Anyone Here? Max's BG is near 600 for an hour

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max&emmasmommie

max&emmasmommie

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My cat Max is almost 16, and he gets 2 units of Lantus 2x/day. His next to last injection was at 11:00 last night, March 6. I took him to the vet to get help with home testing today, and I did not give him insulin this morning before the vet visit, but he ate around 10:00 a.m. His BG was near 490 around 2:00 pm. I intended to give him insulin at 8 pm, but at 6 p.m I tested his blood, and it was over 600, "HI" on the meter - no reading possible. I double checked it - still HI. I gave him 2 units of Lantus at that time, and checked his blood again at 6:10. It was 578. At 6:35 it was 573. He wanted to eat, but I didn't feed him. At 7:00 (just a moment ago) it was 516. Should I give him one more unit? I'm afraid to feed him. Should I not feed him, wait until 4 hours have passed since his dose, and check his blood again? Background: Max was diagnosed on Feb 3, 2012. He keeps losing weight. He was diagnosed with kidney failure before he was diagnosed with diabetes and was on Hills k/d. We switched him to Hills m/d after he was diagnosed with diabetes and his kidney levels were found to be normal.

Update: At 8:05 pm his BG was 434. He can't walk very well at all. He's walking on his hocks, but he jumped up on the couch nonetheless and cleaned his paws. I'll get up every two hours tonight and do a curve. Poor baby, as it is he can't believe I keep stabbing his ears. He's been getting this dose for a little over a month now. I'm very shocked to find out that missing one shot resulted in a reading off the chart. His breath smells normal at least. He doesn't want water, and he hasn't urinated for hours. I know so little about all of this, and it worries me that he hasn't drank or peed in many hours. Maybe I should give him subcutanous fluids? Then, he would pee out some sugar?

I fed him at 8 pm, too, but he only ate less than 25% of a can.

Update: I tested his blood at 10:00 p.m., and it was 452.

Update: I didn't do a curve. He woke me up at 4:45 a.m., March 8th, starving. He tried to jump on the bed, but didn't make it. So, I let him eat about an 1/8 of a can to tide him over. At 6:00 a.m. his BG was 477. (This is ridiculous!) I gave him a shot, more food, and then, I called the vet and left a message. I am concerned that the Lantus pen I got from the vet may not have "good" insulin in it. It was donated to the vet by someone whose cat passed away. So, I'll get another today. His breath smells normal, but I'm headed to the pharmacy to get ketone strips in a minute. He is still walking funny, but not on his hocks. I'll check the board when I get back. I'm thinking of giving him subcutanous fluids to make him pee. He'll be furious!

More background:
1. Two units was his initial prescription from when he was diagnosed about one month ago. I gave him 2 units at 6 p.m. not one. The reason I didn't feed him right away was because the meter said "HI." When I tested myself after I ate yesterday, my BG jumped to 240, and I thought that if I fed Max the Hills m/d (which is too high in carbs) when his blood was over 600 (who knows how much "over") he might die or at least be hospitalized. It felt right that I should see the numbers dropping before I gave him food.
2. He eats Hills m/d wet food. He eats about one can a day or so. I saw that many people think it is too high in carbs, but that the insulin needs can drop quickly if he eats less carbs. (My husband is very suspicious that eating Hills k/d for chronic renal failure caused him to develop diabetes. He ate TWO cans a day although I was originally told he would need one and a quarter. He was so hungry. The doctor said he could have all he wanted, and he got all those carbs!) In any event, I learned the hard way to never switch a cat's food suddenly. I always mix a little of the new in with the old and slowly transition to the new food. I am planning to find a better option.
3. I saw that issue about ketones and high BGs. That scared me, but I smelled his breath, and it's normal for now. I'll have to get sticks right away. Maybe I can get them tonight. (People told me I would love Max less when Emma was born. So not true! but it is hard to take care of them both.)
4. Carolyn, Thank You for sharing -- that is very encouraging that your cat had renal failure and survived. I haven't asked for more kidney test readings because of the cost, and because it doesn't seem to matter until I get the diabetes under control. However, I do give him the herbal treatments in his food -- solidago, Rehmannia Eight, and Standard Process's Feline Renal Support (most bovine kidney, liver and heart extracts). Now, I'm wondering how those interact with diabetes and insulin. More research to do. Anyone know?
5. His kidney levels becoming normal all of a sudden was very strange. I'll find the numbers and post them.
6. He weighs 10 pounds. He weighed 11 pounds in Sept of 2011, and he weighed 10.26 on Feb. 3, 2012. He weighed about 14 pounds in May of 2011, but most of his life he weighed between 10 and 12 pounds.
7. His BG on Feb 2nd was 508. On Feb. 3rd it was 475 and his Urine Glucose was over 1000. Back in Sept of 2011 his Blood Glucose was only 146.
8. On Feb 2nd his creatinine was 2.04. I was told this was very good, within normal limits, and that his BUN was 38 which is only slightly elevated. At the moment, I can't find his original kidney test levels, but he was diagnosed with CRF back in September of 2011.
 
Hi Max's mommie,

Did you make your way ato Lantus land or are you still waiting? You should feed him right away. The rule is to test, feed, shoot. Since you already gave him his shot feed him now.. I will reply more after you do that.
 
His bg will take a while after giving a shot to go down. How many hours is it now after giving the shot? I'm guessing you are on Pacific time. Do not give another shot. He will peak, his lowest point or Nadir will be about 6 hours after his shot or as we say it +6. Do you have Ketone sticks in the house or anything to check ketones with? Any time your cat has bgs higher than the 400's you should check his urine for ketones.

Let him have as much food and water as he wants. Encourage the water drinking and in fact, put some in his food. Does he eat wet or dry food?

Melanie & Racci
 
max&emmasmommie said:
My cat Max is almost 16, and he gets 2 units of Lantus 2x/day. His next to last injection was at 11:00 last night, March 6. I took him to the vet to get help with home testing today, and I did not give him insulin this morning before the vet visit, but he ate around 10:00 a.m. His BG was near 490 around 2:00 pm. I intended to give him insulin at 8 pm, but at 6 p.m I tested his blood, and it was over 600, "HI" on the meter - no reading possible. I double checked it - still HI. I gave him 2 units of Lantus at that time, and checked his blood again at 6:10. It was 578. At 6:35 it was 573. He wanted to eat, but I didn't feed him. At 7:00 (just a moment ago) it was 516. Should I give him one more unit? I'm afraid to feed him. Should I not feed him, wait until 4 hours have passed since his dose, and check his blood again? Background: Max was diagnosed on Feb 3, 2012. He keeps losing weight. He was diagnosed with kidney failure before he was diagnosed with diabetes and was on Hills k/d. We switched him to Hills m/d after he was diagnosed with diabetes and his kidney levels were found to be normal.
Click to expand...

I had a cat who sat in the HI zone for a few months, so I understand how terrifying this can feel. Latte also had Acute renal failure but survived. She lived with chronic renal failure for 3.5 more years.

