Follow-up on Boots

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Megan and Boots (GA)

Megan and Boots (GA)

Member Since 2015
Hi all,

Well we're now a little over a week into treatment, and already the numbers are looking good (I think? I'm honestly not sure exactly what I should be looking for or expecting in his numbers, but overall they're slowly going down, so I guess that's good!). Maybe some of you fine folks can take a peek at his SS and let me know how it's looking, even just after one week. Today he dipped one reading below 200 for the first time, so I feel like that's progress.

The one problem we've been dealing with though is spraying. Or maybe even full-on urinating outside the box, I'm really not sure. He did it once about 3 weeks ago (that was part of what drove us in to the vet to have him checked out, and ultimately got him diagnosed). And now in the past week, he's done it again probably 5-6 times, at least that we know of. Today we caught him twice about to spray on a door (he did it there earlier this weekend too, though we did use an enzyme cleaner on it afterwards, guess it wasn't enough), and thankfully gave him just a tiny nudge and he walked over to the litterbox (feet away) and went in there. But I'm worried about the coming work week when we can't be around to watch him like a hawk.

I guess I'm looking for advice from others who have dealt with this. I have read it's not uncommon for peeing outside the box with diabetes - is that true? And also read that it often goes away once they are regulated and feeling better. anyone else deal with this at some point? any advice for getting him to use the box (we praised and gave him treats today and yesterday when we saw him use it)? Advice for keeping our house from becoming a giant litterbox? Especially when we're away. Confine him to one room, maybe? Any ideas on deterring him from spraying the same spot again?

I appreciate everyone's insight in advance - and so does Boots!
 
Diabetes may affect the nerves, including the ability to be continent.
Diabetics are frequently affected by bladder infections, too.

 
I'm guessing it's not a continence issue, only because the couple times we've caught him, just prior to urinating, he was just walking around, seemingly looking to sniff out a spot to go - didn't seem like it just came on all of a sudden. And today, the two times we moved him when he was about to start urinating, he held it fine for several seconds (maybe up to 30 or so) before he went and sniffed at the litter box and went in and urinated there. And no, no change in litter, boxes, placement, etc. recently.
I am worried about the possibility of infection though. Should I call the vet to see if I should bring him in for a urinalysis? Is there any way of home testing for a UTI?
 
And we did actually just add another litterbox on another floor of the house that didn't previously have one (a floor he hasn't yet urinated on, thankfully) - just thought it might help in case he was in that area and needed to go, maybe he'd choose the new box (same litter as other boxes). Not that the other boxes are far, but I thought it might help since he hangs out on that floor a lot, wouldn't have to go down stairs to urinate if he had to go.
It is a new type of box though, I decided to try the big storage tub DIY litterbox, so it has an opening cut in and high walls, I thought also maybe he was getting used to urinating on a vertical surface and might like that. One of the other cats has already broken in the new box, but Boots hasn't used it yet.
 
The vet needs to do a cystocentesis, then a culture and sensitivity if bacteria are found. A home sample gets contaminated in the process of elimination.
 
Thanks for the guidance. Will call the vet tomorrow, see if we can schedule something soon to check for urinary issues.
Any chance you could take a quick peek at his spreadsheet? I know every cat is different, but I'm just curious if his overall gradual decreases in the past 2 weeks or so look like what one might expect? And the PMPS number being pretty consistently lower than the AMPS number each day - is that "normal" for Lantus or insulin in general? Thanks in advance if you are able to do so!
 
We have 2 protocols for using Lantus:
Tight Regulation
Start Low, Go Slow
Take a look over to see which of those would work best for you to follow, as that affects the suggestions folks give you.
One important point is that we only increase based on the nadir, the lowest glucose post-shot, and the amount of the increase is only 0.25 (eyeballed) to 0.5 units at a time, so we don't miss the best dose.
Unless the nadir is super high, it is the 0.25 unit amount of increase, and only after holding the same dose 3-5 full days to allow it to reach a steady level.
 
I guess I'm going with the Tight Regulation protocol. My vet provided me with documentation/instructions that sound a lot like that, and she interchanged the terms "aggressive treatment' and "tight regulation." She admitted though that most of her diabetic patients' caretakers have opted to not try that because it's too much work to do all that home monitoring, so while I trust her knowledge, she just doesn't have a lot of experience with the protocol, so I'll probably be heavily reliant on you all for advice.
Re: nadir, I'm still trying to figure out when it is. For the curves we've done the past two weekends, should we be getting more readings? Some days it seems to be at +3, other days at +5. Do I just need more data before knowing for certain?
 
The nadir can and does vary, so you really looking for the period of time where it tends to fall, rather than an exact time.
A typical curve is from pre-shot test to pre-shot test, every 2 hours; a total of 12 hours.
You've had 3 full days on 2 units; go look at the guidelines for Tight Regulation and respond with what the instructions say to do with the dose. Hint: it will be an increase, but how much?
 
Uh oh, didn't know there'd be a quiz :) So it looks like since I've been 3 days with our lowest readings between 200-300 (with one exception of 196), I should increase the next dose by .25U?
 
Great! I'll bump to 2.25 tomorrow AM and keep tracking. We work out of the home during the week, so the best I can do (most days, hopefully) is dash home briefly around my lunchtime, which will be about +4/+5 for Boots. Is it worth it to grab that reading during the week, or should I just stick to better curves (every 2 hours) on weekends? The instructions the vet provided are slightly different, but overall the same type of approach. Thanks for the links to the helpful posts. There is SO much great information and knowledge contained on this site, I'm sure I'm asking repeat questions that others have asked before, but while it's great that there's so much info available, it's just a bit overwhelming to sort through it all. I'll keep reading though - thanks!
 
Get them when you can. If the weekend works best,that is fine. Some folks set an occasional alarm overnight to wake and snag a test.
 
In addition to the +5 AM cycle reading I try to get at lunchtime, we've been trying to get a +3 after the PM dose on weeknights, which is just before we go to bed. And considering Boots tends to wake us in the middle of the night with his cries for food (I presume), maybe we should just start setting an alarm for a nighttime +5 or +6 and getting a reading and giving him a snack then. Definitely this weekend we'll try to get readings more like every 2 hours than 3-4, which was the vet's instructions. I know obviously the more readings you have, the better the data is to spot trends, but the truth is I am still getting used to all of this, and I just plain feel bad sticking the poor baby's ear (I am getting better, but still sometimes poke through or he lashes his head or I poke but get no drop, etc.) so that's why we've stuck to 3-4 hours. But we'll try to get more this weekend. We tend to stay up fairly late on weekends too, so we can probably manage to snag every two hours from AM shot through to PM shot and then probably can get readings for another 4-5 hours after that on weekends.
 
Getting up after being asleep works best if you were asleep for a multiple of 45 minutes, the length of the average sleep cycle - ex 4.5 hours, 6 hours, etc.
It is easier to wake at the end of a sleep cycle, than in the middle when you most deeply asleep.
 
Good to know, very interesting. Unfortunately, I am a terrible sleeper, or at least an unpredictable sleeper - some nights I fall right asleep, others half an hour, others a couple hours - so setting an alarm would be a shot in the dark as far as what point in the sleep cycle I am in. Still... interesting stuff! The good news is that ever since Boots started becoming really vocal overnight (most nights not til about 4-5am, thankfully), we've largely come to terms with the fact that our sleep will be messed up a bit until he is feeling better, so setting an alarm once in a while, even just one or two nights a week, wouldn't be a big deal if it would help to get some extra numbers. Maybe it'll be more important as we get closer to regulated and start seeing some of those scarier lower numbers.
 
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