Brittle Diabetes

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As for the free feeding, a lot of us do that here because it's easier on the pancreas to deal with small, frequent meals than to deal with just a couple huge meals, but you'll want to take her food up for the 2 hours before shot times, so that when you test, you get a "true" reading without the influence of any food

Are you signed into Google when you try to enter your numbers on your spreadsheet?
 
Add me to the list of people that think it's a very bad idea to only shoot once a day. Lantus works on a 12 hour cycle, so that's like taking a 12-hour cold medicine once a day - you're only getting half the benefits. Meanwhile, Lily's BG could skyrocket and ketones return and she'll end up back in the hospital.

Yes, a cat can go lower and lower. In general, we want them to do that, but at some point in the cycle, as the insulin wears off, the numbers will climb. If they don't, there are other factors at play: too high of a dose, the pancreas is producing insulin on its own, or some illness or condition is factoring in. When your vet says he has "seen this happen", does he mean just once? Or frequently? Big difference. ECID - every cat is different, but most cats respond in a similar fashion, and that isn't it.
 
Are you signed into Google when you try to enter your numbers on your spreadsheet?
I can see all the colour coding where data has been entered on the World mmol/L tab, Chris, but I can't see the numbers. Bizarre. :-/

@Rkdavid -

Delighted to hear your baby's due home tomorrow, Becka. :cat:


Mogs
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I've been here over 6.5 years and I don't think I've ever seen a cat do well on once a day dosing. It would be better to be shooting 0.5u twice a day and monitoring Lily's BG numbers closely. You can always provide high carb food to counterbalance any low numbers and if necessary, once we see how Lily fares, reduce the dose.

My other concern is that Lily may respond with lower numbers and then either due to the insulin wearing off or due to the effect of lower numbers, bounce into high ranges. Regardless of why, Lantus is a gentle insulin and it doesn't "yank" numbers down. This could put Lily at risk for developing ketones.

Please get the blood glucose results from your vet and post them on your spreadsheet. It will help us to understand how Lily has been doing and what may make sense in terms of dosing.

 
I'm wondering why he has said only once a day then? That is very odd. How odd you can't see any numbers! I haven't written on the US sheet, just the mmol/l.

I will question him on why he has done this, maybe I'll bring him round to twice daily. Does seem odd.
 
Do you think 0.25 iu would be better? She had her insulin at 8am today and at 6pm she was at 5mmol/l
 
Personally, for a DKA cat, I think she should be on no less than 1u every 12 hours.

I can fix the SS for you. I will send you a private message and if you will give me editing rights, I can fix it. Look in the upper right corner of this page, click on "inbox" and you'll see a message from me.
 
I will ask for a full copy of her clinical notes and actually read what the vets have written. They said she may have slipped into acidosis, leading me to believe it was DKA. All will be revealed tomorrow.
 
Becka and I were conversing about the SS in a PM and she had this question which I am posting here.

Lily-Fish said:
I was told if she is low to skip the insulin. Is it the case that I should instead feed a high carb meal and retest in an hour? If so, how will I manage to keep to the 12 hr lantus cycle and get to uni/work in the morning without waking up at 5am and having to somehow either extend the cycle or leave uni much earlier than allowed?

My response: In the Lantus/levemir forum, we tell the caregivers that if you get 150 or under at shot time, do not feed!!! Post for help. We don't want you shooting a food spike and then have her come tumbling down on you. We might have you stall a wee bit (20-30 mins) or have you shoot a reduced dose if you can't stall since you have to go to uni in the morning. If she goes up really high, you can shoot a bit early. We can help you through this and usually get some insulin in her.
 