You do NOT want to give Max more insulin tonight, ok? And yes, it IS OK to feed him now.
What you will want to do is give the 2u of lantus tomorrow @ 6am (shots should be 12hrs apart). Can you do that? Make sure to test before shooting. If you want to test before you go to bed tonight, that would be reasonable. The insulin will take a few hours to kick in, so you may not see any improvement in BG's until that time.
 
Now that I said the stuff that is important for the moment...

Great job with being proactive and learning how to home test! It is so important to do this.

Are you feeding kibble or wet? Either way, the prescription foods will be much higher in carbs. If you are feeding kibble, you will want to work on transitioning Max to wet food with low carb contents. Here is a link with information on calories/carbs/etc:
http://binkyspage.tripod.com/CanFoodNew.html. The transition from high carb food to low carb food can make a big difference (sometimes quickly) with lowering BG's. So, it is good you are monitoring!

A few other things...

2u can sometimes be a high dose depending on your cat's weight. If you are home testing, try to get some checks around 5-6 hrs after giving the shot, as well as when you give the shot. This *might* help you know if you are giving too much or too little insulin.

Ketones- if you are not already checking for these, it would be good to go out and get some ketostix. These can be found at most pharmacies. You will have to stick the strip in the stream of Max's urine. High BG's may lead to ketones, which can be life threatening. Just check often when he is in higher numbers. Any trace and you should bring him to the vet immediately (appt or not).


I am curious about the renal values coming back normal all of a sudden. Is there a chance you have copies of the lab work? Maybe you could post some of those numbers (creatinine and BUN would be helpful).
 
Hi Max's Mom and welcome to FDMB.
You've already been advised not to shoot again until 12 hours past this shot and that the insulin doesn't work "instantly" so it will be a little while until you see something lower on the meter.

Can you tell us a little more about Max? How long has he been on insulin, and was 2u his "starting dose"?
Is that food, the m/d you got from the vet, is that canned or dry food?

The good news is that there are lots and lots of other brands and flavors of food that Max can eat that are actually a lot better than the m/d for a diabetic cat, so if you can tell us what he's currently eating, how much, and how often, we can help you find some food that is better and a lot less expensive.

Carl
 
max&emmasmommie said:
My cat Max is almost 16, and he gets 2 units of Lantus 2x/day. His next to last injection was at 11:00 last night, March 6. I took him to the vet to get help with home testing today, and I did not give him insulin this morning before the vet visit, but he ate around 10:00 a.m. His BG was near 490 around 2:00 pm. I intended to give him insulin at 8 pm, but at 6 p.m I tested his blood, and it was over 600, "HI" on the meter - no reading possible. I double checked it - still HI. I gave him 2 units of Lantus at that time, and checked his blood again at 6:10. It was 578. At 6:35 it was 573. He wanted to eat, but I didn't feed him. At 7:00 (just a moment ago) it was 516. Should I give him one more unit? I'm afraid to feed him. Should I not feed him, wait until 4 hours have passed since his dose, and check his blood again? Background: Max was diagnosed on Feb 3, 2012. He keeps losing weight. He was diagnosed with kidney failure before he was diagnosed with diabetes and was on Hills k/d. We switched him to Hills m/d after he was diagnosed with diabetes and his kidney levels were found to be normal.
Click to expand...
Do NOT give him another shot. Shots are 12hours apart.

Can you tell me why you are not feeding him? If you have given him his shot, it is fine to give him food.
Also, why did you give only 1unit of lantus when his number was HI? If his dose is 2units twice a day, and his number is so high that it registers only HI, you will give him his full dose not less.

What is the food you are feeding, wet food or dry food? If it is dry food, it could be causing his numbers to go very high; you want to feed wet food.

You gave him a 1unit shot of Lantus at 6pm, now you need to give him his next shot at 6am in the morning. Be sure to test him at that time and you can give him his am shot.
The dose of 2units is quite high; have you been giving him this dose since Feb3rd?
Do you have any test numbers from the last month or have you just started testing?
If you are regularly testing him now, you may want to stay with the 1unit twice a day, and if you are able to do a curve, to gather more data, it would be great.

Remember; stick to shots every 12 hours and no shooting early because the numbers are high as you will run into problems.
 
Thank you Melanie, Carolyn, Carlin and Gayle for replying! Yes, I started looking for other people who had the same problem on this forum and saw that I should not give him another shot. I saw Lantusland, too. I posted an update by editing my initial post, but in answer to your questions:

1. Two units was his initial prescription from when he was diagnosed about one month ago. I gave him 2 units at 6 p.m. not one. The reason I didn't feed him right away was because the meter said "HI." When I tested myself after I ate yesterday, my BG jumped to 240, and I thought that if I fed Max the Hills m/d (which is too high in carbs) when his blood was over 600 (who knows how much "over") he might die or at least be hospitalized. It felt right that I should see the numbers dropping before I gave him food.
2. He eats Hills m/d wet food. He eats about one can a day or so. I saw that many people think it is too high in carbs, but that the insulin needs can drop quickly if he eats less carbs. (My husband is very suspicious that eating Hills k/d for chronic renal failure caused him to develop diabetes. He ate TWO cans a day although I was originally told he would need one and a quarter. He was so hungry. The doctor said he could have all he wanted, and he got all those carbs!) In any event, I learned the hard way to never switch a cat's food suddenly. I always mix a little of the new in with the old and slowly transition to the new food. I am planning to find a better option.
3. I saw that issue about ketones and high BGs. That scared me, but I smelled his breath, and it's normal for now. I'll have to get sticks right away. Maybe I can get them tonight. (People told me I would love Max less when Emma was born. So not true! but it is hard to take care of them both.)
4. Carolyn, Thank You for sharing -- that is very encouraging that your cat had renal failure and survived. I haven't asked for more kidney test readings because of the cost, and because it doesn't seem to matter until I get the diabetes under control. However, I do give him the herbal treatments in his food -- solidago, Rehmannia Eight, and Standard Process's Feline Renal Support (mostly bovine kidney, liver and heart extracts). Now, I'm wondering how those interact with diabetes and insulin. More research to do. Anyone know?
5. His kidney levels becoming normal all of a sudden was very strange. I'll find the numbers and post them.
6. He weighs 10 pounds. He weighed 11 pounds in Sept of 2011, and he weighed 10.26 on Feb. 3, 2012. He weighed about 14 pounds in May of 2011, but most of his life he weighed between 10 and 12 pounds.
7. His BG on Feb 2nd was 508. On Feb. 3rd it was 475 and his Urine Glucose was over 1000. Back in Sept of 2011 his Blood Glucose was only 146.
8. On Feb 2nd his creatinine was 2.04. I was told this was very good, within normal limits, and that his BUN was 38 which is only slightly elevated. At the moment, I can't find his original kidney test levels, but he was diagnosed with CRF back in September of 2011.



Thanks again, everyone!
 
Im on my way to bed, so I am not going to add more to your plate right now. I just wanted to say I think you are doing an AMAZING job of educating yourself and being proactive for Max's sake. Really! (and you have a little one, too?!?!)

Test him before you go to bed, if you can. Test in the a.m. before his shot at 6am, then feed him and check in with the board as soon as you can afterwards. We can go from there....

