Best cat-friends, now bickering - help?

[mommie2madison]

I am a new member, I have two cats, Keiko (Female), 14 years old, and Kato (Male), 5 years old. Kato has been with Keiko his entire life since he was adopted at 7 weeks old. Two months ago Kato was severely sick, and a series of tests at the vet turned up a very elevated glucose level (400+). We were able to clear the unknown infection (he was knocking on death's door at the time, and the vet still was not able to identify the source of the infection, but a series of broad-spectrum antibiotics cleared him up). That being said, the vet determined that the increased glucose levels were not related to the infection, and he was diagnosed with Feline Diabetes. Vet prescribed Lantus 2units 2x day. We were giving the insulin blindly for several weeks, but as he beat the infection and was otherwise feeling well - we noticed that suddenly he is no longer happy cohabitating with Keiko, his friend for life. I should also mention that we did a diet change from free-fed dry food, and they are both now on high protein, low carb, canned food only - fed 2x day.

Doing some internet research we decided to test his glucose at home, and have been doing that now for about 4 weeks. I now only give insulin if his bg is above 170. Ironically, there's been no set pattern to his bg levels. Some days he will be "normal" both morning and night, others he is 250+ in morning but good at night, or good in morning and 250+ at night. Absolutely no pattern that I've been able identify in the 4 weeks of home-testing. With that, the rumbling of Kato's aggression toward Keiko seems to be getting worse, and I am seriously concerned. My 14 year old Keiko was my first "baby" as she is older than my human children, but Kato is the 'baby" to my two little girls, and he is normally such a cuddly loving cat - the aggression is SO out of character for him!

Tonight, I checked his bg at 7:15pm, about 30 minutes after eating. It was 222, I gave the 2units of Lantus. At 9:15pm he had a terrible roll-around rumble with Keiko. My first reaction was to crate him while I checked on Keiko to ensure she did not have any injuries. About 10 minutes later I re-checked Kato's bg to see if he had dropped too suddenly and if a hypo could be causing this aggression - but his bg was 247! (Higher than 2 hours earlier, AFTER Lantus dose). Does this make any sense to anyone?

Any & all input is appreciated.

New to feline diabetes... wanting to learn and keep a sane household for all the family members (2 AND 4 legged ones)
Thanks!
Misty

 

[Deb & Wink]

Thank you so much for starting your own post.

Welcome to the FDMB, the best place you never wanted to be. We will be able to help you in this journey you have started with your diabetic cat, Kato. This sugardance as we call it has many steps and we will help to teach you those dance steps along the way.

This process is a marathon, not a sprint. It will take time.

So glad to hear you were able to clear that infection and Kato is now safe at home.

2units of Lantus 2 x a day is a high starting dose. Are you home testing yet? We have tips and a shopping list of supplies if you are interested.

Kato may be either going too high or dropping too low on that 2unit dose. Also, the diet change will often drop the BG number 100m points or more.

Since the cats were used to free feeding, a few more meals a day might help with the 'crankyness' and fighting. If Kato is hungry between meals he may be taking out his dissatisfaction with fewer meals on his buddy Keiko. You can split up the food into more mini-meals and feed more times each day. Ask about hockey pucks ,aka cat food 'cicles, if you work and can't leave out food.

Also, unregulated diabetic kitties are starving- quiet literally. There bodies do not have enough insulin to process the food they are eating so they are not getting the nutrition they need. Adding some water, half a can to a whole can of wet food is about right, applesauce consistency does two things. It helps your cat to feel fuller and it keeps the food from drying out.

Fantastic job on the home testing!!! Good job! Now we need you to enter that data into our standard format spreadsheet and link it to your signature. Here are the directions. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Yell for help if you are having problems with the setup.

Start doing the data entry with the most recent weeks data, work back one week and then do the older data later. Once you have the spreadsheet up and running, people on here can look at it and see what is going on. We may ask for more tests, like a +6. We may see some places where you should have reduced the dose. No way to tell until we have that info to look at.

but his bg was 247! (Higher than 2 hours earlier, AFTER Lantus dose). Does this make any sense to anyone?

