A helpless Newbie has a few questions

[cleothecat]

I am a helpless Newbie and have a few questions. My kitty, Cleo (12y, female) has been through a lot just last 4-5 weeks. After so many tests, shots and not so helpful trips to a vet, who wouldn't really treat her diabetes, for about 3 weeks and we had to changed a vet, and she finally has been on Lantus last 12 days. (1unit every 12 hours) I also bought a glucometer about a week ago. Since my kitty does it so horribly at vet’s office, I thought I would check her blood at home but it hasn’t been as smooth as I hoped. I watched many video links, but unlike the cats I see on the video, my cat doesn't stay calm. She struggles, moves, meows, and it makes me feel anxious. I already failed multiple times because either there was not enough blood, or more often because she shook it off. Also her vein runs so closely to the edge of her ear and there’s not enough room to poke, and especially when she moves it gets very difficult. Because of it, I got her vein this morning, and it bled a lot! I felt so bad and cried. Does this ever get better? Did anybody have to deal with a cat who doesn’t sit tight? Where exactly is the sweet spot? I understood it as in between the vein and the rim of the ear. Please correct me if I am wrong. Is it okay to poke on the rim (ear cartilage)?

Also my vet asked for “fasting glucose” on day 7 and day 14. I am confused a bit here though. Fasting glucose is before food and insulin, correct? Cleo eats at about 5:45-6:00 am and her shot is at 7am. Do I need to check her blood at 5:45? Or don’t feed her until 7am and check her blood then? If so, this is going to be very difficult because she will get more agitated and impatient. Also, is "fasting glucose" different from what I read from FDMB, +0 preshot for curve? Thank you for clarification.

Here I have some numbers before breakfast around an hour before insulin shot (5:45-6:00 am). 7/17: 101, 7/18: failed. (Instead, 8:10 am( an hour after food and insulin):73, 6:20 pm (before 2nd dose): 188), 7/19: 223, 7/20: 437 (previous evening shot leaked) 7/21: 89, 7/22: 88. It seems low lately, but I am not quite sure if it tells anything yet without a curve. I am concerned that there's no constant number so far. The vet said, keep giving insulin for two weeks before making any changes. My understanding is that the vet wants to do a curve after two weeks. Does this look okay? I don’t think I noticed signs of hypoglycemia yet. (She eats Purina DM wet food mainly in the morning and the evening but in smaller amount (either 1/8 or 1/4 of can) 2-3 times within 2-3 hours. This way she wouldn’t eat too fast and throw up.)

Thank you so much for your help! My emotions are raw since it took so long to get Cleo to be this “stable” where now she eats, pees, and poops. I know I still need to learn so much more about her disease and find it overwhelming at times. Nonetheless, I am so grateful for FDMB message board. It is so informative and helpful, and I would like to thank you everyone who try to help others with your expertise and/or experience. Thank you for reading such a long post.

Blessings to you all,
Clara

 

[Wendy&Tiggy(GA)]

Hello and welcome to the board!

You are doing some great things so far and hopefully that will help get Cleo into remission. Good news is that 84% of cats can go into remission in the first six months with a good insulin ( lantus!), home testing ( which u are) and a low carb canned wet food (Purina DM wet is ok but cats get sick of it and its expensive - so many of us feed the fancy feast classic pates, friskies pates or wellness grain free)


Testing - here are some testing tips that might help including a photo of the sweet spot https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

But lets see if we can refine the technique to make it easier

1. are you giving a treat every time?
2. are you holding the ear firmly after you poke so she doesnt shake it off? Otherwise you can collect the blood on your fingernail and test from there. Dont worry about the bleeding, just apply a dab of neosporin on it and she will be fine. They dont have a lot of nerve endings in their ears so it doesnt hurt - its less painful than poking your finger for example
3. You could try putting her in a burrito or between your legs when you test.

Wedy

 

[Wendy&Tiggy(GA)]

Second, can you get another test in ASAP? We dont normally advise newbies shoot under 200 and you just shot at 88. She may drop quite low. If she goes under 50 you will need to reduce the dose 1/4 unit.

Was she eating dry food before this? Often a food change can cause quite a drop in numbers - even into remision

let m eknow on the numbers
Wendy

 

[BJM]

You are giving insulin at pretty low pre-shot numbers, without having much data to show it is safe.