As a side note...aside from the kidney disease and multiple other health issues Latte had causing a lack of appetite, I struggled a lot with encouraging food when I saw high numbers like that, too. A cat HAS to eat and get fluids one way or another, no matter what. I completely understand your train of thought.
 
Well, I tested his blood at 10:00 p.m., and it was 452. So, it went up from 434 two hours ago -- only 4 hours after his shot. This can't be. However, he ate at 8 o'clock. Perhaps that's why. He is walking better, not normally, but not on his hocks, and he ate a little more just after the test. I took him to the litter box, but he just climed back out, and wanted back up on the couch. Good night (I hope.)
 
My first response to your earlier post was that if your BG jumped to 240 after a meal, you might want to get checked for insulin resistance yourself. That’s high even for a post meal sugar in a human.
We have had a lot of trouble controlling our cat Little Bear’s sugar and switched him to a raw food diet in response to the carb levels of the manufactured foods on the market. If we feed him food from the store (which it’s been over six months since) its canned food as it has a higher protein content. Dry food is not the way to go with cats IMO, even if and especially prescription food. Because we have a second civilian cat, they are both fed the same thing at the same time, no favorites, no exceptions. Every three months I pull out the grinder and make cat food for the next little bit. It’s actually cheaper than store bought food and just requires a little room in my freezer.
As far as feeding. We limit LB’s food intake to a weight based intake. He gets 3 ounces of food every 12 hours followed by his shot. We use a food scale to measure it. This was obtained by a caloric estimation of 15-25 cal per kg of weight. His total daily caloric intake needs are just under 300 cal/day. Water is always available and we monitor his litter box usage.
When he was first symptomatic he had a similar difficulty with his haunches. It is what is called neuropathy and is frequently seen in uncontrolled diabetics and kidney patients (cats that is). Often times it reverses when the sugar levels or kidney functions return to a normal or near normal state but can sometimes be persistent and permanent.
Once you have him on a more stable dose of insulin (consider the tight regulation protocols) have his fructosamine levels checked. It is a blood test and tells how how well he is controlled.
The most important thing to remember is that with animals it is a slow and steady change. Don’t be surprised if those sugars only gradually come down over the course of a week. The idea is to do slow changes to the insulin level at the same times every day so that his little body can adjust and utilize the insulin. It may take upwards of a month to get him better regulated. Just breath.
 
Marc&Jenny said:
My first response to your earlier post was that if your BG jumped to 240 after a meal, you might want to get checked for insulin resistance yourself. That’s high even for a post meal sugar in a human.
We have had a lot of trouble controlling our cat Little Bear’s sugar and switched him to a raw food diet in response to the carb levels of the manufactured foods on the market. If we feed him food from the store (which it’s been over six months since) its canned food as it has a higher protein content. Dry food is not the way to go with cats IMO, even if and especially prescription food. Because we have a second civilian cat, they are both fed the same thing at the same time, no favorites, no exceptions. Every three months I pull out the grinder and make cat food for the next little bit. It’s actually cheaper than store bought food and just requires a little room in my freezer.
As far as feeding. We limit LB’s food intake to a weight based intake. He gets 3 ounces of food every 12 hours followed by his shot. We use a food scale to measure it. This was obtained by a caloric estimation of 15-25 cal per kg of weight. His total daily caloric intake needs are just under 300 cal/day. Water is always available and we monitor his litter box usage.
When he was first symptomatic he had a similar difficulty with his haunches. It is what is called neuropathy and is frequently seen in uncontrolled diabetics and kidney patients (cats that is). Often times it reverses when the sugar levels or kidney functions return to a normal or near normal state but can sometimes be persistent and permanent.
Once you have him on a more stable dose of insulin (consider the tight regulation protocols) have his fructosamine levels checked. It is a blood test and tells how how well he is controlled.
The most important thing to remember is that with animals it is a slow and steady change. Don’t be surprised if those sugars only gradually come down over the course of a week. The idea is to do slow changes to the insulin level at the same times every day so that his little body can adjust and utilize the insulin. It may take upwards of a month to get him better regulated. Just breath.
Click to expand...

When you are home testing, the fructosamine test is a waste of money and needless stress on the cat.
You can get the average of your cat's BG from your meter at home.
The fructosamine test is a good thing to have done if you have not yet started insulin, but once you have, go with your BG meter readings.

Also for the food, spreading out the food intake into several smaller meals through the day will help to keep the BG numbers more level. Feeding every 12 hours will not contribute to level BG numbers. In the beginning, your cat may not be able to extract what nutrients are needed, so your cat may be very hungry and needs to be fed more.
 
max&emmasmommie said:
Well, I tested his blood at 10:00 p.m., and it was 452. So, it went up from 434 two hours ago -- only 4 hours after his shot. This can't be.
Click to expand...

That's a change of less than 5%... not enough to be considered very significant given the variance of the meters.

If you can find some time, you might consider setting up a spreadsheet with your kitties blood glucose numbers on it. It will be a great asset when you ask here for help.

I'll second the concern about the 240 reading you got on yourself :cry: , that's pretty high and you might want to look into it if you haven't already.

Hope all went well overnight.
 
Thanks for you concern, Brian and Marc. You are all so helpful on this board! Even just the moral support is invaluable. I know -- that 240 reading freaked me out, too. I checked the label on what I ate. I did not expect the first ingredient in Thai Kitchen Original Pad Thai Sauce to be sugar!!! Good grief - I probably ate 30 grams of sugar in that one meal, plus a bed of rice under the meat and vegetables. Fortunately, my fasting BG is in the middle of the normal range. I'll have to run a curve on myself!
 
I added an update to the original post about an hour ago. (Max is still the same, and his BG is still over 400. Sigh. I'll talk to the vet today.)
 
Hello!

Everyone else has given you some great advice, but I thought I'd sum up the steps for you so you have a clear picture of what needs to be done to lower Max's BG. Remember, it takes time and patience, especially with Lantus, so you can't expect instant results. But if you follow these steps, you'll be in good shape!

1. Change the diet to a low carb, canned diet. Because he has a history of renal problems, you might want to switch to something that's good for both diabetes and renal disease. You simply need a low carb, low phosphorus canned food, preferably without byproducts (higher quality protein sources are easier on the kidneys). It's a good idea to feed cats over the age of 12 this diet anyway, because renal disease is so common among senior cats.

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs and less than 250 mg/kcal of phosphorus. The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, and Blue Wilderness Duck. If cost is a problem, EVO and Wellness both sell their foods in large cans, which makes the price comparable to grocery store brands of food. Because higher quality protein means less protein metabolism residue, you really want to try for the human-grade meat if you can. And you'll find that all of these foods are still less expensive than the prescription diet!

Remember that switching to a low carb, canned diet can significantly drop blood glucose, so make sure you're testing and lowering the insulin dose as needed. Most cats on a low carb canned diet don't need much more than 1u of insulin.