I will ask for a full copy of her clinical notes and actually read what the vets have written. They said she may have slipped into acidosis, leading me to believe it was DKA. All will be revealed tomorrow.
  • I just want to let you know that you have some of the most experienced eyes offering their guidance and I know it is difficult to think that vet may not be giving you the best advice. Just remember the vet only knows what they know --what they were taught (who knows how long ago)
  • In the end it is you holding the syringe and I am sure you will do what you feel is best. I guess I just wanted to let you know that you are being "submerged" with unbelievable knowledge and real life/ hands on experience of all different kinds of scenarios and illness that affect diabetes. Many vets prefer to be (over) cautious especially if they think you are not testing or testing enough.
  • Good luck --:cat:
 
Yeah, I think my vet doesn't quite understand things precisely. However, I called today and her sugars have been normal on the 0.5 iu once daily. Still will challenge him on that frequency. But apparently she appears to be responding!
 
Happy dance! :cat:


iu
 
Honestly so much better than when I got her home on friday. I think she was having a full on hypo weekend. She is playing, engaging with me and having lots of love. I think she is a very happy girl. Todays numbers on the sheet. She is drinking but not eating yet, however she has put on a bit of weight :)
 
Ooh, we like news like this! I'm sure she's absolutely thrilled to be reunited with her mama bean. :)

I love all of Lily's AKAs. :cool:


Mogs
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So I just home tested for the first time. Cherry = Popped.

Lily is at 23.8, which is 428 US but the vet still doesn't want insulin twice daily. I am worried she will have another episode overnight. I know it takes a while to get to thirty. So, It took 4 hours to get to 23.8 from 21.9. so thats 1.9 in 4h. So say we go up 1.9 every 4h. Thats about 4.4 increase by the time I get up. I just don't want her in the danger zone. If my calculations are correct it'll be 28.2 (508) by shooting time...That is very high!

The vet says she needs to stay on this dosage until next week.

Hmm..
 
Congrats on starting to home test. The pair of you are off to a flying start! :)

the vet still doesn't want insulin twice daily.
In those numbers I think your vet is wrong. I think your vet is doubly wrong because Lily is ketone-prone and has a history of DKA. It is imperative that Lily receive enough insulin. You need to get to a dose that keeps her in safe numbers all day and which allows you to give two doses a day.

If Lily were mine I'd be looking to change vets. In a hurry. (And I'd include questions about how the practice works with cats who have a history of DKA as a major part of the interview for any potential new vets.)

If you're not already testing for ketones at home get some urine test strips today and start monitoring daily.

Is Lily eating OK?


Mogs
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She is literally more cat than she has been in a long while. She is playing, grooming, eating and drinking well, peeing and pooing...and all that other cat stuff!

The higher numbers don't seem to outwardly affect her anymore. I'll test in an hour and see where we are with it all.

I definitely realise I need to be giving more insulin than I already am. There was a caninsulin syringe with her lantus so I don't even know what dose she was having...it feels like the people at my vets don't understand enough.
 
The vet has actually seen this happen, she is higher, she gets her dose and then for the next twelve hours she just continues to get lower and lower. He talked through all of the BG tests he did over the day and how the glucose just kept dropping.
This pattern may not necessarily indicate that a cat is responding really well to a given insulin shot.
We can also see this kind of pattern when a cat is simply 'dropping out of a bounce'.

When a cat's blood glucose drops too low her body can respond by releasing stored glucose into the bloodstream to raise the blood glucose level. The effect can be quite dramatic as the blood glucose rebounds to a much higher level. In FDMB-speak we commonly refer to this as 'bouncing'.
The body can also release counter-regulatory hormones the purpose of which is to try to keep the blood glucose high for a time (temporary insulin resistance). It's a protection mechanism. The effect can last up to a few days. But when the effect wears off the body will resume it's previous response to insulin. The blood glucose will drop again. And it's not at all uncommon to see the blood glucose continue to drop throughout the course of a day.

I concur with others here that it is highly unusual for a cat to only need one insulin shot a day. And for a cat who's experienced DKA it is extremely important that she has insulin in her system for as much of the time as possible.

