disease, but until the HCT drops below 20, most vets will not give ESA injections. There is another oral medication called Varenzin which is used to increase red blood cell production in CLD cats, but some cats do not respond well to it. Are you familiar with the felinecrf.org site? I highly recommend that you read as much as you can. It’s full of very well-documented information on kidney disease and other health conditions.
Click to expand...

She gets a B-12 shot once a month. Yes I have been to Tanya's website for my previous cats who had kidney disease but it's been a while because Logan was doing ok up until this month. I will look into the B-vitamins again. I think I used to give them to my other cat.

I've heard about the ESA's but never given them to any of my cats. My vet did mention the newer drug but said there was a lot of blood testing involved. She hasn't used it on any of her patients yet.
 
Jennifer Karpyshyn said:
I tried 3 times this morning to test her and couldn't get enough blood out. I think I'll try and get a bigger lancer.

I don't see a fructosamine test result. We did repeat the urinalysis to see if there was blood in the urine a second time after sampling at home and there was.
Click to expand...
Blood in the urine could be an infection or could be irritation. If they dod a urinalysis then they would have been able to see if there were any bacteria in the urine and if so what general type (shape of the cells.)
 
Jennifer and Logan said:
She gets a B-12 shot once a month. Yes I have been to Tanya's website for my previous cats who had kidney disease but it's been a while because Logan was doing ok up until this month. I will look into the B-vitamins again. I think I used to give them to my other cat.

I've heard about the ESA's but never given them to any of my cats. My vet did mention the newer drug but said there was a lot of blood testing involved. She hasn't used it on any of her patients yet.
Click to expand...
The newer drug - is it Varenzin? I keep seeing posts on Tanya’s CKD group about people trying it on their cats and having not so great side effects. Here is the info on it from Tanya’s website: https://felinecrf.org/anaemia.htm#molidustat
Here about the different types of ESAs: https://felinecrf.org/esas.htm#using_esas
Many people from the group give their cats chicken hearts, 2 to 3 per day. Don’t know personally how effective it is, they swear by it and I would trust them.
It’s good that she gets B12 shots, you could also add some to her food, B12 has no taste (contrary to B-complex that tastes nasty and should never be given with food!) B12 orally as methylcobalamin, not cyanocobalamin.
 
Most recent test results.

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Daphne and Aida said:
The newer drug - is it Varenzin? I keep seeing posts on Tanya’s CKD group about people trying it on their cats and having not so great side effects. Here is the info on it from Tanya’s website: https://felinecrf.org/anaemia.htm#molidustat
Here about the different types of ESAs: https://felinecrf.org/esas.htm#using_esas
Many people from the group give their cats chicken hearts, 2 to 3 per day. Don’t know personally how effective it is, they swear by it and I would trust them.
It’s good that she gets B12 shots, you could also add some to her food, B12 has no taste (contrary to B-complex that tastes nasty and should never be given with food!) B12 orally as methylcobalamin, not cyanocobalamin.
Click to expand...

Thsnk you for this reminder about B vitamins! I checked my stash of meds and my Jarrows B Right has expired but I ordered a new bottle and will start giving it to her next week.
 
Jennifer and Logan said:
I tried 3 times this morning to test her and couldn't get enough blood out. I think I'll try and get a bigger lancer.

I don't see a fructosamine test result. We did repeat the urinalysis to see if there was blood in the urine a second time after sampling at home and there was.
Click to expand...
I have a couple of things that may help with the AT3:
1. It may not be a blood shortage but a timing error. The AT takes a bit longer to be ready to test (which imo is better because I had to race to get blood on a human meter before it times out). If you insert a strip to watch it get ready (you don’t have test, just afterwards remove and immediately return to vial)—if you watch it it displays the taking strip from vial icon and the code and cat icon, and then when it shows a strip icon moving toward a blood drop icon is it ready to test. I got error messages in the beginning because I put the drop too soon. The beep means it’s starting the process, not necessarily that it’s ready for blood. After a while I think you will have a good feel for the right timing

2. the AT actually needs hardly a pin head of blood. I don’t say this to make you feel you’re messing up but rather I think the error message is related to timing not your blood letting skill. That said, I’ve found when the ear won’t cooperate that pressing on either side (or both) of the puncture lets more blood come up (like you’d get if you squeezed a finger tip after lancing it)—it doesn’t need to be a hard squeeze, just gentle pressure. Warming the ear ahead of time may help—my cat hates a warm rice pack so I heat up the house ahead of test time. Another tip I read is lance twice next to each other and there is an increased chance one will bleed enough. And don’t forget to check under (inside) the ear—I’ve pierced his ear more than a few times and sometimes there’s no blood where I’m looking on top and a big drop on the other side

good luck
 
Suzanne & Darcy said:
Hi Jennifer, how are things going with Logan? Are you doing all right?
Click to expand...

BG testing is hit or miss. I started the insulin on Sunday. It seems like it’s already making a difference. Before the insulin started her AMPS # was in the 400s and now it’s down to the 200s.

I’ve been reading about low BG numbers and when to stall. What is too low? I use the Alpha Trak 3.
 
With the Alpha Trak as with any pet monitor, 68 is the number where you start to worry about hypoglycemia. If she hits this number, give her high carbs food and retest 20 min later. No point in testing earlier, as it takes time for the carbs to enter the system.If she’s still low, give her food again.
That is if she doesn’t show any critical signs. Aida has reached the scary number of 38 on human meter and shown no other sign than ravenous hunger. Maybe it depends on the individual cat’s threshold?

Here is the link of the sticky note of the group: https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
It’s best to read it yourself to know how to react.
 
We need to get a test before every shot and a minimum of one test mid-cycle. We need nadir data before knowing what is a safe preshot to shoot. For now — until we get nadir numbers — don’t shoot if the preshot is below 200. But we can do a lot better than this for Logan once we have more spreadsheet data. I understand you are still getting up to speed on testing.
 
SmallestSparrow said:
I have a couple of things that may help with the AT3:
1. It may not be a blood shortage but a timing error. The AT takes a bit longer to be ready to test (which imo is better because I had to race to get blood on a human meter before it times out). If you insert a strip to watch it get ready (you don’t have test, just afterwards remove and immediately return to vial)—if you watch it it displays the taking strip from vial icon and the code and cat icon, and then when it shows a strip icon moving toward a blood drop icon is it ready to test. I got error messages in the beginning because I put the drop too soon. The beep means it’s starting the process, not necessarily that it’s ready for blood. After a while I think you will have a good feel for the right timing

2. the AT actually needs hardly a pin head of blood. I don’t say this to make you feel you’re messing up but rather I think the error message is related to timing not your blood letting skill. That said, I’ve found when the ear won’t cooperate that pressing on either side (or both) of the puncture lets more blood come up (like you’d get if you squeezed a finger tip after lancing it)—it doesn’t need to be a hard squeeze, just gentle pressure. Warming the ear ahead of time may help—my cat hates a warm rice pack so I heat up the house ahead of test time. Another tip I read is lance twice next to each other and there is an increased chance one will bleed enough. And don’t forget to check under (inside) the ear—I’ve pierced his ear more than a few times and sometimes there’s no blood where I’m looking on top and a big drop on the other side

good luck
Click to expand...

Thank you for this. I tried to slow down on putting the monitor up to her ear today and I was successful both times.
 
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