Anyone Awake For Last Minute Advice To A Newbie?

[Snickers15]

I posted a bit ago about my cat Snickers, who was diagnosed 2 weeks ago now. Her glucose was 570, and since then it's always been high mostly...

I have received my AlphaTrak (and a human glucometer, but have only been using the AlphaTrak) and finally got used to using it without wasting strips. I tested her a handful of times before just randomly before her night insulin and it was always high 300s-400s. At the beginning she was on 2U but advice from here made me drop her immediately to start on 1U. By the time I saw this, I raised it again to 2U twice daily. I did this for two days, then finally did a proper glucose curve on Sunday.

She was 340 (8am) to start, then 10am: 338, 3pm: 93, 7:30pm 81... by then, I did not give her the second 2U. It is very strange, because this is the lowest I had ever seen it.

Today, when I woke up, before insulin, it was back at 498 (7:20am). When I got home at 5pm, it was 550. After her insulin at 10pm, it was 454, and then just recently at 12:30am it was 268.

I was actually considering taking her to the emergency room, as I realized I cannot remember if she's had much food at all... I still free feed her, as she has been particularly picky in her feeding and I would rather she eat than not eat at all. I had been picking up her food and trying to feed her only when I give her insulin to time it and then eventually slowly transition to wet food. Except she stopped wanting to eat, so I left it out. I saw her pick a few times, but on Sunday I did not see her eat at all really... I gave her the insulin because she was in the 300s and she was sort of picking at her food when I offered. I did see her pick again at night, but her bowl never really was empty for days. Today, it was full again, except a few pieces of dog food that were gone, I had left it in to make it more appetizing. I ended up replacing the M/D dry food with her old cat food, and she still wasn't interested. I put some cat treats in it, and nothing.

I also noticed the litter box was lacking in bowel movements today. Only one, which is likely the kitten's, and I did recently clean it but there wasn't a lot.

Instead of taking her to emergency, I'm keeping an eye on her and forced fed her some wet M/D. She has still been drinking, at least. I have an appointment with a specialist tomorrow... But I was wondering if I'm just making a big deal of it? I wish I could weigh her, but I feel like she's lost a bit. Or maybe just more lethargic... I wonder if she's angry since I finally learned how to poke her for blood these last few days and she does not like it. Or she gets extra grumpy because of the kitten. I've just been spending SO much money and have no clue where to go anymore, and having to change food maybe or waste all this food... it drives me insane. But I want her to be healthy and just wish it was an easier fix.

 

[Deanie and Boo (GA) and Scout]

I was just heading to bed in a few minutes but am still awake. My big question is are,you checking for ketones? I didn't see any mention of it in your initial post. However, it is a big worry with a cat who has high numbers, is not eating well and is lethargic. Pancreatitis can also cause very similar symptoms.

I'm in Phoenix too. Who do you have an appointment with in the morning?

 

[Dyana]

I agree with Deanie. I would buy some ketone test strips and make sure she has no ketones. It's good to have those on hand. When you go to the vet, you can also have them check her for ketones, and if they are negative, then ask if they think it might be pancreatitis. The best test for pancreatitis is the Spec fPl which needs to be sent out.

Sending eating vines, and Best Of Luck to you and Snickers.

 

[Snickers15]

I should have checked this sooner. I was so worried and it was late that I left the computer to be with her and didn't remember until now.

If Deanie and Boo sees this in the morning, I'll be checking before I go, I'll be heading to Sonora Veterinary Specialists with Dr. Schnier. I volunteered there up to about two weeks ago when she was diagnosed so I know them, but not like I'll be getting any discounts or anything... I'm just not sure who else to trust or go to right now, the vet I was going to was VCA but I do not really know them well, I just took her two weeks ago for the first time and I feel maybe a specialist would be better to consult with.

And they checked for ketones two weeks ago but it was negative. Do they develop that quickly? I should purchase some strips as well... I've tried to reduce my costs with a human glucometer but I did not like the one I purchased, and I'm rather tired of re-learning everything. So I stuck with using the AlphaTrak (after finding out the seller wouldn't take it back anyway).

They hadn't asked me if it might be pancreatitis... I will definitely ask the doctor tomorrow. Thank you for that!

 

[Dyana]

I think Deanie went to bed. I am on the east coast, so am just getting up.
Yes, I would buy some ketones test strips. They are like $15 for 50 strips, and ketones can develope very quickly.
A recipe for ketones is not enough insulin plus not enough food plus an infection. They can be life threatening, if the cat goes into DKA. My cat is a DKA survivor.
You're doing good on the testing, although eventually, you may want to get the glucometer with the test strips that don't cost as much.

What kind of insulin are you using?

Please take a look at my spreadsheet. It is important to mid cycle tests to see how low the insulin is taking Snickers.

I have to go my alarm is ringing for test, feed, and shoot.

 

[Snickers15]

I just bought $155 worth of AlphaTrak test strips on Sunday night so I'll be stuck with that glucometer for awhile now.

She is currently on Lantus. I'll look into buying some ketone test strips tomorrow though I'm not entirely sure how I'll go about testing her for it just yet, since she uses clumping litter.

I also just realized the tuna juice trick and she is /actually/ eating! This is the first time she's been so enthusiastic about the wet food. She is definitely eating a bit more than I've seen her eat in the last two days myself. I think I'll still head to the vet tomorrow to be certain with some idea of what to ask for.

Thank you for the information, I will be looking into it more now.