(Incidentally, my own cat is one of the 'highly unusual' ones that sometimes needs only one insulin shot a day. He is something of an oddity. But I think it's because we're on a particularly long lasting insulin (Hypurin bovine PZI) and his pancreas works sufficiently well for him to be able to 'coast' for a while on his body's own insulin once his blood glucose has dropped to a certain level.)

Waving 'Hi' to you from Surrey, where it looks like being another sunny morning...
:)

Eliz
 
She is ... eating and drinking well ...
Excellent news! :smuggrin:

Going forward, you need to remember the following:

Not enough food + not enough insulin + infection (or other illness) = big risk of DKA.

Given that you know without a shadow of doubt that Lily is a ketone-prone cat you'll need to regularly monitor for ketones. Day to day it's more economical to do so with urine reagent strips but I'd still recommend the blood ketone meter to you because it can tell you 'in real time' what Lily's system is doing; invaluable when there's need for closer monitoring. A trigger to monitor more closely might be on a day when Lily's appetite may be a bit off. Keeping Lily properly hydrated is important, too, since that helps to flush ketones from the system.

There was a caninsulin syringe with her lantus so I don't even know what dose she was having...

:eek:



Thank goodness you're now home testing.

... it feels like the people at my vets don't understand enough.

This is my worry, too.


Mogs
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So yeah, 32.5...Hmm...that 32.5 would easily have been only about a 15 had she had 0.5 u in the evening as well. I'm not a vet, but I know this!
I have been blindly following someone who doesn't really understand what is going on and I feel like a bit of an idiot!

I will look into the ketone monitors although at the moment, the vets bills are now so crippling it is unlikely I will be able to buy anything for the foreseeable future! Maybe just the little sprinkles.
 
OH! Haha, Sorry!. So I just gave her her 0.5 iu. I'll check on her in 6 hours. She is really upset with me for testing her. It seems that it actually hurts her :(
 
Don't let her reaction get you down. Right now it's not as easy to get blood from her ear, but in the future, as her ears develop more capillaries from previous ear pokes..the pain will lessen and she'll become an old hand. Try to get at the very edge of the ear if possible, at the outer edge of the 'sweet spot'. Very few pain nerves there, and any jumping is more from the surprise of getting her ear pinched, than actual pain. Remember..say it over and over..".it's for her own good."
 
OH! Haha, Sorry!.
I'll let you off. This time ... :p ;)

Not sure whether anyone has sent you a link to these useful resources on home testing:

Home testing links and tips

Testing and injecting tips (great ear diagram on this one)

Especially in the early days it helps to warm the ear longer than you think might be necessary. As you continue to test more capillaries will form in the test zones and it will get progressively easier to get a blood sample.


Mogs
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Many thanks for this. The vet seems to think poking the tiny veins from the top of the ear is the way to do it. As it is, I haven't been able yet to get the sweet spot from the edge of the ear. I think it is hurting her going from the top. Plus, with the lancet I don't know how far to push it in! I will get on the homework for now! I have 4.5 hours to figure it out. Plus, the little terror doesn't really like the Thrive treats I got for her!!
 
Plus, the little terror doesn't really like the Thrive treats I got for her!!
Lily! :eek: You thundering ingrate!!! :rolleyes:

Try poaching a chicken breast and cutting it up into little treat-sized pieces. Keep some in the fridge and freeze the rest in small quantities so you only need to defrost enough for a day at at time.

Try folding a sheet of kitchen paper in four lengthwise and cutting it up into 1" strips. Put a thin film of Vaseline onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. Once you have the ear warmed put the strip round your index finger then place finger under the ear you're testing. Use your thumb and middle finger to lightly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much). When it comes to poking, make sure you have the bevelled edge of the lancet face up. Try using the lancet freehand at a slight angle. When it comes to the actual poke think about how you'd quickly prick a balloon with the tip of a needle to make it pop. (Hope that makes sense. o_O )


Mogs
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Lily! :eek: You thundering ingrate!!! :rolleyes:

Try poaching a chicken breast and cutting it up into little treat-sized pieces. Keep some in the fridge and freeze the rest in small quantities so you only need to defrost enough for a day at at time.

