Fostering a diabetic cat

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Shadowboy

Member Since 2013
Hi!
3 weeks ago I started fostering a Shadow, a diabetic cat. Shadow is a gret boy, he's so happy to be out of the shelter. He was in the shelter for almost a year, with poor treatment for his diabetes during that time.

His first blood sugar on arrival was 716! He was on 5units of insulin twice a day at that time. My vet switched him to Lantus 3units twice a day (we went down in the dosing because we were switching to Lantus). Blood sugars have responded some, but I'm routinely getting readings in the 500 and 600s.... I've gotten two readings under 150 in the 3 weeks I've had him.

My vet isn't sure what to make of this. Initially he was also diagnosed with pancreatitis and a urinary tract infection. He was on antibiotics. Repeat culture so far looks negative but the urinalysis had A LOT of blood. Kidney values are fine. Blood work for the pancreatitis has improved.

The vet was wondering if he was dropping low overnight and then rebounding so last night I woke up and checked his blood sugar his low was 318- back up to 340 this morning preinsulin.

Any thoughts? Thanks so much!
 
Hi and welcome
Good for you to foster a sugar kitty, since so many are killed because of their illness in shelters. I am a newbie here myself so I can only speak of what has been good for my boy Loki.
Is your sugar cat eating dry food? When I took Loki off dry he dropped 100 point.
He now gets Fancy Feast anything that is 4.5 or lower in carbs.
Can you tell us where your from? It could help if someone in your area can help you out.
Your are home testing I see. Kuddos this was my biggest fear to do.
Not sure what the blood in the urine means if he does not have a UTI.
Anyway wanted to welcome you and ask away this has been a life saver for my boy and myself.
Mimi & Loki
 
The vet was wondering if he was dropping low overnight and then rebounding so last night I woke up and checked his blood sugar his low was 318- back up to 340 this morning preinsulin.

Any thoughts? Thanks so much!
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Here are some of my thoughts and some questions to give me more information to go on. Three units is actually kind of high for dosing Lantus. How long have you been giving him the Lantus and was it always at the 3 units?

What was the previous insulin before you started on the Lantus?

What times have you been testing? Before shot, what we call the pre shot? After feeding? What time during the night?

We put the times in a +number format to account for the difference in time zones that people live in.The morning pre-shot test is called AMPS. Any tests after that are how many hours have elapsed since the morning test/shot. So two hours after the shot is +2, 6 hours after is +6, etc. The evening pre-shot test is called the PMPS.

So for a day of tracking the BG numbers you might have something like this.

5/3
AMPS 359 3u
+2 370
+6 253
PMPS 402 3u
+6 318 (or whatever the actual time/bg readings were)

5/4
AMPS 340
+6

PMPS
+6

Would you put this data for the last couple of days into your post so we could look at it? I don't believe you have a spreadsheet set up yet for our standard google doc format so this would be a shortcut you could use for now to let us see some numbers and comment.

Are you giving the shots at a consistent 12 hour schedule or are you needing to vary the times due to other life commitments?

What food are you feeding?
What was his diagnosis date? What is your name? Is the UTI cleared up? Is he on any antibiotics now? When was he on the antibiotics?

What color is your foster kitty? ( I love to know those personal things. ;-) My Wink is a black and white medium haired tuxedo boy)
All the answers to these questions give us more clues to see what is going on.
 
Hi! Thanks for the quick replies. My name is Jen. Shadow is a black cat from South Carolina. He's guessed to be between 2 & 4 years old. He came to New Hampshire 3 weeks ago.

Shadow was diagnosed at the shelter about a year ago. They started him on 1u of insluin ( I forget the kind he was on) twice a day. He was picked up from the shelter and brought to one of our partners in South Carolina on a Wednesday- his BG then was 750! They switched him to 5u twice a day. He came to NH the following Sunday and Monday went to our vet.

His blood sugar there was 716. Our vet switched him to Lantus (she's more comfortable with it) He was also diagnosed with a urinary tract infection and pancreatitis. He was started on Baytril until the culture came back and then he was switched to Clavamox twice a day. He was on clavamox until 4/25. 5/3 he went back to the vet for repeat blood/urine tests. His urine nows shows A LOT of blood. Vet also thought his kidneys were large and was worried about renal failure. His kidney values are all normal and so far his culture isn't growing anything. We did restart the clavamox- to be on it until we get final culture results. Levels for pancreatitis are improved.

Shadow has been on 3units of Lantus twice a day since his first vet visit with me. He's 12 pounds so that's about 0.5u/kg/dose (what our vet likes to start with)

I try to give his insulin every 12 hours but I have to be honest that that doesn't always happen. I also work full time- 12 hour shifts and have 5 foster dogs along with my 2 =)

Right now he's eating m/d canned food. He was on prescription dry food when he first got to me. I've read the info here about food and plan to try to switch him over to California Natural or Wellness canned. He's acting like he's starving.

My vet advised against checking sugars with each dose...

The sugars I've gotten so far are:
4/22 6a-554
4/22 1200-105
4/22 6p-223
4/23 6a-583
4/23 1:30p-580
4/23 6p-394
4/24 8a-626

5/3 6a- 584
5/3 1245- 332
5/3 6:15p- 602
5/4 5:15a- 347
5/4 6p-540
5/4 8:45p-488
5/5 1a- 319
5/5 5:45a- 342

He was at the vet 4/16 for a glucose curve- he did curve but didn't drop as much as she had hoped. We left his insulin alone at that time becuase he still had the UTI and was on antibiotics.

Thoughts?
Thanks!
 
