A Newbie's Story and Question on Glucose Meters

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Hannah Belle's Mom

Hannah Belle's Mom

Member Since 2013
Hi Everyone.

I'm new to this forum and my Hannah Belle was diagnosed with diabetes about 8 months ago with diabetes.

Here is my story or should I call it drama. I noticed an increase in water consumption and urine in the litterbox. I had 3 cats, two with existing health issues, so I had no clue who had what going on. Hannah Belle's brother, Elvis, had the most severe health issues, so he was the first suspect. His bloodwork was normal, except for some "old kidneys." Shortly after the vet visit, his cardiomyopathy got the best of him and my little buddy passed away. The water and litter issues continued, so I moved to suspect #2, Raya. She had been going through a health scare that was diagnosed as an inner ear infection and possible chronic condition; she had been on steroids for several months. Her blood sugar was a bit high, but the vet suspected the medication and not full blown diabetes. We thought maybe the increased blood glucose was causing her to drink and urinate more. After trying to get her off the steroids with no success, further tests were conduced and it turns out she had a couple meningioma (tumors on the lining of the brain); two days later she had surgery to remove them. At the same time Raya was in surgery, Hannah Belle got sick and had to go to the vet. That's when we got the diagnosis.

Since then, she has been on Lantus (eventually regulated at 2 units per day), but the vet never had me home test. He's been conducting glucose curves and fructosamine tests. Not sure why he didn't want home testing and I've been worried ever since the diagnosis. Now, he is seeing enough of a change (for the positive) that he wants to start home testing and titrating the insulin dose.

These past 8 months have been challenging in the area of food. I was able to transition Hannah Belle to an all canned food diet, but dry food is not out of the house. Raya experienced a couple of neurological changes from the tumors. She used to love canned food, but now her taste and eating habit have changed. She won't eat most flavors of canned food and doesn't eat as much at a time. I feed them 3 times a day with extra treats for Raya. I had to add dry food back into Raya's diet to get her to eat - Instinct Grain-free Chicken (by the way, Raya's blood glucose level returned to normal after the surgery and subsequent elimination of steroids). Hannah Belle like to sneak Raya's dry food when I'm not watching. Keeping them in separate rooms during feedings is not an option (at least not yet). It's an ongiong learning curve in the house, but we manage the best we can.

Of course, any tips to keep Hannah Belle from sneaking the forbidden food is always appreciated.

Now for my one question. I've been doing research on Glucose meters and test strips. Many people here like Relion and I may get one. I also like the price of test strips for Kroger and Up and Up brands. Any opinions on either one of those?

Thanks for letting me tell a long complicated story. I look forward to chatting with everyone.
 
Welcome to FDMB.

Some low carb dry options:
Evo Cat & Kittne dry is about 8% calories from carbohydrates
Youg Again 0 Carb is 5% calories from carbohydrate (different method of calculation; internet sales only. Can call for a sample to test palatability)
Stella and Chewy's freeze dried

If the Up and Up is made by Arkray, USA, it should be fine.
If you object to WalMart, go to our shopping partner ADW (link at top of page) and pick up the Arkray Glucocard 01, or 01 mini. Its inexpensive and the strips are quite reasonable ... WalMart brands it for resale at their stores.
 
I heard nature variety instinct raw (dry) is also good if you want to try that.

I am glad you are going to home test - heres a shopping list

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

Let us know when you get the meter and we can give you testing tups!

Wendy
 
Thanks for the tips! They're great! My one advantage to this situation is that I previously lived with a diabetic for years. I'm actually well trained in diabetic care for a human. However, sticking a cat's ear to get blood, that's all new territory.

Another glucose monitor question.

Based on all the recommendations on this site, including those in this post, and extensive research on price, I've decided to go with Relion. Why do you recommend Micro or Confirm over Prime? The major difference seemed to be amount of blood and price. Blood was pretty small: .3 microliters for micro/confirm and .5 for prime. Price was more considerable: 50 test strips were $19.95 for micro/confirm and $9 for Prime.
 
