Etta - 4+ years w/diabetes-struggling, making big changes

Status
Not open for further replies.

rix

Member
Hi everyone. My 14 year old cat Etta has been diagnosed with diabetes for at least four years. She has been on vetsulin, but will be switching to a different insulin as it's no longer available. Her dose has been 4u twice a day.

I took this opportunity to do some research, found a lot of information about switching foods, tight regulation, PZI, home testing, etc. I am going to try move her to tight regulation with PZI, although the vet has suggested Lantus. She's not there yet though. And I need some help trying to figure out/understand what's happening to her right now.

When the vet initially told me I was going to have to give this cat shots, I thought this is a death sentence for either her or me. Suffice it to say she is a temperamental tortie. But, it turned out she had no problem with the shots so we both got to live! The good news is that I received my blood testing kit last week, and after staring at it for a day and watching the videos over and over again I got up the nerve to try to use it. Success!

The bad news is that I was prompted to try and use it yesterday evening around 5 pm because she was acting weird, something I've seen a couple of times in the last 6 months. Although she was purring and not crying, she seemed to start acting sluggish, off balance when she was walking, and not wanting to move around. She had to poop but didn't seem to be totally in control of that. After doing all this research, I'm very sad to say that this was probably tied to poor regulation of her diabetes, either over- or under-dosing her.

I tested her and her number was a 38. (Mine was a 108, by the way.) If I'm understanding what's normal, this is too low. She had her vetsulin shot probably about 7 hours before I tested her. Although I am still learning, I was pretty sure that with a low number like 38, I shouldn't give her any insulin. I called the vet. They weren't able to see her because it was too late, but the vet was going to call me back. In the meantime, I got Etta to eat quite a bit of tuna. After a short time, she seemed a little better, able to jump up on stuff, moving around more normally.

The vet called back and said NOT to give her any more insulin last night. The vet said I should take her to the emergency room if number didn't come back up. After a couple of hours, around 7:30 pm, I retested and she was 99, so it seemed ok to wait to bring her in until the next day (today.)

Approx 4 hours after the 99 (around 11:30 pm) -- more than 12 hours after her a.m. insulin -- her level was 319. This worried me, because the vet said not to give her the p.m. shot. According to everything I had read, it seemed like it would be a good idea to give some insulin, perhaps around 1.75u. I was afraid if I didn't give her any insulin her number would be sky high by morning, but I was afraid if I gave her any, her number might drop too low, or interfere with the vet's instruction to not dose her. In the end I decided not to give her any insulin. She did eat again, a little dish of wet food. Not sure if that was a good idea or not.

Her level this morning (around 7:30 am) on the meter was "HI" which according to the manual means above 500. She seems ok, active, a little thirsty and definitely interested in getting some more of that yummy wet food, which I gave her. I was able to talk to the vet around 8:45 am. The vet said to give her 1u at that time, which would be about 2 hours before she will see the vet. Unfortunately, I mucked that up. I don't know if I actually got the 1 unit in, because it is such a small amount and the plunger was hardly raised. (I hate those 3/10cc needles, too small). I'm not used to that, and I may have accidentally pushed the plunger before the needle was in and given a fur shot. I actually did this stupid thing twice. So she got anything from 0-2 units. Not a great way to start to day.

I think she's mostly been fairly regulated over the past 4 years, but the vet has not been able to do curves consistently because she is so difficult to handle. She had the fructosamine tess more. But, given the few episodes I now recognize as hypos or near hypos in the last half year, it's clear she is not as well regulated now. I also am wondering about whether any of that is due to the damn 3/10 cc needles, which the vet switched to in the past six months, and which I obviously have difficulty with. So I feel guilty. While she's currently letting me hometest her, I don't know how long she will continue to allow me. (She tolerated it a lot better when she had a low number than when she was feeling more normal.) I want to switch her to all wet food, and see if I can get her better regulated. I can do extra testing and dosing, etc. initially. But I work a lot and would not be able to test her or give her more than two shots a day in the long run. So I'm worried.