To be prepared, in case the insulin dose is too high, please read this and get yourself some supplies as follow:

Extra supply of testing strips - you don't want to run out if you are monitoring a hypoglycemic incident.
High carb foods, particularly those with gravy. Store them where you won't feed them accidentally and mark them High Carb on the lid.
Karo syrup/honey/maple syrup/glucose syrup - this is to be applied to the gums if the glucose level is below 40-50 mg/dL
Oral syringe - useful in case you need to syringe feed some higher carb foods; also helpful at other times if the cat stops eating and needs to eat.
Address to nearest veterinary emergency center; transportation contacts if you can't drive.

 

[Carl & Polly & Bob (GA)]

Hi Clara,

Where exactly is the sweet spot? I understood it as in between the vein and the rim of the ear. Please correct me if I am wrong. Is it okay to poke on the rim (ear cartilage)?

This pic might help -


You can aim for anyplace in between the vein and the edge of the ear. If you hit the vein directly, it'll bleed a lot more, but it's still okay. And the more often you test, the easier it will be to hit the perfect place, and it does seem that the ears "learn to bleed" as time goes by.

Also my vet asked for “fasting glucose” on day 7 and day 14. I am confused a bit here though. Fasting glucose is before food and insulin, correct? Cleo eats at about 5:45-6:00 am and her shot is at 7am. Do I need to check her blood at 5:45? Or don’t feed her until 7am and check her blood then? If so, this is going to be very difficult because she will get more agitated and impatient. Also, is "fasting glucose" different from what I read from FDMB, +0 preshot for curve? Thank you for clarification.

Yes, fasting glucose would be before food and insulin, so your 5:45-6:00 test would be a fasting number. If possible, you could test then, let her eat, and give the shot right then, rather than wait until 7 for the shot. Would you be able to do the same routine for the PM shot? Or does your schedule make a shot earlier than 7PM impossible? Fasting glucose and AMPS or PMPS would be the same thing, assuming Cleo hasn't eaten in the 2-3 hours prior to the AMPS and PMPS tests.

 

[Amy & Papaya (GA)]

I thought I would check her blood at home but it hasn’t been as smooth as I hoped. I watched many video links, but unlike the cats I see on the video, my cat doesn't stay calm. She struggles, moves, meows, and it makes me feel anxious. . .Does this ever get better? Did anybody have to deal with a cat who doesn’t sit tight?

Hi Clara! Welcome! I think a lot of cats are very squirmy at first. Mine just as a general rule pretty much freaks out if you pick her up for any reason, and tends to be a biter - although she'll be perfectly cuddly sitting next to me on the couch or bed. The first few times I tried to restrain her for a blood test weren't pretty - I remember near the beginning getting up early for her shot, having such a battle with her because I was so stressed, and actually having to shut her in the bathroom for a few minutes while I laid down on the floor since I felt like I was going to pass out! Biggest problem - MY attitude and stress, which she picked up on and reacted accordingly.

I think the biggest turning point was just thinking that I needed to be very matter-of-a-fact about it, not nervous with anticipation, and act like it's no big deal just a little thing that's going to inconvenience the cat just for a second but not really hurt her. Now I don't restrain her, I just pet and cuddle her a bit first then lie down beside her with my arm along her belly and a palm on her forehead so my fingers on that hand can hold the ear against a wad of tissue behind the ear, and my free hand can do the pricking and glucometer stuff. I calmly talk to her either about what I'm doing or just some random how-was-your-day stuff so that we're both calm - and now she lies there and PURRS while I do the testing. As far as she's concerned now, it's just more attention and all attention is good attention.

Easier said than done, I know, but it did work for us and I know you'll get the hang of it soon. Don't give up! Pretty soon you'll be giving pointers to new ones on the board!

PS Probably you know this already from the videos, but are you warming the ear with something like a pill bottle filled with very warm water, or a rice sock? When I started doing that it made it a lot easier to get a blood drop even from a tiny poke with the finest lancet.

 

[MelissaEbby]

Hi Clara, Welcome to the board!

I too had a lot of problems testing my cat in the beginning. People here on the board told me it would get easier, and soon Ebby would cooperate, and honestly I had trouble believing them. I can tell you now, that they were right. Ebby now sits patiently through the test, and even starts purring. I now never have to use any restraint, and she just sits there until she knows we're done.

One thing that helped me, was instead of just one day trying to get a test done right away, I started doing short training sessions with Ebby. I picked a dresser to use as the testing spot, and put a blanket on top. In the beginning I simply picked her up and put her on the dresser, then gave her a treat. I tried to do this 3-4 times a day. After a couple days, I would add to this training. So for example the next time I would pick her up, put her on dresser, and restrain her lightly for a short period of time, then reward the behavior. Again, I stay on this step for a couple days, 3-4 times a day, each time increasing slightly the amount of time she was restrained. Always reward with treat after the training session.

