First Post--Help me help this girl!

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J-FED

Member Since 2014
I've recently taken in a diabetic 8 year old female foster cat, I've had her for just over a month now and have seen little improvement in a number of areas.

She has always lacked stability in her life. She was surrendered BACK to the rescue organization in Sept 2013 because she was sick and peeing outside her litter box, a visit to the vet confirmed that she had diabetes.... Since her diagnosis, she's been passed around to a few different foster homes due to different reasons (people moving, not being able to make the 12h injection intervals, etc), so she has not been consistently receiving her insulin. To boot, her last foster home had unintentionally been giving her 10x her insulin dosage because of a misunderstanding with the syringes (her values were below 2.0mmol/L, barely even consistent with life). She's been through a lot!

So we have taken her in because we had great success with our last diabetic foster cat who achieved remission in less than two weeks!! I thought it would be another cake walk with proper care and lots of love...

We check her BG twice a day: 7am and 7pm. Her previous plan was that if her values were greater than 12.0mmol/L she was to receive 1 unit of Glargine/Lantus insulin. She was eating 1 can of Purina DM wet food per day, served with her BG testing. For about 3 weeks, her values were all over the place: anywhere between 4.0mmol/L and 19.0mmol/L. We could go two days where she wouldn't require insulin at all, and then two days where she would require it every 12 hours.

On top of the fluctuating values, she really began to show signs of neuropathy. She also has had two episodes where she'd collapse and couldn't get herself back up, her legs gave out on her and she would thrash around on the ground (neither episode was consistent with hypoglycemia, her values were normal). Her activity levels are extremely low, she lays on her bed in the bathroom about 23 hours out of the day and has no desire to play whatsoever. When she does get up and wander around, she paces restlessly and lets out loud howls.

She went back to the vet and is now on a new plan:
12.0mmol/L<BG<15.0mmol/L: 1 unit of insulin
BG>15.0mmol/L: 1.5 units of insulin

Plus, she is to eat 1 1/2 cans of DM now because she has been losing weight and she got a shot of antibiotics in case she is struggling with a bladder or urinary infection (she has a history of reoccurring infections)

Her visit to the vet was 2 days ago, and since then (plus a day before) her values have been consistently really high! 13.0mmol/L to 19.0mmol/L. She has been peeing constantly and is slightly dehydrated.

I am concerned for this girl, she is such a sad case. She is scared of everything, especially my 6 year old resident male cat (who LOVES other cats, and is very friendly and non-territorial). If outside of her safe spot (the bathroom), she runs away from us and cowers back on her bed in the bathroom. She rarely comes out to see us...but loves when I go to visit her! She purrs and will sit on my lap.

I understand she doesn't feel well, but this breaks my heart because I want to help her feel more safe and more comfortable in our home, I hate that she secludes herself in the bathroom.

I'd love to hear some insight.... thanks in advance!!
 
Hi and welcome to the message board. Would you please share your first name with us and your cats name?

A few questions for you first
1. How long has she been diabetic? Diagnosis date?
2. What meter are you using for testing?
3. Where do you live? You give the BG (blood glucose) readings in mmol and you are using Lantus so probably Canada would be my guess.

First off, I see you are using Lantus, an excellent insulin. We use a modified version of the only scientifically based and tested dosing protocol for Lantus. With this protocol, dosing for Lantus is not based on the pre-shot BG test numbers. Dosing changes for Lantus are made based on the nadir or lowest point in the cycle, a cycle being 12 hours. Doses are held for a minimum of 6 cycles unless the BG level goes <50 mg/ dL (2.7 mmol) on a human glucometer.

It looks to me like you only test once each cycle, before you give the insulin. Is that correct?

I think you need to find when your foster cats nadir is in the cycle. This is usually somewhere in the +4 to +7 hour timeframe after the shot. So a few tests to see what is going on in the middle of the cycle are needed.

Since we all live in different time zones, we express the hours of testing in a Plus hour format. For example:

AMPS = morning pre-shot test (the test you do before you shoot the insulin)
+1 = 1 hour after shot
+2 = 2 hours after shot
+x = x hours after shot
PMPS = evening pre-shot test (the test you do before you shoot the insulin)

Since most of us on the message board live in the backward USA where we still use mg/dL, it would be much appreciated if you also provide your BG readings in mg/dL. Easily done by multiplying your readings by 18.
For example, 4 mmol = 72 mg/dL, 19 mmol = 342 mg/dL
 
I wish you all the best in helping your poor kitty. When I adopted my kitty Dusty from the local shelter he was the same way, very shy and wouldn't come out. My other kitty Beni who is very friendly had no problem with Dusty but Dusty was just too shy. I would go and grab him from under the bed and sit with him while he would purr and purr. He didn't have diabetes at that time but he slowly came around and now Beni and Dusty are the best of friends. Dusty is still very shy like when someone knocks on the door he'll run and hide not to be seen until the visitors leave. Beni on the other hand will run to the door to see who it is :lol: . Just give her time, once she starts feeling better and sees you're just trying to help her she'll come around. She knows you want to help and love her.
 