Looking for encouragement and support. Better understanding of what numbers are really normal -- that's confusing. Advice from people who may have switched an old cat with chronic diabetes to wet food, home testing and tighter regulation, how to manage this when you work alot. Thanks.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

I had just a couple questions, to clarify where you are right now.

You are still using the Vetsulin insulin or have you switched to PZI.
Are you using U40 or U100 syringes.

I can't comment on the PZI insulin; after switching from Caninsulin, I have used Lantus and Levemir which are longer lasting insulins.

I ask about which insulin and which syringes because you mentioned that your vet recently made a change, and now you have had a very low number from your cat.

If you do test and get another low number, do feed high carb food, and please test again in 15 - 30min rather than wait a few hours. If the next test shows still a low number and no rise you have to feed again, and possibly prepare to take your vet to ER if the BG won't rise.


Jojo’s HYPO TOOLKIT
How to treat HYPOS – They can kill! Print this out!
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

If you commit to home testing and a better insulin (and I agree with your vet on going the Lantus route), you could very well indeed get this under control.
Congrats to you on taking the initiative. Most if not all members here will advise you to start your new insulin at 1 unit BID (BID is the medical term for twice a day). Your 4 units of vetsulin per day seems way too high and likely caused a huge high-to-low swing throughout each cycle. The goal is to have even numbers throughout the 12-hour cycle, and it takes time to find the right dose: "Start Low, Go Slow." Take your time, ask lots of questions here, and in time you will have a healthier, happier cat.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Please give us more info. Are you still using Vetsulin? Are you using U100 needles? Vetsulin is a U40 insulin so if you use U100 needles, you have to use a conversion chart. With PZI, for example, to give a dose of 4 units, I would draw up to the level of 10 on a U100 needle. So we are unclear how much you actually gave.

The other thing at work here is the diet. If you are changing over to wet lo carb, you need to watch the bg levels very closely. When we switched Oliver from dry to wet, his numbers went down 100 points overnight.

As far as testing difficult cats, many people here start with the clothespin trick Clothespin trick in the beginnng. Be sure to give her a lo carb treat after every test, successful or not. Soon she will associate the pokes with the treats and be more willing to sit still. Promise!
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

I have been using vetsulin with u40 needles. Since this was my last bottle the plan was to switch after this bottle was done. My vet was recommending Lantus, but I had read all this info about PZI and wanted to talk to her about it. So the low number came up before making any change in insulin, although I had just opened a new bottle. And I was giving the cat somewhat more wet food.

Then this situation came up. So, after seeing the vet this morning, we made the decision to switch her to Lantus now, and dump the remaining vetsulin. With the Lantus we'll be using the u100 needles. I feel much better after seeing the vet. She clarified some things for me, and had very good reasons for choosing the Lantus over the PZI.

My vet wants to start her out at 1 unit once a day, testing at least twice a day before giving her a shot, then doing a curve in 3-4 days and re-evaluating. The plan is:
- Test her again tonight. If her level is over 200, give her 1/2 unit Lantus. Otherwise nothing.
- Test her in the a.m. If her level is 150 or under don't give her anything. Otherwise give her 1 unit.
- Same as above for 3-4 days, then do a full curve. Unless, something extreme is happening.
This seems to make sense to me, but please let me know if it seems like it doesn't.

The vet says the goal is to keep her 100-200. I have seen posts where people say that between 50-100 is desirable, normal. Is that true?

So, regarding the possible 0-2u of vetsulin I gave her earlier today. It seems like some or all of tha tmust have gone in, because now her levels are much lower again 3.5 hours post shot (and post eating). Because I am new and trying to get the hang of this, I actually tested her 4 times within about 5 minutes. The first reading was "63". Because it surprised me that it was so low, dropping from over 500 to 63 in a few hours, I did it again. Next reading was "Lo". Even worse. So I did it again. Next reading was "49". Better than "Lo" but still low. Then again a minute later it was "87". So 63-Lo-49-87 within a matter of minutes? Is that normal? Does that signify a problem with how I'm doing it, or with the meter?