After she was ok with the restraint, and didn't try to get away as much, I started training her to let me mess with her ears by just rubbing them, and applying the warm rice sock. Again, rewarding every time the training session was done. All in all, this training probably took me about a week, and then I was able to get my first test done successfully. During this time I had a thought that helped change my perspective: If a Circus Lion can be trained, surely I can train this 8 pound cat!

So, yes, the testing does get better, and much, much easier, and being overwhelmed is perfectly normal. :smile:

 

[cleothecat]

Thank you everyone for your support and suggestions! Thank you for the pics, and link for testing. Also Amy and Melissa, your stories are so encouraging. I will try to be more calm and confident. I need to learn to hold her ear tighter though. I offer my kitty a treat (Purebites chicken or turkey) after each testing. I find it very funny when she refuses her treat because I took it too long, which means she had to struggle too long! She will come back for her treat a few minutes later though.

Since her morning fasting glucose was low for two days, I called the vet. He suggested that I give her 1/2 unit (x2) for one week while checking her fasting glucose every morning. He didn’t think I should do a curve yet. Would you agree?

Cleo is still losing weight. Should I feed her more? She gets 1 can of Purina DM a day. She is now 9.3 lb. She used to weight 10.8 to 11 lb and was 9.12 when she was first diagnosed about 4 weeks ago.

She still urinates a lot but less frequently, only once or twice a day. Is this good or bad? I don’t see her drinking at all, she might drink when I don’t see though, but she is getting wet food, and I also add water to her dish each time I feed her.

Cleo always had dry food until she was diagnosed, but ever since then, she is completely on wet food. She is eating well, so I am happy since we went through “not eating or drinking phase” for about 10 days. But I have to admit that Purina DM is very expensive, and a lot of liver also concerns me. I see that fancy feast and wellness grain free are recommended. Anybody has any preference? Also, does anybody prefer homemade meals? I still have sometime to research and make a choice, but will this change her glucose level/insulin dose again? (It might not be related at all, but her complete check up seven month ago came out perfect, but my old recommend that I switch her food to Hills W/D dry because he thought Cleo might have developed allergy on her old food. So I did, and seven month later, I got a very sick kitty and couldn't stop thinking about what happened. I recently learned that it has 37% carb! When I mentioned this to one of the technicians in the clinic, she said it is recommended for diabetic cats too, and it shouldn’t be a problem. This might not be the only reason why my kitty became diabetic, but I am sure it really didn’t help at all. Why would vets recommend dry food at all? ) Sorry for venting.

Thank you again everyone! I now feel like I can handle this. Thank you!!

Clara

 

[Wendy&Tiggy(GA)]

I agree it was a good idea to reduce her dose but I would strongly advise to get some more tests in.. !!

As well as the preshot test (mandatory!!) you want to get one 5-7hours after the shot to see how low she is going if you can..

If she drops under 50 you will need to reduce the dose by another 1/4 unit. You don't want her dropping too low and having a hypo..

Until you get more data I also wouldn't shoot her if she is under 150, again because you don't want her going too low.

Wendy

 

[Wendy&Tiggy(GA)]

The purina dm food is expensive and cats get sick of it, so many of us feed fancy feast classic pâtés, friskies pâtés or wellness grain free. the ff and friskies are cheaper but wellness is better quality. some people also make their own see..http://www.catinfo.org. The ff and homemade food may bring her blood glucose down even further since they are lower carb and help her towards remission..

While she is not regulated she will be starving so if she is losing weight you can increase her food amount. Weigh her every week or so and increase the food accordingly

Wendy

 

[Carl & Polly & Bob (GA)]

I agree it was a good idea to reduce her dose but I would strongly advise to get some more tests in.. !!

I agree with Wendy regarding the additional test. The reason for that is the key to successful dosing with Lantus is the "nadir" number (the lowest point in a 12 hour cycle, which typically happens about halfway through the cycle). That's the number that tells you if the dose is too high, too low, or just right. The preshot tests are always a good idea. For safety and so that you have an idea of where the cycles start and end, numbers-wise.

You don't have to test every day at the same time in the middle of the cycles. It can be +5 one cycle, and +7 the next day. Or +6, just "someplace near the middle".