Because the Micro requires less blood, it is better when first starting out even though the test strips are more expensive. The Prime is great once the ears learn to bleed better and you no longer have to worry about getting as much blood or poking more than once.

Here are some ear testing tips to help you get started.
 
just an FYI - I mentioned the 2 least expensive meter and strips. There are some pet-specific meters that are $1 or more a strip!
 
I got the meter. Relion Micro. Thanks for the tips Wendy. We started testing Saturday morning. This morning was the first time she yelled out from the pinch of the needle. The vet says she'll adjust over time and so will I; hopefully sooner than later!

Also have the spreadsheet created and linked in the signature. Now I need to figure out how to get a photo of my girls uploaded; all of the pictures are too large.
 
She shouldnt feel the needle - can you explain your technique to me?

By the way I usually recommend 3-4 blood tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low she is going. The low point "nadir" is what you base dose changes on since you don't want her dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what her overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy

PS

Here are some more instructions on how to add a picture

First, photo size is limited to: 600x400 pixels max size (width x height) you can upload.
You can use this site to resize the photos:
http://www.shrinkpictures.comDepending upon the aspect ration of the original photo, you have to to select either 600 or 350 as the max image dimension.
After you shrink the photo, either start of new topic or reply to an existing discussion.
Below the preview and submit button click on the tab that says upload attachment. Click on Choose file and navigate to where the shunk photos is. Then upload.
Then click on Add the file. If the file is too big you will get an error message that says it is too big.
 
Right now, my technique is getting used to sticking a needle in my cat. I'm using a lancet (currently the 30G ones that came with the meter) without the lancing device. Massage the ear to warm it up (she likes that part). Pull the ear taut with a cotton ball or pad behind it and then poke a spot between the vein and the edge. I try to go in at an angle to avoid piercing the ear, but I'm not always consistent yet; I did pierce it once. I'm a bit nervous, so it has taken a couple of attempts and I'm probably not quick enough with the lancet. I don't know what happened this morning, maybe I hit the vein; she bled pretty well.

The vet did say 2 times per day is OK; 3 is great.

She gets fed 3 times per day:

7:45 AM
After work (somewhere between 5:30-6:30 PM)
10:00 PM

The first blood test is before the AM meal.
Can't do one 5-7 hours later due to work
Her second shot is around 8:00 PM, so if I can only do 2 tests, I'll get her then (unless there is a more appropriate time)
Any suggestions to incorporate 3 tests with this schedule are appreciated.

Instructions given:

No insulin if less than 200
1 unit if 200-249
2 units if 250+
3 units and call Dr. if above 400 (she has never gone that high)
 
Always test before you shoot - that's 2 times
A before bed test will let you sleep knowing your cat is safe, or staying up if there is a concern about going too low.

When you can (day off, weekends, or setting an alarm for middle of night), testing around the time of the expected nadir or lowest glucose level let's you see how well the insulin is doing. This is good to do when you start insulin or increase the dose.

Vets often want to do a curve - serial glucose tests, 2 hours apart, over 12 hours - you can save yourself a lot of money doing it yourself. Plus, the numbers won't be elevated 100 -180 mg/dL from vet stress, so dosing adjustments will be more appropriate.
 
30 gauge lancet is very fine for a newbie - you could try poking twice at the same spot (or close to) - or get a thicker lancet for now.

testing
7.45am test, shoot feed. - You want to test before you feed because you dont want the test to be influenced by food
5.30pm feed
7.45pm test shoot (you want to withhold food for 2 hours before preshot test - you dont want the test to be influenced by food)
10pm feed
And before bed test - 10pm or 11pm

Insulin - Lantus is not dosed on a sliding scale. It works best on consistency. It is a depot insulin which means it takes 2-3days to build up in the cats system, so changing dose based on preshot numbers doesnt make sense and sets the cat up for chronic bounces and possibly hypos. For safetys sake I do agree with the vet - no insulin if less than 200 for now, however I would hold dose at 1 unit otherwise - no matter what the preshot number. And once you see how that is working, then change by 0.25 units. Read the stickys on this page: http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Wendy
 
Wendy, I'm confused by the statement about insulin.

