Choco and I are Newbies and need input please!

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marleesan71

marleesan71

Member Since 2011
Hello everyone. My name is Maria and my cat Choco was recently diagnosed with diabetes. Choco was a 22lb medium haired black kitty and now he's down to 17lbs. I know that is a much healthier weight but I am now feeling his spine and that's not good. At the vets office last week, his blood sugar reading was in the mid 300's. I just started testing him myself yesterday and so far have only had to give him one shot of insulin (Lantus) because he was at 254. This morning and also tonight he was at 245 so I did not give him any insulin because I was told not to give him any unless he was over 250. He didn't really have an appetite tonight although when I first put his can of food out he was licking at it. I force fed him about a syringe full and then he ate a piece of turkey lunch meat. I am concerned about him because he is just acting very "blah". He is just kind of laying around and although he is fine to get up and walk (he's not wobbly), he doesn't really seem too interested in doing much more than laying down. I can tell he does not feel good by the look in his eyes. I did take his sugar level again a half hour after the first time I took it and he had that little bit to eat and the reading was 240. I need to do the curve test one day this weekend so any advice on what I should be doing would be great! I also picked up some keytone strips tonight (after going to six different stores;O) so I guess when I can catch him urinating then I can test those as well. I'm really tired, stressed, a little confused and a lot worried about Choco.

Update: I just checked his blood again (this is 3 hours since the first test at 7:15) and his number is now 229. I'm not sure if that's a good or bad thing.
 
I can't help with the dosing. Experts will be along to help.

Did you get blood work done? Did you get a copy of the labs? Were his results all normal but the BG?

What are you currently assist feeding Choco and how much per feeding and per day?
 
hello and welcome to lantus Land, Maria and Choco. I'm glad you found this site...I'm hoping that you have read the stickies at the top of the page so you have a little more idea of what is going on.
You said that Choco isn't acting himself, well he probably doesn't feel to goo with his blood sugar being so high. Once he gets regulated, he will start to feel better.
There will be more people stopping by and they will have a few questions...How much insulin are you giving to Choco, what type of food are you feeding...can you start a spreadsheet...all of this information will come in handy.
I will be heading off to bed in a few minutes...long long day at work and my guys (3 cats, one drooler) are getting tired of waiting for their nini snack and me to get up to go to bed, but there are some night owls around.
 
Welcome to Lantus Land.

I suspect we take a bit of a different approach than your vet.

The first thing I would strongly encourage you to do is head over to a pharmacy and get a package of Ketostix. I think you will want to test for ketones. The sticks are a strip of plastic with what looks like a paper patch on the end. You dip the absorbent end in Choco's urine. If you can catch him while in the box, that would be ideal. Once the strip is wet, wait 15 seconds and compare the color to the colors on the chart on the Ketostix container. You should see no ketones or at the very most, trace levels. Ketones are very dangerous. If you smell an acetone odor on Choco's breath, that's ketones and you need to go to the vet. Aside from needing to test for ketones in any unregulated diabetic cat, most unregulated cats are very hungry. I'm just hoping that Choco is having an off day but testing for ketones is a very wise precaution.

I'd also encourage you to read the starred, sticky notes at the top of the Board. There is a HUGE amount of information in those notes. They cover our dosing protocol, getting oriented to the group (including our slang, how to do a curve), how to care for your insulin, and key concepts like the depot/shed as well as how to become data ready.

We encourage new members to give a shot if numbers are above 200. If you have a pre-shot number that's between 150 - 200, you have several options and we are happy to help you if you have a pre-shot number that is lower than what you're comfortable shooting. Most of us work to shoot low numbers. The mantra here is, "shoot low to stay low" -- provided you have the data to support giving a shot. Our goal is to get our kitties into remission or have them tightly regulated on as low a dose of Lantus as possible.

I see from you post on Health that you're feeding Choco Fancy Feast Classics. You may want to take a look at Janet & Binky's food chart to make sure that you are feeding low carb varieties (i.e., less than 10% carbs -- although most of us probably feed less than 6%).

We also keep track of our test data on a spreadsheet that we link to our signature. You can find instructions for setting up Choco's spreadsheet in the Tech Support Center.

I hope that you will decide to continue to post here regularly. The members of the Lantus group are generous with their time and information. Please visit our condos (it's what we call our thread/posts) and look at our spreadsheets. It's a great way to learn.
 
Welcome to LantusLand Maria! There are lots of folks here to help with your questions. Do check out the food charts Sienne mentioned, click on the old list to get the data on Fancy Feast.
 