2. Make sure you're shooting 12 hrs apart and not moving the shot time around. Lantus works best if consistently shot on a 12/12 schedule. Also, you'll want to test at least 3 times a day, with a curve once a week. You test before each shot to make sure it's safe to give insulin, and then a test about 6 hrs into either cycle to show how the insulin is working. Here's the link to set up a spreadsheet to chart your numbers: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

3. Adjust the dose in small increments based on your test results. Here's a link that explains the dosing protocol with Lantus that has been proven to have wonderful results in cats: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. I would also urge you to check out the stickies in the Lantus TR Forum. There's a TON of useful information about the insulin and how it works.

And don't forget to post here or in the Lantus forums for advice! There's a lot of very experienced people that are willing to help guide you and help get Max's BG under control. :smile:
 
Good Morning!
Glad you got some sleep last night. :mrgreen:

You have been given a lot of good suggestions and resources!

Just a note on this a.m.'s BG...that number could have been somewhat reflective of a food spike, if you fed him a bit 1hr before the shot.

If you have time today, maybe you could do a curve.

It will be very helpful for yourself, and others offering suggestions if you can get a spreadsheet set up at some point. The directions to do this are here:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
This is where you document all the home tests you have taken, so patterns can be detected and problems tweaked.

Also, you will want to have a 'hypo kit' (just in case blood sugar goes too low). Here is information on what you need to know and get for that:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122

It has been suggested to look at the Lantus Land forum stickies (someone provided a link in post above). Reading these will help you understand dosing the insulin, what an ideal curve will look like, terminology, what to do when you dont know what to do, and many other things. Once you get your spreadsheet set up, I would highly encourage you to start posting in one or both of the Lantus groups (there are two...1 for folks who want to follow a protocol- TR, and 1 for those who might need to tweak the protocol due to various circumstances- relaxed).

Keep up on testing for ketones. And if Max is experiencing possible neuropathy issues, talk with your vet about getting some B12. Once his blood sugar is somewhat regulated, the neuropathy should start to get better.

There are always people on board to help if you need it! So dont hesitate to post questions anytime.

I hope you have a great day.
 
If you wanted to go back to your first post and edit the 'post icon'. I think you are ok w/o the 911 in there now. :mrgreen:
 
If I tested myself and saw a 240, the first thing I would check is the meter itself. What meter are you using and have you ever checked it with control solution?
carl
 
Hi Max's Mom,

I'm wondering how Max is today. Sorry I had to leave you last night but it was time for Racci's test, food, meds & nightly routine and I saw that other experienced people came on board. When I finished with Racci you still weren't back so I went to bed. :smile:

You got some excellent advice already, I just wanted to add that you should not change doses until Max has been on a specific dose for at least 3 full days or 6 shots (cycles). You also do not want to shoot if his bg is below 200, which believe it or not, could very easily happen once he is getting more regular. You should ask for advice here or in Lantus land in either of those cases. Unfortunately you picked an extra quiet night on the board last night, usually you would have gotten help much faster. :)

I also wanted to mention that you can get Zobaline Methyl B12 for the diabetic neuropathy. It is a lifesaver and has helped many cats here. You can buy it at http://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html. It really helped Racci.

It's almost time for Racci's test, food and meds now so I will be back in about an hour. Then will have more time. Will check back with you. I'm looking forward to an update.
 
carlinsc said:
If I tested myself and saw a 240, the first thing I would check is the meter itself. What meter are you using and have you ever checked it with control solution?
carl
Click to expand...

That is a good question. Are you using a meter the vet gave you (typically an Alpha Trak), or one bought from the store (walmart relion, bayer contour, etc)
 
Hello everyone. The good news is that Max wanted to go out and check his territory this morning when I went to get the Ketone sticks. So, I let him do that. He did a cursory patrol, and I put him on the bed with my husband. When I got back from the pharmacy, Max was peeing in his box, of course! At least he's not choosing an inappropriate place. So, I made him stop with the hope that he'll have to go again soon, and I can catch it. I put the ketone stick in the litter anyway, and there was no reaction which probaby means nothing. I hope to get some pee before his appointment at 1:45 p.m.

The vet called in a Lantus pen prescription for us. I am using a brand new ReliOn Confirm meter.

More later. Thanks again for all your advice and friendliness.
 
I'm so glad to hear that Max is feeling better today! About your supplements and any other meds, food or anything you feed him, you're going to want to look out for carbs and sugar. If it has either of them you want to look for a replacement that doesn't, especially the sugar. The carbs should be as low as possible, preferably under 7% or 10% at the highest.

Btw, the Zobaline methyl B12 does not need a prescription and has no sugar.

Good luck at the vet.

Melanie & Racci
 
max&emmasmommie said:
Hello everyone. The good news is that Max wanted to go out and check his territory this morning when I went to get the Ketone sticks. So, I let him do that. He did a cursory patrol, and I put him on the bed with my husband. When I got back from the pharmacy, Max was peeing in his box, of course! At least he's not choosing an inappropriate place. So, I made him stop with the hope that he'll have to go again soon, and I can catch it. I put the ketone stick in the litter anyway, and there was no reaction which probaby means nothing. I hope to get some pee before his appointment at 1:45 p.m.

The vet called in a Lantus pen prescription for us. I am using a brand new ReliOn Confirm meter.

More later. Thanks again for all your advice and friendliness.
Click to expand...

Wow, it sounds like you are coming along just fine and Max sure sounds good.
I do believe that some people have tested for ketones by placing eh stix into the urine puddle. most of my cats have their heads out the LB opening, so fat chance I had to get a stix under the urine stream.

Best of luck on your vet visit later today!
 
Hello. Max is okay, and so was the vet visit, but his BG is still above 400. Even on the vet's fancy, schmancy, spinning, plasma machine it was 449 at about 2:30 or so. Max is still eager to eat, and isn't walking on his hocks any longer. I discovered that my own BG was never anywhere near 240 - my mistake in the midst of my exhaustion and panic over Max's BG being too hi to register. There are some interesting things about the vet visit that I will share tomorrow. Right now I am completely beat.

I'm so sorry to see that some people on the board have lost their kitties this week.
 
March 9th 12:00 noon Update: The vet prescribed 3u of Lantus yesterday (every 12 hours, of course.) I gave that to Max at 8:30 p.m., and that will be our schedule now. He did fine through the night, and did not wake me up for food until 7:30 a.m.. He has food available all the time, but he prefers that I "move it around" before he eats it. I fed him, gave him his shot at 8:30 am, and fed him more. He ate again at 11:00 a.m. and went for a patrol outside, came back in, drank water, and has been snoring on his favorite chair for the last hour. I'll test his blood at about 2:00 pm.

The vet visit yesterday was very interesting. First of all, the vet said it is unusual for a cat to have ketones if he is receiving insulin, and that the cat would act much differently than Max if he was. He felt it was safe for me to wait until I got a urine sample at home. The tech suggested that I get 6mm non-biodegradable BB gun pellets to put in the litter box in order to get a urine sample -- trying that out today.

