first readings - insulin yet or not?

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Vyktors Mum

Vyktors Mum

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Vyktor is newly diagnosed and not on insulin. Got my glucometer and ketosticks yesterday and took the first tests last night.

Urine test showed sugar levels off the charts and trace ketones. Blood test was 167.4.

Took another blood test this morning, result was 194.4.

I note that Vyktor is free fed, and tends to graze so had not had big meals before either test. His test this morning was before breakfast and he hadn't eaten very much over night (not quite appreciating the change to Whiskas loaf as yet!). Have just given him some food.

Is it a good idea to test again in an hour or two to get the 'food spike' or is that something that should be factored out anyway?

I am going to the vet today so it will be good to have some numbers for him. Originally the vet suggested not to treat Vyktor (any blood curve they could get would be very misleading because he is a psychopuss at the vets and I am quite sure hometesting hadn't occured to him). I then found this site and have since called the vet and, speaking chinese whispers style through the receptionist over a few phone calls, said I would be wanting to treat him. The bit about wanting to home test obviously didn't make it to the vet because the receptionist said to come and get the insulin and we could do it based on urine tests.

Qu: Would this not be more dangerous than not treating at all?

I note that many people say not to give insulin where the reading is under 200 but he does have the trace ketones so I am wondering what the recomendations of you people (who obviously know far more about this than my vet - sticking with him for now in the hope of educating him for the benefit of others) would be as far as giving insulin goes. Should we try the change in diet alone for now (he has been on canned food anyway but FF varieties that contain cereals) and as long as he stays under 200 forgoe the insulin? Or given the trace ketones start him on the insulin straight away. I note that the vet plans to give me Lantus, I asked about PZI but he doesn't prescribe it.
 
I should also mention that we changed canned food (to Whiskas with no cereals or plant products - does avoiding these ingredients make it reasonable to assume the carb levels are low?) the night before last and the following day and last night he has not drank excessive amounts of water.

Is this likely to be indicative that he is improving already, of another problem or just coincidence?
 
Urine tests reflect what happened a few hours earlier. The trace ketones need to be monitored and you want to encourage him to drink lots of water. If the ketones go from trace to higher, you'll need to get him on some insulin asap and may need to take him in to a vet.

Hang in there monitoring - he may come down a bit more on the changed food.
 
With numbers still under 200, he would most likely not be drinking excessively, so I take that as a "positive" rather than a sign that something else is going badly.

Lantus is an excellent choice for insulin. You can continue to BG test at home, and if you feel that the vet is not supportive of that, it's still okay to do. I didn't tell my vet when I started reducing Bob's dosage over the last couple weeks he was on PZI. I simply went in for a scheduled visit, handed her my "log book", and said "Bob hasn't had any insulin for the past 8 days". She was ecstatic. If the vet will write you a prescription for Lantus, take it. Whether you choose to fill it or not is still up to you, but at least you'll have it if you need it.
See what his numbers are like the next couple of days, see if they come down due to food changes. If so, you might not need the lantus. If not, you'll be able to get it quickly, and like I said, it's a great choice that many people here have a lot of experience with.

Carl
 
I have taken another urine sample this morning. Ketones have increased a notch to 'Faible' 15 but sugars seemed to have decreased a little. At the 30 second mark the result was closer to the 1000 rather than the 2000 but did keep darkening. Time to panic?

His water intake has reduced to 'normal' so I have added some to his food. He has been looking at his water bowls but not drinking. Is getting fluid into him all I can do for ketones at home?

Tried for another blood test but he's a bit annoyed about that idea at the moment.
 
He's going to the vet today, right? Definitely have them check his ketones, and tell them what you have gotten from checking. They may advise treatment, and quickly.

Carl
 
I wasn't planning to take him with me just take my results and organise the insulin. He has just urinated so he won't be going again for a while. Should I wait until tomorrow when I can take a urine sample as well or were you thinking they could test his blood? The vet's first thoughts were not to treat vyktor at all because they won't be able to get a blood test out of him without sedating him. He turns psycho as soon as we get to the vets.
 