Yes, it does make sense. Food causes BG to go up, Insulin causes BG to go down but at +2 the insulin has just started to kick in and not dropped numbers yet. Here is a typical lantus curve:

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

There is a lot of information over in the lantus tight regulation group forum, at the top labeled STICKY.... Very informational reading and it's where I copied the typical Lantus curve information from.

Keep asking questions. Be sure to give yourself a treat when you test your kitty, he gets a treat for being good about the testing and so should you. We'll try to help you

keep a sane household for all the family members (2 AND 4 legged one

How much are you feeding?

 

[BJM]

Meters may vary as much as 20% from what a lab woud get. Values of 222 vs 242 are not significantly different.

Please test BEFORE giving insulin to be sure it is safe. For new folk, we suggest they not give insulin if the pre-shot test is under 200. As you get data to show it is safe, that number may be lowered gradually.

A formula for estimating a starting dose is
The lower of current weight if underweight or ideal weight
In kilograns (pounds divided by 2.2)
Times 0.25
How much does Kayo weigh?

If he is getting too much insulin, this may affect his behavior.
If you are not leaving food out between shots, he may be quite irritable. Diabetics can't use the food they eat so they are starving. It is OK to put out about 50% more food, preferably spaced out over 10 hours, to help him be more comfortable.

 

[hmjohnston]

Welcome to the board! The others have pretty much covered it but i just wanted to say hi!

I do have a fe questions-
What meter are you using?
What foods are you feeding? Not all canned foods are the same. We prefer a lower carb food and that is usually the pates rather than the gravy lovers and grilled foods. You can free feed this during the day- add an ice cube to help keep it moist. Or freeze the food with water and let it melt- takes about 2 hours.

And, yes, the 2u as a starting dose is a little high. I would suggest dropping it to 1u while testing for ketones every day. Since he has already had an infection recently keeping a close tab on the ketones means peace of mind.

 

[mommie2madison]

:razz: All - thank you so much for the replies. I feel awful, I had thought when someone replied it would email me, but I didn't get any notification, so I am sorry I am just writing back now. OK, let me try to clarify on topics that came up:

Kato was diagnosed the middle of February. Switched to exclusively wet food immediately without any problems (no problems from the elder cat either - who is not diabetic but we changed them both in light of the circumstances). We are using Binky's Page for food suggestions and staying below 10% carbs. Feeding each cat 1/2 can in morning, and 1/2 can at night, but may increase that based on what you all have shared. I do think he is still hungry because he is always scrounging looking to sneak food - he managed to get into a bag of meaty dog treats and actually ate those, and I constantly catch him trying to take over the other cat's food bowl as well.

We are home testing and always test before giving insulin. (Reli-On Meter from Walmart). I am not sure if I'm testing at the right times/frequency, I have to spend some time researching that. I had the impression I should be testing 2 hours after meals, but the vet said to administer the insulin within 30 minutes of him eating - so I began testing as soon as he was finished eating because I didn't want to administer the insulin blindly.

Kato weighs 10.5 lbs, he has gained back some of the weight he had lost back when he was deathly sick. He was down to 8.75 lbs at that time. Before all this started, I'd say he was about 15 pounds. I never weighed my cats back then, but the feel of him is comparable to what my other cat weighs, and I've since weighed her & she is 15 pounds. I have been administering only 1 unit of Lantus now, typically only once/day, and only if his glucose is above 200. Using a Lantus pen we don't really have the ability to administer in anything other than a full unit increments. His behavior has seemed slightly improved since I cut back to 1 unit, but not markedly enough that I could say for sure. With that, I have also been more proactive about intervening as soon as I see him approaching toward Keiko. I'm also quick to respond when I hear his little whiney/growling/underbreath voice that casually comes out just before he intends to pounce on her.

:idea: I definitely like the idea of more frequent meals, and even increasing the volume he's getting. I will definitely look into hockey pucks/aka cat food "cicles'.

You guys - I can't thank you enough for being so helpful and sharing your personal time with me as I try to figure this all out. This has been a complete life change for me & my family. I know it's not going to be easy, but I'm willing to work at it. If I can just keep these two from rumbling ohmygod_smile in the middle of the night and waking up the whole family (19 month old baby included) :evil: then it will be much more manageable.