Also, the vet agreed that he does not like any Hills prescription food and said there are many other commerical foods he would recommend. He said the quality of the protein is what is important, as well as, the lack of carbohydrates. So, we'll be switching. He gave me a printout about B12 for neuropathy. Max was a little dehydrated, and the vet wanted to give him 150cc of subcutaneous fluids. (The cost for that was $60. So, I did it at home.) He said that if Max's BG was high, he could give him a fast acting insulin to bring it down.

The tech drew blood from the vein in Max's hind leg. She tested it on the vet's AlphaTrac and got 490. I tested it on my Relion Confirm meter and got 534. I tested it again and got 468, and a third time I got 464. The vet's fancy machine got 449. The tech and I were both pretty unhappy about these disparate
numbers, of course. I am questioning whether I can trust my ReliOn Confirm, and she was not at all happy with the AlphaTrac number, and upset that my ReliOn was closer to the actual number than her AlphaTrac. I told her that I had read that the AlpaTrac reads high to prevent animal owners from overdosing their pets. She said, "Well, it would be nice to know that!" This all distracted me from remembering that the vet had mentioned using fast acting insulin. I was anxious to get to the pharmacy for the new Lantus pens, and I left with Max while wondering what I was going to do about the ReliOn meter when Max's numbers start to approach the normal range.

At the moment, I am very worried about his kidneys, nerves, blood vessels, etc., and I know that getting him near the normal range is going to be down the road. He's still walking funny, but not on his hocks. I guess I'll keep the meter. Maybe I had held it in the wrong place near the heat sensor too long. In October of 2011, the ReliOn was a Best Buy in Consumer Reports. The FDA allows home test meters to be off by as much as 20%. Both those readings were within 20% of the 449 on the vet's fancy machine.
 
A human meter will always read about 30 points lower than the alphatrac because one is caliberated for human blood and the other for cat blood. The normal range for a cat on a human meter is between 40-120 while on a pet only meter it is between 70-150. And all meters are allowed a +/- of 20% you can take 3 different readings from the same drop of blood and get 3 different numbers because of that allowed varience. A human meter works just fine for our purposes which is to see trends and make sure they aren't going too low.

Mel, Maxwell, Musette & The Fur Gang
 
Thank you MommaofNurse. I hadn't seen that information about the difference between a reading on an AlphaTrac and on a human meter.
 
Wow! Sounds like your vet is pretty up to speed with things, in general! You could always refer the tech to the information on this site. I dont know if they would get continuing ed credits for it, tho. ;-)

Do you know how much Max weighs? Starting dose with insulin is usually based on weight.

My only concern is such a large jump in insulin + switching to a lower carb food at the same time. I know he is really high, but we Usually we increase in much smaller increments for both safety and making sure the correct dose is not missed (Max may only need 2.5u, or 2.75). Please make sure you keep testing, as you are, AND have that hypo info I posted earlier in the thread. Remember you can post here anytime you have questions or need help, even if it is in the middle of the night.

As mentioned, your meter is perfectly fine! :mrgreen: Most people use that meter because the strips are some of the least expensive.

I know this is all so overwhelming at first. You seem like a very smart person who is really on top of everything. You obviously love and want what is best for Max. Keep giving insulin, keep testing, switch the food slowly, set up a spread sheet and post as much as you like.
 
Thank you, everyone who has read my posts whether you replied or not. Max had a reading of 209 at 6.5 hours after the 3u dose of newly purchased Lantus.

Melanie, Carl, Brian, Julia, and MarcandJenny, Thanks for all your interest, support and advice!

Carolyn, I agree with you about the food. I'm not going to switch the food until I see how this new Lantus pen and higher dose affects him. Max weighs 9.8 pounds! He lost from 10.26 on Feb 3rd, and he was 11 pounds back in September. The Hills m/d is supposed to help him gain weight, but I doubt it will do much if he's having insulin to counteract the carbohydrates. He must have developed diabetes sometime between Sept and January. He was 14 pounds when my baby was born in May 2011, and that was the heaviest he had ever been. He could have been pre-diaebetic, and the Hills k/d pushed him over the edge.

Oh, yes, all of this is overwhelming. I had no idea this was all so complicated. I would move heaven and earth for this cat as he was my only baby for 15 years. However, I do have Karo syrup, and I printed that emergency procedure. I cannot spend $2k for an emergency now that I have a baby.

The vet is pretty good, but he's no expert. He told me that if Max showed the signs of hypoglycemia to rub Karo on his gums. He didn't know about all the different stages or catching it early with a couple of tablespoons of Karo, I guess.

Gayle, I assume your cat won't use the box unless the lid is on? I took the lid off because Max wouldn't cover his poo when it was on, and he'd leave the poo right there at the door. Let me tell you, it is very pretty sitting in my dining room!!!!! My husband said I was nuts when he saw me with the soup ladle! I'll let you know how it works out when I try the BB gun pellets as litter.

Julia, thanks for the great advice about food options. So helpful to have more detail than a chart.

Have a good night all of you, and good luck keeping your kitties healthy and happy.
 
I still suspect 3u might be too much.

Here are some dosing guidelines:
Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:

the formula is 0.25 unit per kg of the cat's ideal weight

if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration

Online Calculator for Converting Pounds to Kilograms
Click to expand...
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Under these guidelines, using Max's current weight of 9.8lbs, you would want to start with approximately 1u. If using his ideal weight (the higher end of 12lbs, which you said he has been most his life) the starting dose would be between 1.25-1.5u. And going off his high weight of 14lbs then the dose would be about 1.75u.

Just a random google search of dosing cat's with lantus provided this link :
http://www.drjohnson.com/a_article_companion_animal_cat_lantus_diabetes.html
STARTING CATS ON GLARINE

If blood glucose conc. > 360mg/dL (20mmol/L) begin glargine at an initial dose of 0.5U/kg ideal body weight twice daily (BID)
If blood glucose conc < 360mg/dL (20mmol/L) begin at 0.25U/kg ideal body weight BID
Click to expand...

Say Max is always over 360 then his dose at his current weight would be 2.25u. At his higher ideal weight of 12lbs it would be 2.75u

Most vets will only move the dose 1u at a time because not all caregivers will measure so precisely. The good news is...You can! :mrgreen: I can't remember if anyone has asked you what syringes you are using? You can get syringes with half unit markings at walmart. I think I had bought some at Walgreens at one point. There are also places you can purchase online.


Another thing I am don't recall being mentioned in your thread/post is the talk about 'bouncing'. When a cat has had high BG's for a while and suddenly see's lower one's, even if they are out of normal range, the liver panics. It freaks out and dumps a bunch of sugar into the body to protect itself. Sometimes the effects (higher BG's) can last up to 72hrs!! Depending on how often you are able to test, all you may see are the high numbers. So, you think the dose needs to be increased, and the pattern continues....
What I am saying is sometimes high BG's are due to too little insulin. And, sometimes they can be caused by too much.