Hannah Belle was gradually increased to 2 units twice daily and has been on that dosage for several months.

Now, we are starting to see a change in her levels. Her BG levels are lower and it's time to reduce the insulin. So, we are titrating insulin according to her BG levels to avoid a hypo situation. Which is why she gets nothing if under 200, 1 unit for 200+ and her regular dose of 2 units for 250+.

Is this not correct? Are you recommending a reduction to 1 unit regardless of the blood levels over 200?

As it stands right now, she's pretty much been either under 200 and skipping a dose of insulin or in the 250-295 range and getting her normal dose.


Not forgetting your post BJM. Thanks for the tips and clarification! I am going to have the pleasure of conducting the glucose curve. Hopefully, no more stressful vet trips for these types of tests.
 
Ok I will see if I can clarify.

The issue is that Lantus is a depot insulin http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
So if you are constantly changing dose then you don't know which dose is really working for her because any dose takes a few days before showing an impact - it needs a few doses to build to the right level one system as it absorbs so slowly.. And as Lantus only lasts 12 hours in her system you don't want to keep skipping as it stresses the pancreas having to work so much for those 12 hours .

You need to find a dose you can give twice a day. Chances are 2 units is too high since its forcing you to skip quite often. I would try 1 unit for 3 days and see how that works (unless she drops under 50). If she isn't getting blues or greens then I would increase to 1.25 and repeat. here is a dosing protocol we use: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. But it will be important to try and get an occasional mid cycle test.and/or a before bed test 2-3 hours after evening shot.

Does that make sense?
Wendy
 
I think I understand. We have to bring her down in a similar manner to the way we brought her dose up to 2 units to minimize the effect on the pancreas. I've got a call into the vet to discuss.

Thanks to you and BJM for your awesome help!
 
I spoke with the vet. We're going to keep her on one unit for a few days and see how she does. He also wants to minimize stress since Hannah Belle is having a negative reaction to so much poking, so no home testing for a few days. I'll start again on Sunday or Monday.

I know home testing is best for her and will keep trying. I'm not sure what I'm doing wrong; guess I have to give this time and patience. So many people here say their cats come running to them when it's time. Hannah Belle runs under a bed.
 
See my signature link Secondary Monitoring Tools for less invasive assessments which can provide you some clues on her status.

In particular, I would encourage urine ketone and glucose monitoring with KetoDiaStix. Too high glucose will spill into urine and show up. Fat breakdown due to lack of insulin will show up as ketones. If more than a trace of ketones, it is a medical emergency.

Water consumption and urination volume are also good to assess.
 
Heidi said:
I know home testing is best for her and will keep trying. I'm not sure what I'm doing wrong; guess I have to give this time and patience. So many people here say their cats come running to them when it's time. Hannah Belle runs under a bed.
Click to expand...

:lol: Pretty much everyone here went through similar with their cats. :lol: I even wrote this up for difficult cats because it took such a long time for me to get Michelangelo to the place we're at now: he actively seeks me out for tests and considers that our "special time." If it happened for me and Michelangelo, it will eventually happen with you and Hannah Belle. Patience, Grasshopper. ;-)
 
They get used to it - Some cats take longer than others. My Bailey comes running cos of the treat. Tiggy ignores me and tolerates it.

A few thoughts
- ensure he always get a treat even if unsuccessful in getting blood
- do the three strike rule- three failed tests you leave it for later
- are you restraining him? If so, try waiting till he is snoozing and go for him then. Go up. stroke him. Stroke his ears. Ensure he is nice and relaxed. poky poke test stroke treat.
- Practice the process a few times a day without testing. Start by just rubbing the ears and giving a treat. Then getting your kit out and putting it beside you, rubbing the ear and giving a treat. Then go through the process without poke.. treat. You get the idea.
- if you are using the lancet tool get him used to the noise by clicking it by his ear and giving a treat. No poky. Get him used to the noise. Or freehand the lancet

Wendy
 
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