Assuming it is dropping 400 points because of that vetsulin dose, and not just because she ate, I would expect it's going to get even lower before it starts to go up again. Is that a reasonable expectation? While she ate quite a bit of wet food, does this mean I should give her higher carb dry food in the hope her level will come up and drop less? Or is there a high carb wet food to use in this case? Or is just eating in general good in this case, even if it's low carb wet food?

I am working on switching her to more wet food, which as I said she is just loving. Based on what I was reading, I was going to phase out the dry food entirely. But the vet doesn't totally recommend that, since I am gone for typically at least 10 hours for work each day. The vet recommended still leaving some dry food out, in case it's one of those days when the cat decides not to have diabetes. :) She was kidding, but the point she was making makes sense to me. I know the cat will eat less dry food if she is full on wet food.

Sorry so much information and so many questions. I am all over the place dealing with this. But I REALLY appreciate the support and information.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

This is very complicated. If you don't ask questions, how will you figure it out? We were all completely overwhelmed when we first came here, and someone helped us. We are just paying it forward.

Today, I would get another test in right away. You don't want her going below 40. If she does, post and we will help you intervene with syrup. Meters have a 20% variance so the variety of numbers you got is not unusual. But we want her in the 80s, not the 40s. So please test and post her number.

We have a lantus support group. I would suggest you read the stickies at the top of the page: viewforum.php?f=9 They are full of great info on dosing, storage - everything you will need to know. You might also look at the posts threads, read how kitties are doing and looking at some of the spreadsheets attached to people's threads.

You can free feed wet - freezing it and leaving it to thaw or in an automatic feeder. Better to get rid of the dry food completely.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

The first thing that jumped out at me was give insulin once a day.... no. Cats need twice a day.

Here are some links with info for you:

Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

And because you are getting quite low numbers, here are links to info on handling those low numbers:

List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

Others here will have lots more info for you.

ETA: If your cat is loving the wet food, stop the dry now, all of it. The dry is high carb and no dry food or treats will help you get your cat into decent BG numbers.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

About an hour and half after the 63-lo-49-87, she tested at 95. I only tested her once, but I hope it means her levels are going up, rather than down. I will test again in a few hours.

Just to reiterate, she has been getting Vetsulin twice a day for more than four years. Her current dose isn't working so in addition to trying to get the correct amount of insulin into her system at the right times, we are also switching her to Lantus.
Considering that she may have been getting too much insulin possibly for a while, the vet thinks that starting with 1 unit in the a.m. (if her bg warrants it) and seeing how it affects her, is a good way to go for a few days. However, she also wants me to test her again at night and give her 1/2 unit if she needs it. She does not want Etta to have too much insulin right now, better too little than too much while we are working all this out. The vet is not suggesting permanently dosing her once a day.

Re: stopping all dry food immediately: I'm trying to do what's best for Etta, work with my vet, and also do what is going to work with the reality of our schedule. My vet thinks that while she's having these fluctuations and may be under stress, that cutting out all her dry food cold turkey, while trying to also get the dosage set on a new insulin, when the cat may be left alone for up to 12 hours during the day, is not a good idea. That makes sense to me. I want to get Etta stabilized and then try to transition her more completely. The good news is that she's eating much more canned food and less dry food. It's very helpful to get advice that supports making a slow and careful transition. The "you must do this" and "you can't do this" isn't as helpful.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

When you read the lantus info, you can check out the protocol developed for its use in cats. It supports choosing one dose, giving that same dose every 12 hours and staying with it for a week or so, so that the shed can be filled. Alternating between different doses would make that difficult. You could choose to start with .5 units twice daily to be sure the dose is low and safe.