I just urge you to be cautious if you continue with the 3u. If this were my cat, I would probably stick with 2u and get a full curve once or twice. If high numbers persisted, I would increase the lantus by .25u for about 3-5 days and do another curve. I almost wonder if following a protocol and changing his food would decrease his need for insulin to zero. Have you had a chance to read the Lantus TR protocol? It is in the link I posted above with dosing information. There is also a start low/go slow approach:
http://binkyspage.tripod.com/SLGS.html

I just had another thought....how does Max get along with the baby? Is it possible he is stressed at all? Stress, along with diet may have been what sent him over the diabetic edge. If you think that is an issue, maybe try some of the feliway diffusers, or rescue remedy. Or maybe in time he will just get used to the fact he is not the only baby anymore. :mrgreen:

Hopefully if my math regarding dosing is wrong, or others feel 3u is just fine they will chime in and offer their corrections/thoughts.....
 
The tech drew blood from the vein in Max's hind leg. She tested it on the vet's AlphaTrac and got 490. I tested it on my Relion Confirm meter and got 534. I tested it again and got 468, and a third time I got 464. The vet's fancy machine got 449.
Click to expand...

Not to add yet another issue into the "meter" uncertainty but.... It sounds like all the meters were used by taking blood from that drawn sample out of Max's leg, which would be from the vein? Well, human meters are calibrated to read capillary blood, rather than venal blood, which is why humans can test themselves just by poking a fingertip.
I have no stats on this, but I have seen many posts where testers have hit the vein in kitty's ear rather than the "sweet spot" on the capillaries, and they have gotten a higher reading. Same thing seems to happen if the sample is so large that it floods the test strip rather than being "sipped" up the strip. So it makes sense that the Confirm read higher initially than the fancy machine. I am not certain, but I think the Alpah Trac is intended to read capillary blood as well.

Carl
 
I tested Max's blood at 3:30. This was 6.5 hours after 2u of Lantus at 9 p.m. Max's BG is 559. Retest was 500. My poor baby. At least he ate some just now.

Thanks for noticing that vein/capillary issue, Carl. I'm quite sure the AlphaTrac is for capillary blood. However, she did have to put in a code. Perhaps she had a way of accounting for the use of a vein -- I don't know.
 
I really need some help. In the morning, I desperately need some advice from someone who is very familiar with bouncing. Carolyn? If not Carolyn, does anyone know someone on this board who knows a lot about it, and if so, could you tell him/her about my post?

Max was doing well with the 3u from this morning with a BG of 209 at 6.5 hours after the dose and a reading of 264 at 11.75 hours after the dose. I thought that 264 right before the next dose was due was really good news. However, this past evening, I had accidentally loaded the syringe with only 2u, and my husband gave that to him at 9 p.m. while I was with the baby. We decided to let that be to see if it would be enough. At 6.5 hours after the shot, his BG was 559 and the retest showed 500. Does this help to clarify Carolyn's (or anyone else's) opinion on whether he simply needs 3 units or whether he is bouncing? I am feeling so bad for him having such a high BG right now, but I'll have to let it go until 9 a.m. This is so hard.

I am very concerned about raising the dose from 2u incrementally for 3-7 days at a time because this would mean leaving him at kidney, nerve and blood vessel damaging levels for who knows how long plus there would be a risk of Ketones.
 
Hi, I was asked to come take a look and see if I can help. Have you already given the dose of insulin for this morning?
This is a very long thread and it will take me a long time to read it all. Can you give me a condensed version?

I also have to go to work, today, but I will try to get some other eyes on your condo.
 
I was also asked to come look..
First, I need to let you off the organ damage hook. That only occurs after weeks and maybe months of sustained high levels.
Ketones are definitely a risk but it looks like you've been getting some good numbers. I'm gonna read the rest of the thread, but a slow increase is what works for Lantus. Fast increases, such as a full unit, can cause huge problems, including hypoglycemia. The results are often confusing, and will show high numbers even when overdosed, so don't feel panicked or pressured into moving too fast. :)
 
good morning - you've had quite a lot going on.

i'm a lantus user - several people who have posted are also experienced with lantus. you've been given a lot of good advice.

i want to reaffirm what others have said. lantus dosing needs consistency. the way lantus works is cumulative. we call it a "shed" but what it means is that lantus takes a while for you to see the consequence of changes. we adjust doses by 1/4 unit, not a full unit. you would be amazed at how much difference 1/4 unit can make in a cat.

your vet is wrong that cats on insulin do not develop ketones. that is simply inaccurate. we've got a cat on the Lantus TR forum right now that has been on insulin and just got through a major illness with ketones. the formula for ketones is an illness (infection) plus not enough food and not enough insulin. it often shows up with high numbers, but not always. checking for ketones while we help you get max stabilized is essential. get some ketostix and check him daily while we're working on this. this is critical - a cat that develops ketones can become very sick very quickly and almost always needs hospitalization to get through it.

you can use anything non-absorbent to get the urine to test. make sure you time the reading of the strip EXACTLY. it will continue to change colors and the color is the key to diagnosis. many people just stick the strip in the urine stream, some use a spoon or ladle to catch some fresh urine, some put plastic wrap over part of the litter. i have a spare box with lentils in it - they are non-absorbent. some people use aquarium gravel.

are you able to get a spreadsheet set up for us? we use a spreadsheet because the numbers form patterns that an experienced person can "read." too much insulin looks a lot like not enough insulin - so numbers just put out are hard for us to see the pattern. everything is in relationship to the shot - so we look at what happened to the BG over the course of the next 12 hours after the shot. your dose is definitely off or you wouldn't be seeing these high numbers. what we don't know is HOW it's off.

if you can get the ss set up asap that would make it so much easier to help you. if you can't make the directions work, we can set one up for you and transfer it to you. follow the link that you were given above.

i want to ask if you will post new replies here at the bottom instead of editing the first post of the thread. it helps to bump up your thread and tells us that you've replied.

and please try not to be too discouraged. your story is not unusual and we can definitely help you. most of us arrived here in a very worried state also, with kitties that were sick. we understand. we'll help. this is why we are here. check back in often to answer people's questions and post your replies. :YMHUG:
 
Ok I read it all

"On Feb 2nd his creatinine was 2.04. I was told this was very good, within normal limits, and that his BUN was 38 which is only slightly elevated. At the moment, I can't find his original kidney test levels, but he was diagnosed with CRF back in September of 2011."

Re: CRF - if the BUN is slightly elevated and the creatinine is not, this is not necessarily CRF. Recommend you read felinecrf.org for further information. It sounds like this dx is possibly a little advanced for your cat's condition. In fact, I am highly concerned by this dx. CRF is FAILURE, and in my uneducated opinion, it sounds like the renal damage is reversing, which is not possible with CRF, which means that perhaps the diagnosis is incorrect/incomplete/early.

"1. Two units was his initial prescription from when he was diagnosed about one month ago. I gave him 2 units at 6 p.m. not one. The reason I didn't feed him right away was because the meter said "HI." When I tested myself after I ate yesterday, my BG jumped to 240, and I thought that if I fed Max the Hills m/d (which is too high in carbs) when his blood was over 600 (who knows how much "over") he might die or at least be hospitalized. It felt right that I should see the numbers dropping before I gave him food."

You're overthinking.. feed the kitty, he's sick and the diabetes is making it so that he can not process his food properly.