Hmmm, quite the dilemma you have there. If he goes to the vet and becomes the tasmanian devil, that's not good. But if he gets ketonic, he's going to the vet for sure.
Here's some reading that may help:
http://petdiabetes.wikia.com/wiki/Ketoacidosis#When_to_come_to_the_vet

just a portion of it:
Trace urinary ketones may or may not be an emergency, depending on the case. If a vet is unavailable, look for some of the other signs or triggers, and try to remedy any you can. Give extra water and food, by syringe if necessary. If it's nearly time for an insulin shot, give one. Continue testing and call a vet when possible.
DKA cannot be treated at home. Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones and when necessary, to replace depleted electrolytes[19][20][21], such as bicarbonate; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down[22][23]; measured amounts of glucose or force feeding, sometimes by feeding tube, to force the metabolism back from fat-burning to glucose-burning.

Dehydration becomes involved with ketoacidosis, which can mean that subcutaneous insulin injections are not properly absorbed; when this occurs, intravenous treatment with soluble, short-acting insulin is needed[24],along with rehydrating intravenous fluids[25].

Veterinary care for DKA may involve a hospital stay of five days or more and cost, in the U.S., $2,000 or more. Some animals are DKA prone, and may have multiple episodes of the condition.
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Carl
 
If his BG is getting close to 200, and he's showing ketones, then you are most likely going to need the lantus sooner rather than later.
If you bring him to the vet, they can test for ketones using blood rather than urine. It's more "up to the minute" in blood too. They won't have to wait around until Vyktor feels the need to pee.

Carl
 
Because of his behavior at the vet, you might ask for a modest amount of sedative to give before going, to reduce the stress.

Also, urine test strips have expiration dates, and may lose effectiveness if old, exposed to moisture, or otherwise contaminated. And they are not as precise as a blood reading.

In a pinch, if the vet won't prescribe anything, Humulin N is available over the counter.

It lasts roughly 6-8 hours and hits a bit harder than Lantus, Levemir, or Prozinc, so may be more stressfull on the cat, plus it may need 3 times a day injection.

It is a U-100 insulin, meaning there are 100 units in 1 mL.

The correct insulin syringe for this is a U-100 syringe - get the 3/10, 33 gauge (needle thinness), 5/16" needle, with half unit markings (WalMart has them, or they may be ordered online, ex American Diabetes Wholesale.)

The starting dose we encourage for most newbies on other insulins is 0.5 to 1.0 units, with the caveat that more can be added, but once its in the cat, you can't take it out.
 
Got a higher reading on ketones again last night but OOPS, I may have stuffed up the tests. I realised last night that just rinsing the spoon under tap water between uses probably wasn't good enough! So I have cleaned the wee spoon in boiling water and we shall see what the next test has to say.

Saw the vet without Vyktor yesterday. I think he was quite impressed with my getting Vyktor's blood samples (he didn't charge me for the visit!) and is on board for treatment. He says Vyktor's numbers are too low for insulin for now and has asked me to take curves for a week. I'm going to attempt 7 tests a day at the same time each day 2 1/2 hours apart. Probably a bit ambitious but if I have to skip a couple on any day due to grumpy cat I should still get enough useful information

This mornings test, an hour and a half after eating 100g of wet food (which I gather means he should have been having a food spike?) came in at 194.4 this was the same as at the same time yesterday morning but without having had a big meal. Vyktor is free fed so usually grazes but pigged out this morning because he wasn't happy with last nights food and didn't eat overnight.

Vet also said not to be concerned about the ketones just yet because the problems that arise from them arise over the long term.
 
PLEASE keep testing for ketones. Ketoacidosis (DKA) is not something to triffle with. It can develop quickly & is life-threatening. If you continue to get trace ketones, or especially if you get something higher than trace, get Vyktor to the vet.
 
Just got another urine sample and the ketone reading is still between trace and the next one up but I think closer to trace this time.

I also just did another BG - very exciting - it was 149.4 so maybe Vyktor can be sorted out on diet alone.

He stopped drinking excessively as soon as I changed his food.

If that's all it takes for Vyktor I'm sure my vet will reconsider his diet is quite ineffectual idea!!
 
About the water drinking? A kitty eating nothing but canned food and never touching the water bowl gets more water than a kitty eating dry and using the water bowl regularly (according to catinfo.org)

A cat's normal prey is ~70% water. Canned food is ~78% water. Dry food is ~5-10% water. Cats have a low thirst drive and do not make up the deficit at the water bowl. They are designed to get water with their food.

Cats on canned food have been shown to consume at least double the amount of water (from food and water bowl) when compared to a dry food-fed cat.
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So, makes perfect sense that he's stopped excessive drinking! Good news.