Try folding a sheet of kitchen paper in four lengthwise and cutting it up into 1" strips. Put a thin film of Vaseline onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. Once you have the ear warmed put the strip round your index finger then place finger under the ear you're testing. Use your thumb and middle finger to lightly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much). When it comes to poking, make sure you have the bevelled edge of the lancet face up. Try using the lancet freehand at a slight angle. When it comes to the actual poke think about how you'd quickly prick a balloon with a needle to make it pop. (Hope that makes sense. o_O )


Mogs
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You're a GENIUS. I just got a lovely sample from Lily so easily (I had to use two strips but I managed to hit the sweet spot twice. She is just a wriggler)

I am genuinely so thankful for all of you lovely people. The amount of anxiety you've taken from me is immense!

She is sleeping in the sun as we speak. I am apprehensive about leaving her til next friday on this dose of insulin. I might try to do a curve on wednesday and then just present my results to the vet. She is at around 370 and rising. I think she needs 0.25 BD.
 
Hey, I have posted this in the lantus forum, but no reply yet. Just a bit worried because her sugars have gone up since I injected her this evening. I have no idea how this has happened. Numbers are on the sheet.

Is there any reason this could happen?!
 
A rise in the first couple of hours can be perfectly normal for Lantus. Its onset isn't immediate or harsh like some of the other insulin. You've also usually just fed It looks like you reduced your dose tonight so that may affect things too.
I know you are worried about hypos, but that 27.1 was a pretty high number and you could have probably shot the 0.5U. You might see some higher numbers with giving less insulin.
 
Heh...Lily, we can all declare ourselves to be blood kin of our kitties. :p:cat: Mingling our blood because we 'missed' or went too deep into the ear, is a common happenstance when we're new and nervous.

I rather like the outer edge of the ear..but the tip is ok too.o_O Not as much space to choose if you keep to the tips, though. I think there is, or was, a member who used her flashlight, and went ALL OVER the ear in her quest for the best spot on her kitty.

Remember to alternate ears, ok?:bighug::bighug::bighug:
 
Heh...Lily, we can all declare ourselves to be blood kin of our kitties. :p:cat: Mingling our blood because we 'missed' or went too deep into the ear, is a common happenstance when we're new and nervous.

I rather like the outer edge of the ear..but the tip is ok too.o_O Not as much space to choose if you keep to the tips, though. I think there is, or was, a member who used her flashlight, and went ALL OVER the ear in her quest for the best spot on her kitty.

Remember to alternate ears, ok?:bighug::bighug::bighug:
Lily has a little gap I have found on the outside of the ear at around the midway point. She doesn't seem to care too much if I poke that area (as long as there is a treat after- but not the treats I bought, oh no, she wants the real deal) . She has had a small piece of salmon (plain cooked- treat size) she apparently adores. Why she couldn't adore the package of freeze dried salmon pieces I bought I don't know! Finicky princess :D

Her sugars were 27.6 this morning, more acceptable...shot .5 and will shoot .5 tonight.
 
Well done for learning to hometest - and for finding acceptable treats! :cat:

Do we know your name? What would you like us to call you? (Sorry if I missed it... :oops: )

Eliz
 
Oh, sorry, I'm Becka. I come from Norwich UK. Lily pie is 12 and comes from Carlisle...I feel like I'm writing her a speed dating application.
Likes: playing with feathers, watching Obese: a year to save my life, and eating.
Dislikes: cats who think they know it all, cats who don't like commenting on Obese: a year to save my life, and cats who love themselves too much.