"2. He eats Hills m/d wet food. He eats about one can a day or so. I saw that many people think it is too high in carbs, but that the insulin needs can drop quickly if he eats less carbs. (My husband is very suspicious that eating Hills k/d for chronic renal failure caused him to develop diabetes. He ate TWO cans a day although I was originally told he would need one and a quarter. He was so hungry. The doctor said he could have all he wanted, and he got all those carbs!) In any event, I learned the hard way to never switch a cat's food suddenly. I always mix a little of the new in with the old and slowly transition to the new food. I am planning to find a better option."

Don't overthink it. The k/d might have caused the diabetes, but more likely it was the prior diet that caused both. A healthy cat eats 6-8oz a day of wet food. Your cat is not healthy or digestively sound at the moment, so may need an ounce or 3 more for the duration. He needs less carbs, and he needs better food. Dump the m/d, it's playing havoc with your regulation. If this is what you are feeding (ingredients below) you might as well just be setting your dollar bills on fire. It's crap. Further, it's crap.

Ingredients (I pulled these ingredients from http://www.hillspet.com/products/pd-fel ... anned.html)
Pork By-Products (NOT MUSCLE MEAT), Pork Liver (ORGAN MEAT), Water, Corn Starch (CARB), Powdered Cellulose (SRSLY?), Soy Protein Isolate (CARB), Chicken Fat (YUMMY *gack*) (preserved with mixed tocopherols and citric acid), Calcium Carbonate, Guar Gum, Locust Bean Gum, Calcium Sulfate, Dicalcium Phosphate, Carrageenan, Rice Flour, Choline Chloride, Taurine, Potassium Chloride, DL-Methionine, Vitamin E Supplement, L-Carnitine, Thiamine Mononitrate, Ascorbic Acid (source of vitamin C), Zinc Oxide, Ferrous Sulfate, Beta-Carotene, Niacin, Manganous Oxide, Copper Sulfate, Pyridoxine Hydrochloride, Calcium Pantothenate, Vitamin B12 Supplement, Riboflavin, Biotin, Vitamin D3 Supplement, Calcium Iodate, Folic Acid, Sodium Selenite.

It is DISGUSTING that pet food companies get away with this. Why? No government regulation. They can say what they want, and they can claim what they want, and if any vet looked closely at the ingredients in the can they'd see it. You can't say it's low carbohydrate (on the can!) if there are two major carbohydrate sources in it. Cats are carnivores, they do not forage in corn and soy fields. If Slimfast came out with something like this for diabetics, they'd be in court or FDA lockdown so fast their heads would spin.
//rant

KISS Theory: Pay attention to human diabetes. If you want your cat regulated and possibly off the juice, cut the carbs.
____


I see multiple things that are causing me to think you are frantic for control. I totally understand this, and we have all been where you are now. I know you're worried because of his kidneys, and I know you're thinking horrible things are happening inside his body every single minute he is above 200. I'm gonna let you breathe: he's gonna be fine, and you're gonna get there. It just takes time. You have time. He has time. :)

I would:

1. go shopping. buy new food. Fancy Feast Gluten Free list is a great place to start - feed no more than 3 cans per day for now. Add plenty of water to his food, even up to 50-50 water to food ratio. That will help him feel fuller and get the water his body needs at the same time.

2. Invest in a cheaper meter (relion at walmart is great)

3. While you're at the walmart, pick up some ketostix and test urine once daily.

4. Hold that dose at 2u. Pay close attention to midcycle numbers, you're going to be cutting the carbs. Don't play around with this, once you cut that corn starch, those numbers are going to come down. Honest!! I would not lie to you :)

5. Retest blood panels. I suspect CRF is a problem diagnosis. If you find out it's a problem diagnosis (study felinecrf.org, that site is so amazingly good) switch vets. The last thing you need is a vet who can't diagnose a disease properly and thus sends your cat into a second disease with the treatment of the first one.

6. Learn Lantus. Lantus is not a quick acting insulin. It's an astoundingly good insulin for cats, but its action is slow and steady, over the course of 12 hours. If you withhold food, for instance, looking for a good drop, you're not going to get one. It takes HOURS for Lantus to get to work. That's the great thing about it. If it was faster, your cat would be sent into a constant UP DOWN UP DOWN UP DOWN series of cycles that is really not conducive to getting a sick cat healthy again.

7. Give yourself a chance to relax. You're gonna fix this cat. All by yourself. And it's gonna be great. :)
 
First and foremost, please, please, please.... get a spreadsheet set up. It's very difficult to help you with dose information without having the numbers in one place. Trying to piece your dosing and test numbers together from your posts is next to impossible. No one wants to endanger your cat and it's easy to misunderstand what's been going on without having the numbers to look at. Here's a link to how to set-up a spreadsheet and link it to your signature.

There is no difference in BG readings resulting from capillary vs. venous blood. There are differences in arterial vs. venous blood when it comes to blood gases. It's more the issue that there can be as much as a 20% difference between any two tests.

There are two possible explanations for the numbers. First, Lantus really likes consistency both with dose and with shot times. The reduced dose (2.0u) not only may be the reason for higher numbers but also the large change in dose (2.0 increased to 3.0 and the mistakenly shot 2.0u) are also effecting BG numbers. As Carolyn noted, typically when we change Lantus dose, an increase is not more than 0.5u.

The other explanation for the numbers is a bounce. Max is used to spending time in high numbers. When he dropped into the 200s, it most likely triggered a bounce. When a cat's numbers drop into a range that's lower than what their body is used to or if there is a fast drop in numbers, the liver responds in a protective manner. The process involves a release of a stored form of glucose along with counterregulatory hormones. These cause BG levels to spike upward. It can take as long as 72 hours for a bounce to clear. You do not want to raise the insulin dose during a bounce.

I love the information that Carolyn & Spot posted above (the chicken fact comment made me giggle!). Others have also given you a wealth of information on food. There really is a huge volume of information to learn. We've all been in your shoes and know how daunting it feels. However, once you get a handle on the basics, it gets much easier. Another resource is the Lantus board. There is a great deal of information there. I've linked the starred, sticky notes and provided a guide to what those notes contain:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
THANK YOU! Thank you! Thank you! for making me feel okay with staying with 2 units for now. I am going to test him and give him his shot now.
 
Dyana, Thank you so much. I wish I had the time to prepare a condensed version right now, but I'll get my husband to set the spreadsheet soon. I'm going to stick with 2u for now, and buy new food today.

Everyone,

So, I tested Max and the meter read "HI" (over 600). I gave him two units, and he ate a little. Then, he went back to his chair. I'm going to get different food today. (My baby LOVES his food; so, it won't be wasted. I'm just kidding!) He's acting normal, if lethargic, and he's walking on his pads - wobbly, but not on his hocks. I'll test his urine, and I'll have to stay home with him today.

It is extremely hard for me to give him his dose on time. I suppose it's partially because of the baby. I seem to miss by 1/2 an hour to an hour, and then I have to wait 12 more hours, and if I miss again, the time gets later and later. It got to the point that I was staying up until 11 o'clock at night to give him his shot. That is why I skipped it on the evening of March 6. I was going in to get help from the vet tech with the ear stick the next day, and if I had given him his shot at 11 am, he would not have been insulin free. Now I regret it -- he didn't need to be insulin free --but it's in the past. Nonetheless, if he had not tested over 600 that night at 6 p.m., I wouldn't have reached out to all of you. So, maybe it was "in the cards." You have been so helpful and set my mind at ease about the organ damage. It is better to get him regulated.