 

[Dyana]

I'm glad she's eating with the tuna juice. If she doesn't eat as much as she normally does, she should go to the vet.
Believe me, you don't want ketones. Treatment for that is very expensive. There are tricks to getting the sample of urine. You can cover the litter box with a sheet of plastic wrap and get some off of that, you can replace the litter with something non absorbant like fish tank gravel or one member used lima beans. I use a cleaned out Fancy Feast Appetizer tub and just wait for J.D. to start peeing and the quietly put it in the stream under his tail.

The next time you buy tuna, make sure to get the kind without soy added, as it is not good for cats.

 

[BJM]

Really important: the curve you did shows the insulin does work and the dose may be too high.
The objective is to have:
a dose you can shoot every 12 hours,
without having to skip due to low preshot numbers and
which brings the glucose down to a mid-cycle nadir on no less than 80 on an AlphaTrak or 50 on a human glucometer.

Note that Lantus is a depot insulin. It is not completely out of the cat's body 12 hours after a shot. It builds up a bit more each day until the amount going out vs the amount going in are balanced. It may take 3 to 7 days for dose changes to stabilize. Kind of like walking up a down escalator at a steady pace to maintain a particular level. Given that, it may be prudent to reduce the dose to 1 unit every 12 hours, then 3 days later, re-evaluate the dose by checking around +6 hours after the insulin, when the nadir is expected. At that time, the Lantus users can give you feedback based on the protocols for using Lantus.

 

[Deanie and Boo (GA) and Scout]

I should have checked this sooner. I was so worried and it was late that I left the computer to be with her and didn't remember until now.

If Deanie and Boo sees this in the morning, I'll be checking before I go, I'll be heading to Sonora Veterinary Specialists with Dr. Schnier. I volunteered there up to about two weeks ago when she was diagnosed so I know them, but not like I'll be getting any discounts or anything... I'm just not sure who else to trust or go to right now.

An excellent clinic. You'll be in good hands there.

If you want a good, basic vet clinic (and less expensive than a specialist)' my clinic is Blue Cross Vet Clinic and we see Dr. Peter there. Over the years, I think I've sent at least 8 FDMB members to Blue Cross and only one didn't like it. They're very reasonable and will work with you on home testing and not try to push stuff on you if you let them know you have budget issues. All,of the vets are nice but Dr. Peter has helped me with a lot,of very sick cats and I trust him completely. They're at 36th St. and Indian School. They're worth driving to even if you aren't in the area.

 

[Snickers15]

Thank you, I do like Sonora and wish I had gone there the first time. It was Snickers' yearly check up when I found out she was diabetic as well (only just noticed her increase in urinating the day before taking her in). It's bad timing all around but they're all great people that I know well and I feel they won't push things on me.

I appreciate the vet name as well, as I do not know anyone else but the Sonora vets and do not like any of the vets I have tried before with my other pets (VCA, Banfield). I'll definitely look into traveling if I have to, since any vet is always going to be cheaper than a specialist's price. As of now, I've been gathering up a bit of an estimate simply because I want to check Snickers over, we'll be going back for her ultrasound and a ketones test this afternoon. She has lost at least a pound in two weeks, has been dehydrated, and she's definitely a lot colder in temp than is normal (98s). I noticed her being out of character and more lethargic at the clinic than at home. While she would normally howl up a storm and wander anxiously or try to climb up on me to escape, she just sat there today and was very quiet. Just hoping it's nothing else and things get better...

 

[Deanie and Boo (GA) and Scout]

As of now, I've been gathering up a bit of an estimate simply because I want to check Snickers over, we'll be going back for her ultrasound and a ketones test this afternoon. She has lost at least a pound in two weeks, has been dehydrated, and she's definitely a lot colder in temp than is normal (98s).

Yeah, that really makes me worry that it may be ketones. However, Sonora did some miraculous work with PJ's Cagney when she was in DKA and after a severe hypo event so that would be the best place for her if she is in DKA. They're staffed 24 hours which is what she would need. One of the night shift docs actually went to vet school with my vet. If she's having a crisis, it's the only place in town that I would want to go to. For routine care, you could switch her over to Blue Cross.

I haven't heard a lot of good things about VCA or Banfield clinics. I got lucky--I stumbled into Blue Cross when the small clinic I was using closed down. They were nearby and I liked the look of the clinic and the staff. Dr. Peter impressed me from the start--he really listens to what an owner says and comes up with clear treatment plans. He's always willing to consult with another vet if he isn't sure what to do. I've been going there for 11 years now and will never switch to another clinic.

 

[Snickers15]

Finding a good vet is extremely difficult, so it is very much appreciated. I'm not sure how much longer I will be living in Phoenix but now I know at least one place I can feel good to go to. Out of all the places I have volunteered/interned at as a vet tech, Sonora has by far been the best experience and they have been the staff that actually seemed to care about the clients as well and knows their stuff. I also externed at of the Emergency Animal Clinics and I would rather not go there at all.

I take my dog to Banfield because the wellness plan is affordable for her, but she has never had many problems. The VCA at McCormick Ranch I picked had a very good Senior plan that had bloodwork, urinalysis, x-rays, blood pressure, and the exam all for $350. It was a good packaged deal but it was intended to be Snickers' yearly checkup that I give her now that she is older. I never suspected she would fall ill and since then the bill has been stacking up from bad decisions after VCA's advice. Glucometer, the overly charged insulin pen, etc. Definitely wouldn't recommend that...


Update for those that may check:

Snickers had an ultrasound and so far everything looked good besides a little abnormality in her liver, but they were not too concerned with it. They gave her an IM injection dose of half a unit, because her glucose hasn't dropped at all, and her ketones were negative.

She got home and decided to pick at her food, for once -.- But besides that it'll be monitoring and treatments at home with some fluids.