Welcome to Lantus Land Maria and Choco!! Sienne gave you tons of great info!!! She's one of our wise ones who can help you with dosing suggestions, etc. We're all here to help and we've all been exactly where you are now. It's wise to check for ketones as Sienne suggested....I test Gracie every day that she is not in totally normal numbers. But also, the first couple of weeks Gracie was on insulin, she was still lethargic and acted like she did not feel well. It didn't take too long, though, before she returned to her normal, silly, playful self. Ask questions...hope you will stick with us. It is an amazing group.
 
Thank you all so much for your information. As some of you may know, it was a rough weekend for Choco as he ended up in the Animal Emergency Clinic due to being DKA. He came home yesterday and seems to be doing much better. I am now giving him 2 units twice a day. I am getting help setting up a spreadsheet so that will be up shortly. I have a couple of questions.

1. I accidently shot probably only a drop of insulin back into the pen this morning when I was pulling it out. I know you are NOT supposed to put any amount back into the pen because of the powder in the syringe. Did I just ruin my whole pen of Lantus? ;O/

2. My has never prescribed Lantus and is not familiar with it other than an article or two she has read. Does 2 units sound like the right amount to be giving Choco? He is 17lbs and his BG numbers have generally been in the mid 200's. This morning he was at 242.

I have gone out and bought the keytone strips and was able to test him yesterday. No keytones but a high amount of sugar.

Thanks for all y'alls help! This is the first day since his emergency that he's been without somebody looking after him (I'm at work) so I hope he's okay.

Maria
 
Did you leave any extra food out for him, Maria?
Most of us use automatic timed feeders to give our cat's a meal around nadir time. And I, and others, will freeze cubes of Fancy Feast and leave those out to slowly defrost.
 
Hi Maria: Welcome to LL. You are in great hand here. Sorry you had such a bad weekend. Some in LL have experience with DKA. Post daily, ask questions and read condos and SS. Lots to learn but it will all be second-hand soon. You can leave out catsickles (freeze cat food in ice cube trays) when you are at work. We tend to feed small frequent meals. Yes, they are very hungry initially. Good luck and again, WELCOME TO LL.
 
Welcome back Maria. Several of us have followed what transpired over the weekend. Likewise, there are several of us who have cats that have survived DKA and know just how serious it can be. (It was why, when you described what was going on with Choco on Friday, that I suggested you test for ketones.) The good news is that Choco is home and doing well.

The chances are good that your Lantus is fine. If you see any "floaties", if the insulin becomes cloudy, or none of us can get a handle on Choco's numbers, then you should get new insulin. There's information in the starred, sticky note at the top of the board about caring for you Lantus if you have questions.

I know there was some discussion on Health about a starting dose. Providing Choco is around his ideal weight, according to the Tight Regulation protocol that we use here, your starting dose would be 1.93u. I think 2.0u sounds fine. We encourage you to test frequently during this initial period.

If you are home testing, which it sounds like you're doing, I would not rely on urine glucose tests. They are not accurate in the lower ranges and the value they give you is hours old. (Think about how long it takes to fill your bladder and that's how old the data is.) Blood glucose tests give you an immediate level which is far more helpful and the range isn't restricted.

If you are planning on following the Tight Regulation Protocol that we use here, there are several things it will be helpful for you to know. The link to the protocol that was developed by Jacqui Rand, DVM at the University of Queensland in the Tight Regulation sticky.

There are also several aspects of the protocol that you will want to be aware of, most of which I'm assuming Jennifer and Venita have familiarized you with:

  • it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week
  • it is more expensive than most other protocols, but costs can be reduced (e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay or on Amazon or Hocks)
  • members typically buy 3 ml Lantus pens and refrigerate them after opening. When refrigerated, opened Lantus Solostar pens are extraordinarily stable
  • you will need to test the blood glucose levels of your cat multiple times per day. At the beginning, getting a test at pre-shot, +3, +6, and +9 is encouraged.
  • you will need to know about hypoglycemia and be prepared to deal with it
  • you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated
  • you will need to use syringes which allow you to measure tiny doses: U100-type, 3/10 cc = 0.3 ml volume and with the half-unit increments printed on the barrel
  • you will need to feed the right diet: high-quality low-carb canned food or raw food exclusively
  • you will need to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats
I have no doubt that this sounds completely overwhelming, especially after dealing with DKA. However, the community here is incredible! People are very generous with their time and their knowledge. We all remember what it felt like to be new at managing our cat's diabetes. We're all here to help. Please ask questions and please post regularly.
 
Thanks everybody. I did leave the food out that he did not eat this morning to have throughout the day. Should I not do that? Does it have to be frozen? He can have any kind of protien right? I thought of boiling some chicken up for him although I don't know if that might spoil him to the point that I'd really have a hard time getting him to eat his Fancy Feast. I am literally gone for 11 1/2 hours a day so I have to hope that he will nibble throughout the day since I am not there to monitor him. Uuuhh, if I could just win the lottery. :O)
 
Welcome Maria and Choco! I'm glad Choco is home and doing well!