:)
 
Ok, so you play with feathers, and Lily watches "Obese: a year to save my life"? Or do the both of you watch and play with feathers? :smuggrin:

Just teasing, Becka:bighug: Since I play with Gizmo and Dottie, waving a Da Bird toy at them for about an hour a day, you might say I play with feathers, too:p And my kitties DO watch television, although they have a short attention span. Gizmo likes to watch "House", a show about a cranky doctor. I'm not sure what draws him to stare at a crabby human. And Patches, my surrogate mommy cat, would race to the screen if there were kittens being shown.

That little space you found, on the outer edge of the ear, is exactly the "sweet spot". Most of us test right there, too. It's possible to poke the center pad of the foot, too...some kitties mind that even less than the ear. The skin is a wee bit thicker there, though..my Dottie doesn't like it much.

Sick kitties have a perverse habit of not drinking, just when they need body fluid most. And when they get dehydrated, they can crash and burn pretty fast. :banghead::arghh::banghead: Have your vet outfit you with a bag of fluid, a tubing kit, and some 18 gauge needles, and teach you how to rehydrate your kitty if she gets stubborn about drinking. The 18 gauge needle can look daunting, but if you keep the beveled edge of the point on the top when you slide it in, it's only a pinch for a second..and the scruff area where you will do the poke, doesn't have many nerve endings. :cat:One member here even has her cat sit on her lap when she does fluid rehydration..it bothers her kitty so little that the prospect of sitting on Mom's Lap makes the whole process a pleasure instead of something to be feared. You'll be able to tell if she's low on fluid by pinching Lily's skin...if the skin snaps back quickly, she's good to go; if the skin stays tented for a second before it slowly slides back down...she needs a refill.

This will help you both to sleep better, knowing that if all she needs is a drink to set her right..you can do it without the added expense of hauling her, (and stressing her:nailbiting:) to the vet. Since you will probably be taking your kitty to the vet more frequently than is routine for kitties without health issues, they will usually agree to this. Rehydration can save lives..particularly since, at least for me...they always seem to need fluids over a weekend when the vet is not commonly available here.
 
Ok, so you play with feathers, and Lily watches "Obese: a year to save my life"? Or do the both of you watch and play with feathers? :smuggrin:

Just teasing, Becka:bighug: Since I play with Gizmo and Dottie, waving a Da Bird toy at them for about an hour a day, you might say I play with feathers, too:p And my kitties DO watch television, although they have a short attention span. Gizmo likes to watch "House", a show about a cranky doctor. I'm not sure what draws him to stare at a crabby human. And Patches, my surrogate mommy cat, would race to the screen if there were kittens being shown.

That little space you found, on the outer edge of the ear, is exactly the "sweet spot". Most of us test right there, too. It's possible to poke the center pad of the foot, too...some kitties mind that even less than the ear. The skin is a wee bit thicker there, though..my Dottie doesn't like it much.

Sick kitties have a perverse habit of not drinking, just when they need body fluid most. And when they get dehydrated, they can crash and burn pretty fast. :banghead::arghh::banghead: Have your vet outfit you with a bag of fluid, a tubing kit, and some 18 gauge needles, and teach you how to rehydrate your kitty if she gets stubborn about drinking. The 18 gauge needle can look daunting, but if you keep the beveled edge of the point on the top when you slide it in, it's only a pinch for a second..and the scruff area where you will do the poke, doesn't have many nerve endings. :cat:One member here even has her cat sit on her lap when she does fluid rehydration..it bothers her kitty so little that the prospect of sitting on Mom's Lap makes the whole process a pleasure instead of something to be feared. You'll be able to tell if she's low on fluid by pinching Lily's skin...if the skin snaps back quickly, she's good to go; if the skin stays tented for a second before it slowly slides back down...she needs a refill.

This will help you both to sleep better, knowing that if all she needs is a drink to set her right..you can do it without the added expense of hauling her, (and stressing her:nailbiting:) to the vet. Since you will probably be taking your kitty to the vet more frequently than is routine for kitties without health issues, they will usually agree to this. Rehydration can save lives..particularly since, at least for me...they always seem to need fluids over a weekend when the vet is not commonly available here.