Keep a close eye on the ketones. Bob went from "trace" to full blown DKA in three days. His BG was off the charts however (500+), but it isn't something that takes a long time to go really bad really fast.

Carl
 
S, I emailed you some other excellent pet foods.

I maybe need educating on this subject. I didn't think ketones occurred until numbers well over 2 - 300, on going for several weeks.

You can buy test strips for ketones for blood - go to one of the big pharmacy that have a large range of diabetic testing equipment - the bigger whole-sale pharmacies usually have a big range. Ask them if you can get the ketone test strip for your meter.

I guess that ketones might be more of a problem for older cats in lower level bg readings? Plus I'm shocked that my vet didn't do anything about the ketone reading for my cat when he was first dx. He didn't take him in and give him fluids etc. Mmmm.



m
 
Well, using Bob as my example, you could be right about "how long". He was diagnosed with a 350ish, received fluids but not any insulin for 3 days (hadn't arrived in the mail over a weekend yet), and between dx on Friday, and DKA on Monday, his BG was 550+ and ketones were bad.

But, I have no idea how long before dx he had been over 200 or 300. He was "trace" on Friday, and DKA on Monday, though.


There was another kitty this summer in PZI, Risky, who arrived with really high numbers and on a high dose of insulin, who went from trace to the ER in two or three days.

Carl
 
Cats on canned food have been shown to consume at least double the amount of water (from food and water bowl) when compared to a dry food-fed cat.[/quote]

So, makes perfect sense that he's stopped excessive drinking! Good news.

He wasn't on dry food previously, except for about 3 pieces a day, he was eating the Fancy Feast grilled varieties.

I'm sticking the wee spoon under him at every opportunity to check the ketones!
 
Just did another BG - not so good this time, he was 11.3 / 203.4. He's mostly been lazing around since his last test (he did have a wander round to survey his territory but then back into the cupboard) and hasn't eaten anything, is it right that his levels have gone up? I wasn't sure his blood drop was big enough when I did his previous 8.3 / 149.4 but the FreeStyle Lite beeped and told me it had tested so that should be right yes?

Vyktor hadn't had any blood tests before a change of diet and had already stopped drinking excessive amounts of water before I did the first one. He had been drinking excessively for the better part of three weeks prior to that. Perhaps his ketones are a carry over from that period when his glucose levels may have been much higher?

I just tested myself and came up negative so there isn't a problem with the strips.
 
Sounds like the same deal as LB. I just knew something was wrong & took him to the vet but vet didn't spot it. ohmygod_smile I changed his diet after reading this forum. I presume his numbers were slightly down when he was dx coz of the new diet .... but his bgs see ed high to me. Including low grade ketoacidosis. He was mid 400s after two weeks of raw meat diet. I suppose this is the reason he's been so difficult to manage over the long term - too long undiagnosed. Certainly Vyktor may have had higher numbers than he is currently showing and numbers like 11 suggest you pay attention.

You really need to test his blood for ketones. I just can't see him having ketoacidosis with numbers around 11 - 15. I only check LB for ketones if he goes above 17.

Also bear in mind that when you start Vyktor on insulin you will have the opposite problem if he's borderline for insulin. You will be worried about hypo attacks. My kitty was 2.1 the other day - out of the blue their lives can hang in the balance if you aren't keeping a close eye on them.

marilyn
 
With numbers around 10 & 11 you should give it more time for the new diet to do its stuff. Can I buy that brand you mentioned at the supermarket? I've never seen it. The gravy wouldn't worry me if LB wasn't allergic to it - 2% carbs is fine by me! I gave him a tin of Fancy Feast the other day to get his numbers up quickly and he hasn't forgotten it. He's playing hardball over his usual diet and keeps walking to the laundry where he thinks I might be hiding more tins of fancy feast. They are sooooo smart!
 
Anyname said:
Can I buy that brand you mentioned at the supermarket? I've never seen it. The gravy wouldn't worry me if LB wasn't allergic to it - 2% carbs is fine by me!

Yes Nature's Gift is available at some supermarkets. I was disappointed to find that my local Coles only has the dog varieties but my Woolworths (which is Safeway in Victoria) stocks it. If you have an IGA nearby and they don't have it they will most likely get it in for you if you ask them to.
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