For notable mention - not sure if it matters: I notice that he is doing everything he can to try to sneak outside into the yard. He's never been an outdoor cat. He would sit at the door/window and gaze out (we have a ton of birds that frequent the yard), but now, one instant of an open door and he darts outside. We quickly round him up back indoors, but it's a new behavior. Another new behavior is he is trying to eat anything green (plants). I don't have a lot of houseplants, never have, but he has shown a new interest in them. Also,those times that he darts out the back door into the yard - he always goes straight for the outdoor vegetation plants that are near the door and instantly begins to nibble on them. (Another thing leaning me toward increasing his food intake).

A closing question - we are supposed to go out of town for upcoming Memorial Day weekend. Previously, if we were out of town for a couple of days, the cats were free-fed, so we would have a family member stop by every other day to handle litter needs & check in, but the cats were nearly self-sufficient. We are now looking into arrangements. To board at the vet is cost prohibitive as they want an arm & a leg given "medical needs" and Kato gets extremely stressed at the vet anyway. We've found some in-home pet sitters we like, but so far none have any experience with glucose testing / insulin injections. What do you guys do when you need to be away from your feline needy children? :?:

 

[Deb & Wink]

Glad to hear that Kato likes the wet food and his civie buddy Keiko likes it too. It makes it so much easier when you only have to feed a single food type to multiple cats.

I do think he is still hungry because he is always scrounging looking to sneak food - he managed to get into a bag of meaty dog treats and actually ate those, and I constantly catch him trying to take over the other cat's food bowl as well.

Unregulated diabetic cats are extremely hungry, usually until they are receiving enough insulin to properly process their food. Without enough insulin, the cat is literally starving and needs a higher intake of food, up to 50% more. I would add at least another 1/2 to whole can of food to Kato's diet. A diabetic cat eating 10-12 ounces of food is not unusual. You do not want to overfeed too much because there may not be enough insulin even with the amount of insulin you are shooting to process too much food. There is a weight based formula but I must have missed how much Kato weighs. Ok, I found the weight, 10.5 pounds so 10.5 *15 calories = 158+70 = 230 calories + 50% = 341 calories

Are you adding water to his food, say 1/4 to 1/2 can extra water and mixing?

If the meaty dog treats were something like jerky or a pure protein source that is ok. Something else with some grains in it will raise the BG numbers so you want to keep those locked away in a cabinet. We think of that as a kitty getting into contraband.

I am not sure if I'm testing at the right times/frequency, I have to spend some time researching that.

1. Pre-shot. To make sure your kitty Kato has a BG high enough to be safe to shoot the insulin.
2. +2 to get an idea if your cat is rising or dropping. a drop indicates an active cycle and you will want to test more.
3. +6 plus or minus an hour. to find what the nadir or low point is for your cat
4. random times throughout the day and night, over a several day period to get more of a snapshot of what is happening during different times.
5. a before bed test. Many cats tend to drop low overnight. It's nice to get a daily before bed test to give you more data to work with. A lot of people work during the day and this is a good opportunity to get another test number
6. when the cats wake you up in the middle of the night and you need to go quite down your 19 month old (just a little levity here but if you do get up in the middle of the night for something, another test is always an option)

The most important tests are the pre-shot tests in the AM and PM and you already said you were doing those. At least one other test sometime during the day would be very helpful, especially around the normal nadir time of +6. That before bed test is a nice to have. We may want to see some other times but this gives you some ideas for when to test.

We are using Binky's Page for food suggestions and staying below 10% carbs.

Binky's page is a good place for food suggestions but there is a more current, up-to-date food list on Dr. Lisa Pierson's website, catinfo.org with carb content for most commercially available foods in the USA. See here: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Using a Lantus pen we don't really have the ability to administer in anything other than a full unit increments.

You can use insulin syringes to draw the insulin out of the pens. Insulin syringes with 1/2 unit markings will let you fine tune the dose. Reliion syringes available at Walmart 3/10cc, 5/16" needle, 30 gauge, with 1/2 unit markings, box of 100 will cost you about $12.80. Most states require a prescription for insulin syringes.