I'll get my husband to set up the spreadsheet soon so that it will be easier for you to help me.

Thank you!!!
 
great plan! funny how these things work out for the best, isn't it?

you can move the shot time by 1/2 hr once a day, or 15 minute intervals on every shot with basically no impact on the numbers. in other words, 30 minutes of adjusting in a 24 hr period won't do anything. if you have to adjust more than that, just know that he might be a little wonky in numbers. life happens, sounds like you've got a new baby - and that would add a special extra-crazy dimension to having a diabetic cat! you just do what you can!

as you learn more you'll learn how to work things to be a little more flexible for your life. the only thing you absolutely should not do is shoot more than an hour early, and that only with someone telling you it looks like in that particular situation and numbers at that moment, that max would do ok with it. shooting early acts like a dose increase and because lantus works in a timed-release sort of manner, you don't want to mess with it.

anytime you want to change the time or dose, just ask us and we can let you know if it will work and be safe.

we'll watch for your post - thanks for getting the spreadsheet up. it seems like a picky thing, but for us it's like looking at a snapshot of how max's body is responding to the insulin. it's amazing how much it tells us.
 
Hi Max's mom!
I saw your post this a.m. as I was about to walk out the door for work. I am glad others came around to help you out. Thank you Carolyn, Dyana, Sienne, and Julie! I also see you posted in the relaxed lantus forum and received some feedback there as well.
Here is the post, for anyone interested:http://www.felinediabetes.com/FDMB/viewtopic.php?f=32&t=65868

I think there is an overwhelming agreement among a number of topics.
1. Food change, sooner than later.
2. Set up a spreadsheet a.s.a.p. so when you do need help with dosing, others can do so.
3. Stick with 2 units and keep testing (I would suggest a curve in a few days)
4. Find a time you can shoot 12hrs apart.
5. Keep testing for ketones.
6. Get some clarification from the vet regarding his dx of kidney disease.
(am I missing anything? ;-) )

Regarding the kidney values...I guess I did not realize you edited your first post with that information. Those values appear to be right on the edge of normal. Without knowing what the range is for your cat, it is hard to say for sure. You could ask the vet for a copy of Max's labs. You will find his results, range, and if he is HI/LO/Normal. Cat's with a slightly raised creatinine can be due to pancreatitis (common with diabetes), or ketoacidosis (also a product of uncontrolled diabetes). A slightly higher BUN and normal creatinine (which is what it may have been) can be a sign of dehydration, GI bleeding, or high protein diet. Considering his values came back 'normal' the second time around, I do not know if I would be too worried about this. I do think it is worth a discussion with your vet. It would be wise to also continue monitoring Kidney values since Chronic Renal Failure (CRF/CKD) is fairly common as cats grow older. The link (the other) Carolyn provided to Tanya's CRF site is probably the best reference around for us caregivers-
http://www.felinecrf.org/index.htm

Just to give you some perspective on CRF/CKD. My Latte went into Acute Renal Failure from a medication called metacam. Her creatinine was well above 10, and BUN did not register (it was too high). With aggressive tx and lots of touch/go moments her creatinine went down and stayed between 2-2.5 for nearly 3yrs. Her BUN never went above 100. The kidney disease ended up being the least of our concerns in the end.

At this point, I might suggest starting a new thread/topic. You could title it with the date, Max's name, and insulin or question you have (3/10 Max, Lantus OR 3/10 Max, Help with dose change). In the beginning of your post, it is helpful to put a link to the last one you wrote so people can easily go back and see what happened, or what advice you received. If you are cross posting in other forums (relaxed or TR lantus), it is also helpful to add the links to those posts. It just helps with continuity and allows everyone to get all the information they need to help you.

So how did your day go? How is Max feeling? Is there anything we can do to help you figure out a regular shot time? It might get confusing with the time change tonight.

You know...for the life of me, I cannot remember if you told us your name?!?! For now, you are Max's mom :mrgreen: . You are really doing a wonderful job under circumstances that feel extremely overwhelming. We all know this feeling. We have ALL been there. Some of us get it right away, and some of us flounder for a while. The nice thing is no one will give up on you. We will continue to offer help, guidance, and do what we can to make it easier and keep Max safe.
 
Hello. Max is doing okay today. He's eating and drinking. I've tested him at +5.5 and +6.5. His levels were 487 for the first and 443 for the second. It may be noteworthy that his level is still falling at +6.5.

Thanks, Julia, for the tips about timing shots, and thank you, Carolyn, for all the tips about how to use this site. I'm not sure how to post a link, but if I can't figure it out, I'll let you know. I can see that posting a new thread would be quite useful.

Oh, my, the time change! Well, yes, if you have any ideas, I would greatly appreciate that. Spring Forward/Fall Back; So, we set the 9 p.m. clock to 10 p.m., and then I give him his a.m. shot at 10 a.m.? Julia mentioned the 15 min/half hour rule. I imagine I could "inch" back in 15 min. to 1/2 hour increments to get him to 9 a.m. again?

As to the CRF, I don't know what to make of the fact that when he was diagnosed with that, his BG was 146 - perfectly normal. Medicine is never an exact science. However, I have read that low protein diets for that condition are very controversial, and if diabetes is a secondary condition, the consensus is to feed the diabetic not the CRF part of the cat.

Hope your kitties are doing well!
 
Now he's at 377 eight hours after the shot which is lower than both the +5.5 (487) and the +6.5 (443). He tested negative for ketones right after the 377 reading. Oh, and my name is Dale, but I'm female. (Kinda like Dale Evans.)

Ah, I see the link you pasted for the daylight savings time change problem. Thank you, Carolyn!

Gayle, you typed all of that in the Lantus Relaxed forum on a cell phone?! Wow. Thank you a million times over!
 
Hi Dale!
What time zone are you in? What time is the evening shot? Could you get a +11 (1hr before you shoot).
If it is lower, will you post? If no one responds, you can post again in the LL relaxed forum and LL TR forum. The TR forum will likely have more traffic later in the evening.
 
hi dale!

i'm going to guess based upon your last post that your shot time is in about 2 hrs from now. i'll check back in an hour and see if you've got a +11 (test 11 hrs after your last shot) so we can see if there needs to be any dose adjustments.
 
I'm going to ask a horribly obvious question. Could you set the alarm on your cell phone with Max's shot time. It may help to have a reminder.

It may be possible to make an hour adjustment in your shot time if Max's numbers are still on the high side. Because Lantus is a long-acting insulin, if numbers are low, this isn't recommended. (An early shot acts like a dose increase and a late shot acts like a dose decrease.)
 
Thank you Julie, Carolyn and Sienne for wanting to help me with the time change. I just saw your posts about an hour ago, and I will post his BG value after a 9am new time test.
 
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