We both watch it! She plays with the feathers. We have a lot of birds around our area and the pigeons leave feathers all over the place! Lily LOVES House...Again, no idea what she likes about an arrogant Hugh Laurie...She does weigh in on a lot of shows (Commenting and giving her opinion).

I have been meaning to ask about fluids, but every time I have gone in I have forgotten to. Lily has been drinking and eating well. Her numbers for today have actually been very good. Not sure about what will happen with her overnight numbers if I give her half a unit this evening too.

I guess I will just have to monitor her. But she's not too bad today.
 
Those numbers today are good to see, Becka. Lily's responded really nicely to today's shot. And it looks like she may be dropping out of a bounce (triggered by hypo a few days ago, maybe...). ...Will you be able to get a couple of tests in after this evening's shot...?
.
 
I will be able to get +2 and maybe +6 but it would require me to stay up until 0400! However, I am so worried about a hypo I likely will do this anyway...

Plus, what if her numbers are mega low in the morning...where do I go with that?
 
Ok, so you play with feathers, and Lily watches "Obese: a year to save my life"? Or do the both of you watch and play with feathers? :smuggrin:

Just teasing, Becka:bighug: Since I play with Gizmo and Dottie, waving a Da Bird toy at them for about an hour a day, you might say I play with feathers, too:p And my kitties DO watch television, although they have a short attention span. Gizmo likes to watch "House", a show about a cranky doctor. I'm not sure what draws him to stare at a crabby human. And Patches, my surrogate mommy cat, would race to the screen if there were kittens being shown.

That little space you found, on the outer edge of the ear, is exactly the "sweet spot". Most of us test right there, too. It's possible to poke the center pad of the foot, too...some kitties mind that even less than the ear. The skin is a wee bit thicker there, though..my Dottie doesn't like it much.

Sick kitties have a perverse habit of not drinking, just when they need body fluid most. And when they get dehydrated, they can crash and burn pretty fast. :banghead::arghh::banghead: Have your vet outfit you with a bag of fluid, a tubing kit, and some 18 gauge needles, and teach you how to rehydrate your kitty if she gets stubborn about drinking. The 18 gauge needle can look daunting, but if you keep the beveled edge of the point on the top when you slide it in, it's only a pinch for a second..and the scruff area where you will do the poke, doesn't have many nerve endings. :cat:One member here even has her cat sit on her lap when she does fluid rehydration..it bothers her kitty so little that the prospect of sitting on Mom's Lap makes the whole process a pleasure instead of something to be feared. You'll be able to tell if she's low on fluid by pinching Lily's skin...if the skin snaps back quickly, she's good to go; if the skin stays tented for a second before it slowly slides back down...she needs a refill.

This will help you both to sleep better, knowing that if all she needs is a drink to set her right..you can do it without the added expense of hauling her, (and stressing her:nailbiting:) to the vet. Since you will probably be taking your kitty to the vet more frequently than is routine for kitties without health issues, they will usually agree to this. Rehydration can save lives..particularly since, at least for me...they always seem to need fluids over a weekend when the vet is not commonly available here.

https://m.flickr.com/#/photos/139965299@N04/25169805689/
Lily, with her feather!
 
Much better numbers on the AM cycle, Becka. Far better than those ugly blacks last night. Can't have been much fun seeing those appear on Lily's meter.

I hope that your vet takes on board what the BG data is showing.


Mogs
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So, I have to leave Lily because I'm taking my mum to lunch. She is at 3.3 now. I have left some food out for her but now I'm worrying. She is a symptomatic
 
How long after her shot did you get the 3.3? Her preshot showed as 24.1. That is a HUGE drop!!! You said she was symptomatic. How is she acting?

Could you retest to make sure the number is correct?
 
4 hours! She is eating really well and is wandering in and out of the room. I've had to leave her now...I put a bit of high carb down. She is eating it. I hope it's okay!
 
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