? Feel like I’m going backwards

[Mae’s Mama]

As stated in the subject, I feel like we are going backwards. Bad on me to not start home testing until now but alas I can only go forward. Mae has been on 2 units twice per day of glargine since 10/20. She was doing better then was diagnosed with UTI on 11/9 and was given a course of amoxicillin. I have admittedly missed a few doses of the amoxicillin but will not anymore.

The last few days she is back to drinking like she’s been in the desert for a week and peeing on the floor. I noticed it looks like her neuropathy is coming back too because as she’s peeing on the floor the back of her legs are getting wet.

I’m at a loss what to do here; I thought we were rounding a corner and getting better.

I was just reading the Lantus stickies and maybe I should try upping her dose by 0.25? Again I know I just started testing so you guys don’t have number data to go off of but again she’s been on 2 units for 4 weeks now. I’m going to try to get some good testing in this weekend- not sure if I’ll be home enough to do an every 2 hour curve but will try.

thanks for all you do!
Mandy

 

[Sienne and Gabby (GA)]

Mandy -

It's hard to give you solid suggestions without more than a handful of tests. Without benefit of seeing Mae's numbers, I'm going to give you my best guess at what's going on but please understand, my hunches work best with data to back them up so I may be wrong!

I don't think it's a matter of your going backwards. Insulin needs can and do change. There are any number of reasons that a dose that was great last week isn't looking so good this week. As you were noting, an inflammation or infection, like a UTI, can cause numbers to be higher. Once the antibiotics start working, numbers can then drop. You also have a kitty with an autoimmune disorder and the treatment is steroids. The pemphigus likely causes some inflammation and steroids cause blood glucose numbers to be higher. Both of these factors may influence Mae's numbers.

You're very likely correct that Mae needs a dose increase. I'm reticent to suggest that you raise the dose based on 5 tests though. If you're going to be around and can monitor, it may be fine but personally, I'd want to see more information. The other issue is that if a dose that isn't bringing numbers into a good range isn't changed, glucose toxicity can develop. The term makes it sound worse than it is! Glucose toxicity means that your cat is treating the higher numbers as the new "normal." It can make it a bit more challenging to bring numbers down but managing a cat's diabetes is always a matter of patience and not speed. If I'm remembering correctly, you had an initial post where you said you were holding off a bit on testing -- although this may be my faulty memory since I couldn't track down another post from you.

Have you been able to transition Mae off of the dry food. It's also a consideration with regard to higher numbers as well as eliminating it will bring numbers down.

I also want to make a suggestion about testing. You need to always get a pre-shot test. It's the only way you will know if it's safe to give Mae insulin. With Lantus, dose changes are based on how low the dose takes the numbers. As a result, you need to get a minimum of one additional test during both the AM and PM cycles. Getting more tests in over the weekend (and maybe over the upcoming holiday???) would also be very helpful.

 

[Mae’s Mama]

Mandy -

It's hard to give you solid suggestions without more than a handful of tests. Without benefit of seeing Mae's numbers, I'm going to give you my best guess at what's going on but please understand, my hunches work best with data to back them up so I may be wrong!

I don't think it's a matter of your going backwards. Insulin needs can and do change. There are any number of reasons that a dose that was great last week isn't looking so good this week. As you were noting, an inflammation or infection, like a UTI, can cause numbers to be higher. Once the antibiotics start working, numbers can then drop. You also have a kitty with an autoimmune disorder and the treatment is steroids. The pemphigus likely causes some inflammation and steroids cause blood glucose numbers to be higher. Both of these factors may influence Mae's numbers.

You're very likely correct that Mae needs a dose increase. I'm reticent to suggest that you raise the dose based on 5 tests though. If you're going to be around and can monitor, it may be fine but personally, I'd want to see more information. The other issue is that if a dose that isn't bringing numbers into a good range isn't changed, glucose toxicity can develop. The term makes it sound worse than it is! Glucose toxicity means that your cat is treating the higher numbers as the new "normal." It can make it a bit more challenging to bring numbers down but managing a cat's diabetes is always a matter of patience and not speed. If I'm remembering correctly, you had an initial post where you said you were holding off a bit on testing -- although this may be my faulty memory since I couldn't track down another post from you.

Have you been able to transition Mae off of the dry food. It's also a consideration with regard to higher numbers as well as eliminating it will bring numbers down.

I also want to make a suggestion about testing. You need to always get a pre-shot test. It's the only way you will know if it's safe to give Mae insulin. With Lantus, dose changes are based on how low the dose takes the numbers. As a result, you need to get a minimum of one additional test during both the AM and PM cycles. Getting more tests in over the weekend (and maybe over the upcoming holiday???) would also be very helpful.