You can leave canned food out, fresh and frozen. If you leave out some of each, then he will have fresh food for now, and then the frozen food will thaw out for later.

I use boiled chicken breast for testing treats, some people also use meat to supplement the diet. If you do that, be careful about the percentage of his diet that is plain meat, as it isn't a complete diet. I think it should be no more than 20% of his diet. You could find out more about that on Dr. Lisa's site, http://catinfo.org/
 
Welcome Maria & Choco to LL,
You have gotten excellent advice and I just wanted to welcome you and give you a tip about the Cat Mate C-20 automatic feeder: It has 2 compartments (with separate timers) and--important for you--has a freezer block that fits under the compartments and helps to keep the food cool. By using it in conjunction with Choco's regular bowl, you can feed 3 meals while you are out at work. Unlike the rotary feeders, once the compartments on the Cat Mate C-20 open, they stay open, so any uneaten food is still available to your kitty.

You have a lot to read and get accustomed to, but you are doing so well. I am very glad that Choco is home from the ER and that he is stabilized.

Ella & Rusty
 
What a relief that he's home already and doing better. That must have been very scary for you both.

The new dose may take several days to "settle" so don't get discouraged. Many of us feed small meals or snacks every few hours, up until about 2 hours before the pre-shot test (so that your BG test is not influenced by food). You'll get the hang of it, especially if you read other "condos" to see what other people are doing.

Choco is very handsome, by the way.
 
It has been very nice meeting all of you. I appreciate all of your guidance. I do apologize if I do not respond back to you all individually but do know that I AM reading every bit of advice as I try to figure everything out. Thanks everybody and have a great day!

Maria and Choco
 
Welcome to Lantus Land! The people here are so helpful! I too am a newbie and my kitty is now doing so much better thanks to these folks here! :smile:
 
I'm glad to see that you've got your SS up and running!!

A quick question -- are you home during the day? If possible, we like to encourage getting at least one spot check, in addition to your pre-shot tests, each cycle. Lantus dosing is based on the lowest point (nadir) of the cycle. As a result, those spot checks are very important.
 
I am usally not home during the day. I telework from home once every two weeks, which is why I am home today. I did check his BG at Noon today and it was 245. I will go and post that on my ss in just a minute. How long before I should start seeing his numbers go down? I'm really going to have to work on some ideas to get him to eat a little more. You mentioned the nadir being the lowest point of the cycle. When exactly is that?
 
marleesan71 said:
I am usally not home during the day. I telework from home once every two weeks, which is why I am home today. I did check his BG at Noon today and it was 245. I will go and post that on my ss in just a minute. How long before I should start seeing his numbers go down? I'm really going to have to work on some ideas to get him to eat a little more. You mentioned the nadir being the lowest point of the cycle. When exactly is that?
Click to expand...


Maria, if you need to syringe a little food right now to supplement each day it's not hard. Tucker gets two meals per day that way. I can post a video on how to do it and I have some recomendations on syringes, the ones from the vet are terrible. You can prepare syringes, store them in a ziploc bag up to three days in the fridge and warm them in hot water. The entire process with Tucker from start to finish is less than five minutes.
 
If it were an ideal world, the nadir would be at +6. However, some cats have early or late nadirs and to complicate things even further, the nadir is a moving target. It can change from day to day or even from cycle to cycle. (These are cats. They love to be unpredictable if for no other reasons than to keep us guessing.)

Given your work schedule, you may want to think about when you're shooting. Would it make sense to shift your shot time so you can get a spot check before you leave and still keep you on a schedule to give your PM shot 12 hours later? Sometimes shifting things by an an hour, or even 30 min., can mean a lot.

Also, on your SS, can you fill in the dose of insulin you are giving in the pale blue column that has the "U" label? (The "U" refers to units of insulin.) That way we'll know what you're dosing and how long you've been giving that dose. Right now, being post-DKA, insulin and water/fluids are the best way to keep ketones at bay. We will want to be aggressive about dosing and you will need to be vigilant about testing for both BG and ketones.

I'd also suggest putting the results of your ketone tests in the "Comments" column. In the comments, you said, "Catching a cold." If Choco is sneezing, please stay on top of this. Any infection (or inflammation) can raise BG numbers as well as increase the risk for DKA. You may want to see about ordering some L-lysine. It's an immune system booster. Several of us use it for cats who have allergies or who get sneezy.
 
Just speaking on nadirs, my kitty's nadir is around 4.5/5th hour. I had to keep on checking her BG to find this out though. She is not a +6 nadir kitty at all!
 