I have been administering only 1 unit of Lantus now, typically only once/day, and only if his glucose is above 200.

Lantus is best dosed in cats on a 12/12 schedule twice a day because of a cat's rapid metabolism and the duration of the lantus is not 24 hours. So by dosing once a day as you are doing, your cat is running out of insulin and his numbers are going higher once he runs out. We want to find a dose that you can give Kato twice a day to keep his numbers more even and the insulin always available to him.

What do you guys do when you need to be away from your feline needy children?

I have seen all of the following suggestions from other posts on this board. Hire a vet tech from your local animal hospital. Take the cat with you. Take separate vacations. Have multiple family/friends come to feed more often and teach the family/friend how to home test and shoot the insulin. Reduce the dose by half if someone else is taking over. Post on Care.com to find an experienced pet sitter with diabetes experience.

 

[hmjohnston]

:razz: All - thank you so much for the replies. I feel awful, I had thought when someone replied it would email me, but I didn't get any notification, so I am sorry I am just writing back now. OK, let me try to clarify on topics that came up:

It will- you just have to make sure at the bottom of your email and before the review starts you have the box checked for the last item- notify me when a reply is posted

Feeding each cat 1/2 can in morning, and 1/2 can at night, but may increase that based on what you all have shared. I do think he is still hungry because he is always scrounging looking to sneak food - he managed to get into a bag of meaty dog treats and actually ate those, and I constantly catch him trying to take over the other cat's food bowl as well.

Feeding more is better for right now and the multiple meals will help. You will be able to tell when his body is getting the nutrients required when the food intake goes down.

We are home testing and always test before giving insulin. (Reli-On Meter from Walmart). I am not sure if I'm testing at the right times/frequency,

Testing- before food/shot at the AM and PM. Most cats have a food spike 2 hours after eating, so maybe try for a +4, +6, or +9 after shot. At +10 the food needs to come back up so you get a fasting BG for the next shot.

I have been administering only 1 unit of Lantus now, typically only once/day, and only if his glucose is above 200. Using a Lantus pen we don't really have the ability to administer in anything other than a full unit increments. His behavior has seemed slightly improved since I cut back to 1 unit, but not markedly enough that I could say for sure.

I would advise you to get the syringes and use those. The needles that come with the pen are not as accurate as a syringe is and you are also able to get ones with half unit markings to help with dosing. Also- if you can only shoot once a day you need to halve the dose to shoot .5u twice a day (BID). That way the insulin is a buffer the whole time rather than half the time.

This has been a complete life change for me & my family. I know it's not going to be easy, but I'm willing to work at it. If I can just keep these two from rumbling ohmygod_smile in the middle of the night and waking up the whole family (19 month old baby included) :evil: then it will be much more manageable.

I use those times to get up in the middle of the night and test. it usually happens around the +9 or +10 anyway.

we are supposed to go out of town for upcoming Memorial Day weekend. Previously, if we were out of town for a couple of days, the cats were free-fed, so we would have a family member stop by every other day to handle litter needs & check in, but the cats were nearly self-sufficient. We are now looking into arrangements. To board at the vet is cost prohibitive as they want an arm & a leg given "medical needs" and Kato gets extremely stressed at the vet anyway. We've found some in-home pet sitters we like, but so far none have any experience with glucose testing / insulin injections. What do you guys do when you need to be away from your feline needy children? :?:

I have my family that come in (or mine go to their house- Granny visit!!!). I taught someone at church to test/shoot and they come in and do the LB and feed twice a day. I used a feeder at that time and it was set to turn at specific times. Teach the pet sitters- I did that as well when it came to Christmas vacation and all my other caretakers where otherwise occupied. You must stress, however, that you need to know the number before they shoot. Or, if you will be out of pocket, give a no shoot # (usually 200). Rather high for a time than low with no one home to do prevention.

 

[BJM]

Until he is regulated, he'll feel more satisfied with about 50% more food, spread out into 4 meals or more per day, so he doesn't get too hungry.

Having 1/3 to 1/2 of each regular meal frozen will let him nibble on the frozen as it thaws, thus spreading out the calorie intake.

Alternatively, an electronic feeder may be used - the PetSafe 5 gets pretty good reviews here.