? advice/experience for Ashley's treatment plan

[alli24]

Hi all,

My cat Ashley is about 16-17 years old and was diagnosed with diabetes four years ago. It was under control until a few months ago - without going into too many details, my partner and I messed up her care by giving her too little insulin which resulted in her becoming symptomatic again (frequent urination and extremely frequent/excessive thirst). We feel terribly and have been trying to get her back on track but it's going pretty poorly. She is currently on 2 units of insulin 2x a day (morning and evening) via the Lantus Pen. However, we had a freestyle libre attached and found her blood sugar is very high. We tried going up to 3x units twice a day as advised by our vet but she nosedived and seemed to be exhibiting signs of hypoglycemia (extreme lethargy) so we pulled back to 2 units, twice a day and she bounced back somewhat. This has all been complicated by the fact that she is dealing with dermatitis on her skin and an ear infection, both of which we are treating separately with topical wipes and antibacterial shots from the vet. It's hard to know what symptoms are coming from the dermatitis and treatment and what is coming from the diabetes.

The big issue we are struggling with is she is not making it to the litterbox to pee. She's mostly making it to poop (sometimes she does poop in her bed) but when it comes to peeing, she is consistently urinating just outside the litterbox, right outside hr bed, or sometimes right in her bed This has really impacted her quality of life and it has been hard on us as caretakers as it's gone on for about two months. She has had some good days where she is able to make it but the past three weeks have been almost all accidents.

Our vet wants to do another freestyle libre and he also mentioned maybe we should switch from the lantus pen to a syringe to have finer control over insulin dosing.

I'm just curious what everyone thinks we should try in general and whether there are any tricks you have for when a cat is peeing *just outside* the litterbox? We have tried getting a lower box and even sawing off the entrance to it so she has a low barrier to entry (she has some arthritis in her back legs)

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
First of all, have you had Ashley’s urine test for a UTI?

Have you thought about hometesting the blood glucose (BG) yourself instead of getting A libre?
We all do that here and everyone has learnt how to do it. It is not hard. Just takes a bit of time and Ashley will adapt well.
You can buy a ReliOn premier meter for Walmart if you live in the US cheaply and we can help you how to test. You will also need a box of 100 test strips to go with the meter, a box of 100 lancets size 26 or 28 and some cotton balls to hold behind the ear when testing.
Here is a link to HOMETESTING
I will also give you a link to HELP US HELP YOU which has links to lots of useful information for new members including our spreadsheet, signature, and hypo box. If you could set those up it would help us a lot to help you. If you need help, let us know.

What are you feeding Ashley?

In regards to the insulin dose, I would recommend you start using syringes to draw up the insulin as you can draw up smaller doses and this is what Ashley needs. If you are hometesting you will be able to see who well each dose is working and it takes all the guesswork out of it. And it is much safer. The syringes you need are U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings. There are several brands which carry them.
After we can see a couple of days BGs we can advise you on the dose to give.
The routine is test the BG, feed, given the dose if the BG is high enough.
Keep asking questions. We can help you get Ashley back on track.

 

[SmallestSparrow]

I second the question about testing for a UTI—it’s a common reason cats poop but don’t pee in the box, it’s common for diabetics to get UTIs, and UTI wreck havoc on BG control.

other suggestions: if she’s peeing more bc of diabetes, box will get full fast and cats don’t like stepping on pee so if you’re not home (eg working) to frequently scoop perhaps get additional boxes. And wash them more frequently than you normally do when she’s under better control. Also understand that diabetes not only messes with nerves in the feet but all nerves so bladder and bowel control can be less predictable. All good reasons to consider switching to syringes to get a better handle on her BG so things return to normal (I say all this not as a parent of a well regulated cat—he’s not—but I am an old cat woman who volunteered in shelters so know a few tricks re inappropriate elimination. Last but not least there’s an additive (I think Dr Elsey’s cat attract) that helps entice them to per in the box—but not if the box is dirty or the cat has pain peeing (UTI)

 

[Sienne and Gabby (GA)]

The other possibility is if your cat is struggling with the litterbox height. If Ashley is developing arthritis, she may be having trouble climbing into the litterbox. There are a couple of options. There are litterboxes that have a cutdown on one side for easier entry/exit. You can also find boxes that are sorted by their height. There are quite a few on the Chewy's website.

Another alternative if arthritis is the problem is Cosequin. This is a capsule that you empty into canned food. It was very helpful with my cat.