I do have L Lysine and I will start putting it on his food. Sienne, you mentioned maybe shifting my shot time. I'm a little confused as to how I would do that so I will tell you my schedule and maybe you can help me out. I check his BG at 6am, feed him and give him his shot at 6:15am. I don't get home until around 6:00pm each day so I stick to the same schedule as the morning. Choco has been asleep for a couple of hours now so I'm hoping he'll have to go potty when he wakes up and I can check his keytones. Thanks for the advice on the ss. I will start to put that info in as well. Somebody did mention to me about being able to fluctuate his insulin according to his numbers and that just has me all confused. ;O/

Jennifer, I will take a look at the videos. He's actually really good about letting me put some food in his mouth and eating it or just eating it out of my hand but a syringe technique is a good idea too. Remember when I was telling you about the guy at work who has a diabetic kitty and how he is feeding it EVO (hard)? Would it be okay if I were to leave just a LITTLE of either Wellness, Evo, or Royal Canine (DS) out for him to eat througout the day? I do leave the wet food out that he did not finish in the morning but by the time I come home, he's only eatin a little of it. I would love for him to be eating more throughout the 12 hours that I'm gone. I hope Tucker is feeling okay today.
 
I forgot to ask a question. Since he is post DKA and he is sneezing with a runny eye and nose, would it be a good idea for me to give him some fluids? Sienne, you said that would help to keep the keytones at bay.
 
It sounds like you've taken your arrival home time into consideration with your AM shot time. I'm hoping that you have at least an hour after you give the AM shot in order to get another test in. Even though it may be early in the cycle, a test at +1 can be revealing. If your +1 is the same or lower than your pre-shot test, it means that numbers are dropping. If you're not going to be home, you will need to be sure that food is available.

I'm not sure who was suggesting that you could fluctuate Lantus dose based on the pre-shot number. That's not the way Lantus works. You want to keep the dose as consistent as possible. (There are other types of insulin, like PZI or Humulin N that base dosing on the pre-shot numbers. Lantus is based on the nadir.) There is only one exception. If you get a pre-shot value that is unexpectedly low, there are times when you may need to shoot what we refer to as a BCS ("big chicken sh*t) dose. This is a temporary dose reduction. If you get a low pre-shot, definitely post and someone should be around to help weigh the alternatives and walk you through the process.

Also, since you're not home most days, you may want to think about a timed feeder. I use a 2 compartment feeder. Once a compartment is open, it stays open so if Choco's numbers are dropping there will be food available. There are other, 5-compartment models, as well.

Just to help you get posting conventions here under your belt, we each open a new thread (we call them "condos") daily. We maintain one condo, per cat, per day. That allows us to keep information current. We also keep the subject lines current with our cat's BG info. The structure is:
date -- cat's name -- AMBG# -- time & BG#​
So for today, Choco's condo would have it's subject line as:
2/9 Choco AMBG-244, +6-245​
We also link our condo's together. You simply copy the URL from the previous condo into the current day's first post.

Dry food, even a lower carb dry like EVO, makes a mess out of BG values. In a word, dry = bad, canned = good. If you're having trouble transitioning Choco to canned food, it's important that he eat. Lisa Pierson, DVM has an excellent website on feline nutrition. She discusses transitioning a cat from dry to canned food.

I would check with your vet about administering fluids. You don't want to fluid overload Choco. If you can add liquid to the canned food,that would be great. Tuna juice or chicken broth may entice him to eat more of the canned food and be a source of liquid. If you can find low sodium varieties, that would be even better.
 
Maria, do you have any fosters right now? I know you had your hands full with Polly and family and they were so sick. I think you have one now, but that one is not sick, right? I know you know this, but with my fosters I wear scrubs when playing with them and use hand sanitizer so I don't get Tucker sick, his immune system is shot :( He's not well today either, thank you for asking.

Do you have FortiFlora? It's great to sprinkle on the canned food, most of my cats can't resist it and you have the added benefit of being good for digestion. Do you think Choco might have a belly ache? I would talk to your vet, but I have found that fluids have helped Tucker feel better and eat food on his own when his belly hurts, however Tucker's situation is completely different, so check with your vet.
 
Good morning, I was just checking to see if anybody was up and could answer a question. Choco's reading was 150 this morning and now I don't know if I should shoot him. I have to get going to work and don't know what to do. I started a new thread on the Lantus area but haven't gotten any response yet. Thanks!
 
I don't think you are data ready to shoot 150, Maria, but you also have the recent DKA to contend with. If it were me, I would shoot one-half his normal dose and expect a slightly higher preshot this evening.

You hold the syringe, you make the decision. I hope you get more input.
 
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