I got an AMPS shot this morning although again not sure if she ate anything within 2 hours because I fell asleep before taking the food away. She was at 314 and I gave her just a smidge above the 2 unit line and less than the 2.5 line. I’ll be around for the next 6 hours or so and will test her every 2 hours and then again when I come back.

Mae is on cyclosporine for the pemphigus since prednisolone isn’t good for cats with diabetes. (Mind you before we figured out she had diabetes she had been on a few courses of steroids). The cyclosporine is supposed to suppress her immune system I guess so she doesn’t get the horrible flare ups. She was so itchy she was biting herself constantly, had tons of bald patches, and awful chin acne. She physically looks better in that regard.

I haven’t transitioned her completely off the dry food because I was waiting until I knew I’d be testing consistently. Since the diagnosis we moved to a new house but are finally getting settled. The last week I’ve been mixing in a 1/4 can of FF classic pate with the dry food and she seems to love it. Funny I used to get her friskies and she turned her nose up at it lol. I’d love suggestions how/when to fully transition her to the wet only. Also to note I have another cat who is not diabetic and they’ve always been on the same food so it’s a double transition. I noticed yesterday there was diarrhea in the litter box but not sure which of them it was from.

 

[Mae’s Mama]

Also I don’t know if it’s me or the strips but I’m wasting a ton and getting Er4 almost all the time. I’m getting good amounts of blood on there and it’s an error like I’m having to use 3 strips at least to get the sample to read. I just had to poke her twice and used 4 strips and still can’t get a read. It’s so frustrating

 

[Mae’s Mama]

Also I don’t know if it’s me or the strips but I’m wasting a ton and getting Er4 almost all the time. I’m getting good amounts of blood on there and it’s an error like I’m having to use 3 strips at least to get the sample to read. I just had to poke her twice and used 4 strips and still can’t get a read. It’s so frustrating

Ran to Walmart as there is one 5 minutes from me and got a new pack of strips. I was able to get a reading with 1 strip so we’ll see. Too early to tell if it’s just me being new and sucky at this or if the other batch has some defective ones. I’m keeping the other batch for now to see.

 

[Sienne and Gabby (GA)]

I don't know if you looked over Lisa Pierson, DVM's site on feline nutrition. Aside from all of the great information about diet and cats along with the chart we use to track down the carbs in canned food, there are a number of links to other helpful information. This one on transitioning from dry to canned food may be helpful. The bottom line is don't go too fast. Some cats experience a GI upset if you change foods too quickly. On the other hand, with a diabetic cat, getting the kitty transitioned to a low carb food is important.

Also, if you recently moved, that can be contributing to Mae's higher numbers. If you've not done so, you may want to put some Feliway diffusers around the house.

 

[Mae’s Mama]

I don't know if you looked over Lisa Pierson, DVM's site on feline nutrition. Aside from all of the great information about diet and cats along with the chart we use to track down the carbs in canned food, there are a number of links to other helpful information. This one on transitioning from dry to canned food may be helpful. The bottom line is don't go too fast. Some cats experience a GI upset if you change foods too quickly. On the other hand, with a diabetic cat, getting the kitty transitioned to a low carb food is important.

Also, if you recently moved, that can be contributing to Mae's higher numbers. If you've not done so, you may want to put some Feliway diffusers around the house.

I’ll definitely read that over, thank you!

I have two feliway diffusers in the house. One in the main living area and one where the litter robot is.

 

[Ale & Bobo & Minnie (GA)]

Meters can be finicky and you can get error numbers with too little but also with too much blood. Basically, you don’t want to “dump” blood onto the test strip. You want to bring the strip to the edge of the blood droplet and let it “suck it up”. Once I started collecting the blood onto my mail and testing from there, it became a lot easier for me. I wasn’t rushed and could take my time doing it right since I didn’t have to worry about them moving or flicking their ear.

 

[Mae’s Mama]

Meters can be finicky and you can get error numbers with too little but also with too much blood. Basically, you don’t want to “dump” blood onto the test strip. You want to bring the strip to the edge of the blood droplet and let it “suck it up”. Once I started collecting the blood onto my mail and testing from there, it became a lot easier for me. I wasn’t rushed and could take my time doing it right since I didn’t have to worry about them moving or flicking their ear.

I tried the fingernail thing and I smudged it on my nail so wasn’t helpful lol but I will keep trying - trial and error over here!

 

[Ale & Bobo & Minnie (GA)]

You need to “deposit” the droplet onto your nail as opposed to rubbing the ear with your nail