Thank you for your response, Deb & Wink!

I am Julia, and poor little orphan Annie is my diabetic foster cat. We both live on Vancouver Island, Canada (you guessed it!)

To answer your questions...
1. Annie was diagnosed with diabetes in Sept 2013, so about 7 months ago. I am uncertain as to how long she was sick/showing symptoms before then.
2. We are using a General Electric blood glucose monitoring system, model GE200 (human). Here is a link to it if necessary: http://www.gediabetes.ca/ge200/
3. Canada, yes....I'll be sure to convert my values to mg/dL. Thank you for the conversion info.
4.I do only test her BG once each cycle (AMPS & PMPS only), this is to determine if she needs an injection and if so, how to dose accordingly (either 1u or 1.5 units)

Is this kind of approach consistent with Lantus insulin then? I was wondering why I haven't been asked to construct a curve, instead the vet only would like me to send her the two values per day, once a week.

The last foster girl we helped was on 2u of Lantus every 12 hours until we saw her levels become more normalized, and then she only required 1u if her BG<180mg/dL. We quickly saw her stabilize after that point. This was great! I guess I just don't understand why we haven't taken a similar approach with Annie... mind you, previous cat was obese and a brand spankin' new diabetic.

I could certainly come up with some values throughout the day starting this weekend. I definitely need a little more insight into what's going on with her, her values are up and down and then waaayy up! Unfortunately, today I noticed her limping...she was dragging one of her back legs as she walked around. Poor thing, I'm anxious for her to maintain normal values so we can deal with this neuropathy especially.

Thanks for the kind words Dustybones. It is always such a rewarding experience to win over the trust and affection of a timid scaredy-cat! When I brought home my adopted boy Gus, he was scared of everything and would always hide in hard to reach places. Luckily, he's a sucker for treats and I could lure him out to give him pets and love. Now he is the most curious and 'in-your-face-cat'; always at my heels and chattering on about his day. You're right, time and patience is all she needs. Being a foster though, I am concerned for the day that she does come around and creates a strong bond with us, only to have her new world turned upside down when she's put up for adoption :(
 
Hi Julie. I wish The Best for you and Annie.

Lantus dosing is based on the lowest point in the cycle which happens around +5 to +7 (somewhere between 5 hours after she gets the shot to 7 hours after she gets the shot). It sounds like your vet is used to other non depot type of insulins. Lots of vets do this, they just can't keep up with the latest information on every disease, and medication.

When you have a chance, please read the starred stickys on the Lantus forum. They will help you to understand how Lantus (& Levemir) works.

I would encourage you to get as many mid-cycle tests as you can, so you can see how low she is going on the dose.

Also, Lantus does best when given the same dose every 12 hours, otherwise it throws the numbers off and they become all wonky.

I hope you can get a spreadsheet up for her soon, so we can help you more with your sweet Annie. cat_pet_icon

Blessings to you to taking care of her and for caring so much about her. :YMHUG:

We can and will help you. You've come to the right place. Welcome :-D
 
Thanks for introducing yourself Julia and telling us this little sugar princess's name is Annie.

The reason we test before we give the insulin shot, is so we know if that number is high enough to give insulin or if you need to wait. We suggest that new members do not shoot unless the BG readings is >200 mg/dL (11.1 mmoL). As you gather test data, that shoot/no shoot number gets reduced. Over in the Lantus TR forum for example, that shoot/no shoot threshold is 150 (8.3).

I think you should pick one of the doses and stick with it for a minimum of 3 days or 6 cycles. For safety, I think that should be the 1U dose.

With those wild ranges of numbers you are getting, it's very likely that Annie is dropping very low, then her body pumps out hormones to keep her safe and bring her back to higher BG levels in an attempt to protect her from hypo (hypoglycemia). Bouncing we call it. Bounces can last up to 72 hours with Lantus.