It certainly can be a good idea to slowly change the food over to not risk stomach upsets. Just wanted you to know that grazing is possible with wet food.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

The Lantus dose needs to be the same for am and pm shots. Changing the dose frequently will not allow this insulin to settle. See the link that talks about the shed, storage depot.

From the protocol for Lantus:

"General" Guidelines:

--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.

--- Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

It's great that Etta likes wet food. My cat J.D. did too, so the transition was no problem. Some people have a huge battle trying to get their cats off the dry food.

I would recommend taking a look at Janet & Binky's food carts it will help you to decide which wet foods have the lowest carb content. I printed out the pages and went cat food shopping. I would also recommend getting a half dozen or so cans of the high carb (18%) flavors just in case you need them to bring up a low number.

I also work a lot. I freeze Fancy Feast (with a little water added) and put the frozen food out to slowly thaw when I leave for work. I also set a timed feeder to open at +5 and at +7. That way I figure, my cat gets some food in an hour to two, when the frozen food thaws and again at +5 and +7 when the feeder opens. Because I often come home from work 11 hours after I left, with leftover food still uneaten, it's basically free feeding.

I am glad you're starting to home test. By the low numbers you're getting, it will probably be a life saver.

Ask as many questions as you want. We are here to help and guide you to help your Etta.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

I am about an hour away from the 1st Lantus shot, potentially. I picked up the Lantus and u-100 syringes (Ulticare) at Target. They didn't have syringes with half unit markings, which seems like it would be very helpful if you are raising/lowering by half units. I read that the Walmart brand (Relion) of the 3/10 cc syringes is supposed to have the half unit markings, but when I called Warmart they said they didn't. Any recommendations on a source/brand for the syringes with half unit markings?

Unfortunately, I won't be able to talk to my vet until Monday, so I can't clarify why she wanted to go with 1 unit in the a.m. and 1/2 unit in the p.m. I think she initially just wanted to go with 1 unit in the a.m. for a few days to see how Etta reacted to this insulin, and then added the point about the 1/2 unit in the p.m. in case her bg was high. Her written instructions say "She may require 1 unit twice daily but no rush to find out given her low sugar episodes." She said that given the potential for low numbers she would rather Etta be high than low. I have some pretty serious doubts about my being able to actually give her a half unit with these syringes. But I'm going to try. In terms of the what to do tomorrow a.m., I will wait and see what her numbers look like.

To recap her numbers since I started testing yesterday:
4/8
10 am: 4u vetsulin
5:30 pm +7 hrs: bg 38
7:30 pm +9 hrs: bg 99
11:15 pm +13 hrs: bg 319

4/9
7:45 am +22 hrs: bg HI
8:45 am 0-2u vetsulin
12:15 pm +3.5 hrs: bg 63-Lo-49-87
1:45 pm +5 hrs: bg 95
5:45 pm + 9hrs: bg 270

I'll be checking her again in a half hour at 8pm, and giving her a half unit of Lantus as her bg is likely to still be over 200.

I was planning on checking her once more before I go to bed, around 11 pm or midnight. Then not again until the morning. Should I check her sooner than 11pm/midnight?
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Lantus acts much different than Vetsulin. You shouldn't get an immediate response or fast drop. It takes a while for the shed to build up. I would think a before bed test will probably reassure you but she should be okay.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Her bg at 8pm was 332.

I loaded what seemed close to 1/2 unit of Lantus in the syringe, but I have no idea if I actually gave it to her or not. It's such a small amount, and when I went to plunge, it was already plunged. Hopefully that happened when the needle was in. I have no idea.

When could I expect that to have any effect, as its effect is so much different than vetsulin?