 

[Diane Tyler's Mom GA]

Using syringes with a pen, cartridge, or vial:

• U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars from vials, cartridges, and pens.
• BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
• Syringes come in 5/64 inch (6mm), ½ inch (8mm) or 5/16 inch (12.7mm) needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
• Full and half-unit syringe scales:

• Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:

If you order any of those syringes here is a promo code from ADW Diabetes
DIA10

10% off your next order

The Relion Syringes are from Walmart but I have read they are out of stock plus you have to go into the store to buy them

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there

We use the syringes because with using the pens you can only adjust the dose by whole units with a pen so we use the syringes since we either increase or decrease by 0.25 units at a time

If you plan on getting a human meter
Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
At least if you need more test strips you can run into Walmart and pick them up or if you're running low you can just order them from Walmart


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 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

Try putting a thin layer of Vaseline on the ear so the blood will bead up
Here's a video one of our members did she used a pet meter which has to be coded , so ignore that part , get a human meter , doesn't have to be coded. Most all of us use a human meter since that's what our numbers are based on
VIDEO: How to test your cat's blood sugar

 

[alli24]

Hi and welcome to the forum.
First of all, have you had Ashley’s urine test for a UTI?

Have you thought about hometesting the blood glucose (BG) yourself instead of getting A libre?
We all do that here and everyone has learnt how to do it. It is not hard. Just takes a bit of time and Ashley will adapt well.
You can buy a ReliOn premier meter for Walmart if you live in the US cheaply and we can help you how to test. You will also need a box of 100 test strips to go with the meter, a box of 100 lancets size 26 or 28 and some cotton balls to hold behind the ear when testing.
Here is a link to HOMETESTING
I will also give you a link to HELP US HELP YOU which has links to lots of useful information for new members including our spreadsheet, signature, and hypo box. If you could set those up it would help us a lot to help you. If you need help, let us know.

What are you feeding Ashley?

In regards to the insulin dose, I would recommend you start using syringes to draw up the insulin as you can draw up smaller doses and this is what Ashley needs. If you are hometesting you will be able to see who well each dose is working and it takes all the guesswork out of it. And it is much safer. The syringes you need are U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings. There are several brands which carry them.
After we can see a couple of days BGs we can advise you on the dose to give.
The routine is test the BG, feed, given the dose if the BG is high enough.
Keep asking questions. We can help you get Ashley back on track.

Thanks for replying. She was tested and treated for a UTI earlier this summer but the vet has cleared her and says it's gone.

RE: BG, when she first was diagnosed we were able to do 3 at home blood glucose curves. However, towards the end, she absolutely hated it and we were not able to do one (it was too hard on her and us). I tried last week to get at least a quick check on her blood sugar via her ear but no luck - I wasn't able to draw enough blood and she hated it. But maybe I can follow the guide and try again.

Right now for food she is getting Royal Canin digestive wet food (she also struggles with constipation but this food has been helping)

I will look into getting these syringes!

 

[alli24]

The other possibility is if your cat is struggling with the litterbox height. If Ashley is developing arthritis, she may be having trouble climbing into the litterbox. There are a couple of options. There are litterboxes that have a cutdown on one side for easier entry/exit. You can also find boxes that are sorted by their height. There are quite a few on the Chewy's website.

Another alternative if arthritis is the problem is Cosequin. This is a capsule that you empty into canned food. It was very helpful with my cat.

Oh we were giving her cosequin for a while -- maybe we should go back to it.

She seems to get into the litterbox but only one step and she thinks that's enough and then pees but. maybe if it was lower it would help, although it's pretty low

 

[SmallestSparrow]

Oh we were giving her cosequin for a while -- maybe we should go back to it.

She seems to get into the litterbox but only one step and she thinks that's enough and then pees but. maybe if it was lower it would help, although it's pretty low

This may not work for your set up but: my boy is a very long cat and because of muscle wasting can’t hop into boxes (I used to just use a big storage tub). I bought the largest I could find with the very lowered entrance (this does mean more frequent sweeping). Even then he dragged his Cushing belly on the edge. So I got a puppy pan but that really got litter everywhere (I use a soft sided crate as a litter box enclosure to give them privacy and corral *some* of the litter. But it really was a mess). So I got a step like for step aerobics, and it’s in front of the low entrance. The litter inside is high enough for him to step back out.
I still suspect she’s having pain with urination if she’s pooping in the box, and that’s making her fear peeing in the box.

edit: by vet cleared her do you mean he’s done a recent UA, or that a UA this summer was normal after treatment?