I'm betting you will find that Annie drops low somewhere in the middle of the cycle. To help you narrow in on the lowest point or nadir, doing a test at +5 and then another one at +7 would be helpful. Then, you test an hour on either side of whichever of these numbers were lower. Some cats nadir early, some nadir later. ECID. Every Cat is Different. The +5 to +7 hour timeframe for the nadir is simply an average and you need to test to see where Annie's nadir is. Once we get that narrowed down, and see some tests at the midpoint of the cycle, we'll have a better idea of how this dose is working for her.

Dyana mentioned setting up a spreadsheet to help track the BG readings, the insulin doses, etc. We use a nice standardized color coded template. Since you are in Canada, if you set up the World version and enter all your data there, there is a second tab labeled US so those of us in the US see our more familiar number system. No data entry on that second US tab is needed because there are formulas behind the scenes that take what you enter on the World sheet and automatically enter them on the US version.

How to instructions on setting up a Spreadsheet and linking it into your user signature(SS) are here. The one step the instructions omit, is you need to change the Share options to "anyone with the link". That gives us read only access to the document that you put in your signature.

BJM said:
Member BJM gives this nice explanation of the SS (spreadsheet/grid)

Understanding the spreadsheet/grid:

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
Click to expand...
 
Hi Julie

I am a failed foster. I took in a 10 year old male diabetic and when they asked me to start bringing him to adoption fairs - I couldn't do it. I adopted him five months after I took him in. I think there are others here who will fess up as failed fosters too :lol:

Maybe you will be one too!
 
Yes, I will admit too. I am a failed foster. Not once, but twice. :shock:

The first time I took in Spot, a diabetic calico and her sister, Tiger. Unfortunately I lost Spot a couple years later to cancer, but I still have her sister. A few years later, Ricky came to live with me "temporarily". He was another diabetic cat. He also became a permanent member of my household.

Caring for a diabetic cat is not difficult once you find the routine that works best for you. You are already off to a great start with proper diet, insulin and hometesting. I encourage anyone who is considering adopting a sugar kitty to go for it. I have had four of them and if I did not already have a full house with pets, would easily take in another one. Even though all of my sugar kitties have passed on, none of them died because of their diabetes. With the proper care, a diabetic cat can live for many years.

Hopefully you will join the failed fosters club. We are always welcoming new members. :mrgreen:
 
Lol! Yes, I've been warned about the hazards of fostering... Annie is my second foster cat, my first one I only had for 3 weeks and as soon as she achieved remission she was scooped off to another foster home so I could make room for another diabetic kitty. Fortunately though, I did hear today that she was adopted and still in remission!

Annie however, is a tougher nut to crack but the more I see her come out of her shell, the more I adore her. All this girl needs in her life is a stable home, she's been passed around so much in the past that the guilt of uprooting her life again would just torment me. I don't know what I'll do!

Speaking of Annie, I do plan to construct a proper BG curve this weekend but I have noticed that since her visit to the vet this last Tuesday, her values have been consistently high! Between 240 and 350 (I have only been checking AMPs and PMPs) and she's been peeing like a race horse. She did receive a shot of antibiotics while there, can this have an effect on her?
 
If she has an infection and it isn't clearing, it could be raising the glucose.
 
Hi everyone,

Sorry it's taken me a while to respond. I have been working with her vet on a new insulin protocol since the last one that we discussed earlier was not doing much for her. She is currently on 1.5u twice a day, and after about a 1 1/2 weeks on this, I took some values from her:

AMPS: 88.2 (served 1/2 can DM for breakfast)
+2= 63 (given 1/8C dry DM)
+4= 84.6
+6= 118.8
+8= 133.2
+10= 154.8
PMPS=214.2 (served 1/2 can DM for dinner)
+2=210.6
+4=237.6

I have difficulties interpreting these values. The vet was concerned with how low she was in the morning and does not want her to receive the injection if she's below 216 from this point on.

The poor girl has been having some difficulties with seizures, I've seen her have 3 so far and have taken her BG immediately afterwards only to find that she's been at a normal level each time. She had a more severe one a couple of days ago, and she was only at 118. There is concern now that she may have suffered brain damage from her insulin overdoses earlier on before she was in my care. The prolonged hypoglycemia may have killed some of the neurons in her brain, and this could be what is causing the seizures. I am to start her on phenobarbital asap.

Before her most recent seizure, I had allowed her to play with some catnip which she went bonkers for (maybe about 20 mins before the seizure). I would hate to think that the nip induced it for her... will avoid the catnip from now on just to be safe. Any ideas if there could be a relation between the two? Any other ideas on what can trigger seizures so I can be sure to avoid that as well?