Thanks.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Boy, those Walmart people should get some brains. Their syringes are now all marked with 1/2 unit markings and even when they weren't and you had to specify it, the people working there still didn't know what I was talking about till I showed them the correct box and pointed it out to them. Walmart's ReliOn U-100 3/10 cc insulin syringes are marked in 1 unit and 1/2 unit now. Just go there and ask for a 3/10 cc U-100 box of syringes with either 1/2" or 5/16" needle.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Thanks!! Walmart is not as convenient as Target, and the insulin was cheaper at Target, so I didn't think that I should go and actually look at them. I even read the guy what the Relion website said, and he said "No, these don't have that."
I wonder if I need a prescription to get syringes at Wal Mart, since I gave the prescription to Target.... I guess I can try to transfer it.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Thanks for the screenshot! Getting syringes at Walmart is on my to-do list for today.

It would seem that maybe Etta did get 1/2 unit of Lantus from 8pm yesterday. At that time her BG was 332. +4 her BG was 203, and +12 this morning, her BG is 300. I didn't do any additional blood tests after midnight last night, so I have no idea how low the BG got. But I did wake up a few times and she seemed fine, and seems good this morning.

How possible is that the Lantus dose didn't take and that these are just her "normal" numbers after off Vetsulin?

It's 8 a.m. and time to give Etta the next dose, which is 1 unit per the vet. Of course I am nervous that this will be too much if in fact she didn't get the 1/2 unit, or even if she did. But I'm going to go for it.

UGH! I cannot believe I may have fumbled this shot too! Again, the plunger was pushed in when I went to push it. So another day worrying about whether she got the dose. I have been giving shots for 4 years and never have had this trouble, although nearly most of that time the dose was bigger than 1 unit. But 1 unit size on the 40-u syringe is so much bigger. This is really stressing me out!
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

It takes a while for the Lantus to work because of the shed. But the numbers you got look a lot gentler than the usual Vetsulin curve so I would think your dose worked. This lantus stickie has picture of what the smaller doses look like. viewtopic.php?f=9&t=18139

You certainly can give two daily doses of .5 if you are concerned. As we have said, Lantus works best with two doses of the same amount twice daily.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Thanks. I hope I did actually get a dose into her this a.m. I will check her in a few hours, and hopefully her number will be lower.

YAY! +3.5 hours her BG is down to 236 from 300, so once again it appears the dose actually made it in.
Either that or her level is naturally going down. I wish I knew.
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Etta's numbers so far today are pretty consistent. Not under 200, but not off the chart low or high.

yesterday night:
+0 bg 332 (1/2 unit Lantus, possible fur shot)
+4 bg 203

today:
+0 bg 300 (1 unit Lantus, another possible fur shot)
+3.5 bg 236
+6.5 bg 232
+9.5 bg 298

I'm still wondering if it's possible if these are her "regular" numbers, if there's a chance the shots didn't work. Although the last days on Vetsulin, while she had extreme lows from too much vetsulin, she also had a level of "HI" which would make me think that numbers in the 200s are evidence of some kind of control. I guess it could also be a drop from eating more canned food. I'm just worried that she hasn't gotten either of the Lantus doses and when I finally get one right, it will be too much.

Thoughts?
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Breathe ..... give the insulin time to work, the numbers are decent. When you shoot a small amount it doesn't seem like anything is going in, but your numbers tell otherwise. You are testing, you are paying attention, now go eat some chocolate or have a glass of wine! the hardest part is letting it all work .....
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Thanks! I needed that! I'm fine letting it work, if I could give one of these shots and feel like I did it right. Giving 4 units of vetsulin in a u-40 is like turning on a firehose in comparison to these little bitty amounts of Lantus in the u-100.

I'm in the Bay Area too!
 
Re: Etta - 4+ years w/diabetes-struggling, making big change

Just a thought and then I need to give Payne her last shot .... you should start posting a condo (thread) with the Lantus group. They are great people and will help you down this road. They can give you the precise instructions you need to be successful with this insulin, because it does work very different from the insulin you were using. You will need that and can't really get it to that degree on health.

I live two bridges from the city but close enough to still be called "SF area" :)
Nancy and Payne (waiting, waiting ...... )
 
Status
Not open for further replies.
Back
Top