Thanks in advance!!
 
Ok two things jump out at me..

1. Feeding her dry food will spike her BG for up to 24 hours, was that intentional as you were worried about low levels?

2. I suspect her dose may be too high, She may have dropped below 50 without the dry which merits a dose decrease. I would try and reduce her back to 1 unit for a few days (3 minimum) and see how that new dose works. And stop the dry. And I agree with your vet about not shooting under 200 for now.

If you are worried about hypos or low numbers read this.. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

Also setting up the spreadsheet mentioned above would really help us, you and your vet see what's going on..
 
If she has damaged her brain from prior hypoglycemic events, depending on how bad the damage is, the seizures may be a chronic problem. Additionaly hypo events will aggravate that ... of could kill her. Also, she may have a seizure disorder unrelated to the diabetes - from a fall, an infection/parasite, epilepsy, or a growth in the brain (benign or otherwise). You may want to see if you can find a relatively nearby pet neurologist if the problem worsens. These tend to be specialist and located in or near veterinary schools or larger cities.

Excess stimulation, ie catnip in large quantities, may or may not trigger seizures. Think about how much you gave her - just a pinch? A teaspoon? More? Chemists have a saying "the dose makes the poison'. And we humans often think "if a little was good, more is better" which isn't always true. If you gave her a lot, you could test out a tiny pinch. If she seizes immediately, you have your answer.
 
Thank you! Wendy&Tiggy and BJM for responses. I can't believe how informative this site is and how willing everyone is to help. A lot of time has been dedicated to helping others and their kitties. Thank you.

That's right, Wendy&Tiggy, I did give her the dry DM because I was concerned for that low value. I was also told to leave her no more than 1/8C of it whenever she is left alone, just in case she drops very low and I'm not around for her. Under these circumstances only are when she gets the dry food.

I seem to be a little bit challenged when it comes to publishing the document from my Google drive, it won't give me the option when I go to "file"... I will play around some more and see what I can figure out. In the meantime, I can post a link to the spreadsheet.....

https://drive.google.com/file/d/0B2Qym3 ... sp=sharing

I will retrieve some mid day values tomorrow and the next day (my days off). Her last few values (AMPS & PMPS) have been especially high, and I have two possible reasons as to why....

(1)My partner has been out of town and typically checks the blood because he is much quicker and efficient at it. I tend to take longer and it takes me a few tries before I can actually get a drop of blood. I feel horrible for her because she does get fed up with me during my sad attempts, and I can't help but think this causes her stress and attribute to such high values?

(2)Since my partner has been out of town she has been left at home while I'm at work for 8 hours during the day. So for the 26th, 27th, and 28th, I followed instructions and left her a bit of the dry food while I was not home...just in case.

For my days off, I will make sure she eats no dry and see how this effects her levels. Would you still advise that I drop the dose to 1.0 even after I've gotten these high values from her the last 3 days?

BJM--- I did give her a large amount of cat nip, I sprinkled some over her cardboard scratching pad... maybe a few teaspoons worth? I am avoiding it just to be safe from now on.

I am picking up her anticonvulsant meds tomorrow... I have such a broken heart for this girl and her health issues; diabetes, neuropathy, seizures. She will have difficulties getting adopted if I can't help to reverse/stabilize her condition but I feel like I'm making things so much worse for her because I can't get her values in normal range! She is a challenge but I am so eager to help this poor girl.

Thank you for all your advice and time.
 
I leave out canned food for my diabetic and the other cats from shot to +10 hours later. It is usually down to crumbs by the next shot time so I have a roughly fasting pre-shot glucose test.
 
Thats good news on mid cycle tests - you need to see how low the dose is taking her so you know how well it is working.

I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Give her a treat after testing and she won't mind. Unless she is totally hissing and freaking out I doubt it will cause any change to her BG levels. If anything you just need to work on getting her to a good dose. Without more tests we won't know if her current dose is too low or too high!

Sooner you get her off dry the better, it can spike her BG for over 24 hours. When we see a cat going low (and low means under 50 - or dropping very fast early in the cycle ) we give a very small amount go a high carb gravy food (1-2 tsps) and test again in 30 minutes.. It maybe lasts an hour at most so does the job without sticking around too long.

I think dropping the dose (if you stop dry entirely) wouldn't be a bad idea - especially if you can't get extra tests. Are you testing her urine for ketones?

Wendy

Wendy
 
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