Ok, from the numbers you gave me I am going to put them into a format that is more understandable for those of us here that are in different time zones.

4/22
AMPS 554 shot 3U lantus
+6 105
PMPS 223 shot 3U lantus

4/23
AMPS 583 Shot 3U lantus
+7.5 580
PMPS 394 shot 3U lantus

4/24
AMPS 626 shot 3U lantus (shot delayed 2 hours due to?? work schedule??)

no testing from 4/24 AMPS until 5/3 AMPS

5/3
AMPS 584 shot 3U lantus
+6.75 332
PMPS 602 (shot delayed 15 minutes)

5/4
AMPS 347 shot 3U lantus (shot early 45 minutes due to?? work schedule??)
PMPS 540
+2.75 488
+7 319

5/5
AMPS 345 shot 3U lantus (shot 30 minutes early due to?? work schedule??)

I have to say that I find it harder to look at a column of numbers and see what is going on but I'll give it a shot. I am much better at reading our standard format spreadsheet and seeing the waves of action or trends over a couple of days or longer.

1. The dose is too high. If this were my cat, I would drop the dose to 1 -1.5 units immediately. Our starting dose for a 12 pound cat would have been ideal weight or current weight if underweight / kilos (2.2 per pound) * 0.25units rounded down to the nearest whole unit for safety. So 12/2.2= 5.45 kilos * 0.25 units = 1.36Units rounded down = 1 Unit Hold the dose for 5-7 days to build up the shed/depot and then start to raise the dose in quarter units based on the nadir, not the pre-shot BG number. If you have needles that have the 1/2 unit markings on the barrel like the Relion 3/10cc syringes available at Walmart, you can measure the 0.25 units and the 0.5 units easier and could do 1.25 units. (you need a prescription in NH. I live on north shore MA and drive to Seabrook to get my Walmart supplies which is how I know) I can provide pictures of syringes with these smaller units if you are interested.

2. Shadow is definitely bouncing. For example on 4/22 AMPS was 554 and +6 was 105 for a 449 drop in 6 hours which is a VERY steep and rapid drop. That causes the liver to compensate and pump out glycogen because it is not used to seeing those low numbers and is protecting the cats body by supplying energy.

3. bounces last up to 72 hours or 6 insulin cycles, sometimes longer because, ECID (every cat is different) Bounce on 4/22 is still evident that evening and the next morning 4/23 and again on 4/24. Still bouncing. Bouncing is because the dose is too high causing those steep, rapid drops.

4. 4/16 glucose curve at the vet. Can you get those numbers and post them? More data to work with. Most cats are stressed at the vet which can raise BG numbers 100-180 points within 5 minutes and last for 90 minutes or more. Some researchers did a test with bathing cats and measured the BG numbers while doing this. It's how they found out this information and labeled it Vet Stress Syndrome . Unless your foster Shadow is a laid back, love the vet kind of cat, scarfs down his food with no problem while caged at the vet, is not afraid of strangers, other cats and barking dogs, then the BG curve your vet did is probably showing elevated numbers due to vet stress.

5. Numbers on 5/3 through 5/5 look like they could be from another low on a previous day. No way to tell without more test data.

6. Would you be willing to get some more testing? A +2 tonight would be nice along with a before bed test if you are willing. The +2 will help us to see if this is going to be an active cycle or not.

7. I think because Shadow has been so high that daily ketone testing of the urine is very important to prevent life threatening DKA episode, emergency vet visit, overnight several days, $3000-5000 to treat. urine ketone testing strips available at the drugstore.

My vet advised against checking sugars with each dose...
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Why did your vet not want you to test before every time you gave insulin (pre-shot)? This is very common by the way.

We like to think of cats being more like small children or infants who can not tell us that their BG numbers might be low and need some food or OJ to help bring their BG number up. If the pre-shot BG is below 200, we advise new members to delay the shot, post on the board and ask for help by putting the ?mark radio button on and editing and changing the header text on the first post in the thread/condo/post to something like 'dose advice needed tonight'.

We have also seen many members dosing too much and going into low numbers and experience hypo symptoms which can be life threatening to your cat. We think of not doing the pre-shot tests as being like driving with a bag over your head. Which may be fine if you are parked in your driveway, with the engine turned off. :lol:

To verify,Shadow went back on the Clavamox as of 5/3 until final test results come back from the vet?

Would you be willing to create that standard format spreadsheet and link it into your signature. I realize that it is asking a lot of you to set this up with all the other things going on in your life but it really helps us to advise you better. Instructions are herehttp://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207.

I'm sure I have missed replying on some of your other questions but this is already a long post and I need to go feed my own cats.
 
Food

We like to feed our sugar kitties a low carb diet with <10% of carbs from calories. We do this because various vet studies have shown the benefits of feeding a low-carb diet to diabetic cats and non-diabetic cats alike.

Dr. Lisa Pierson has updated her wonderful food chart as of September 2012. We look at the third column under calorie % to find a food that meets this <10% criteria. There are lots to choose from on the chart which you can find here: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Of the foods you are considering switching your cat Shadow to, the California Natural Chicken and Brown Rice (9%) and the Salmon and Sweet Potato (7%) are low carb enough for a sugar dude. For the Wellness canned foods, all the grain-free varieties (4-6%) are under our recommended carb limit. Salmon and Trout (8%) is ok, and the Core grain-free (5-8% carbs) are ok EXCEPT for the Indoor and Salmon/Whitefish/Herring. Other choices for those of us on limited budgets are Friskies pates and Fancy Feast classic pates.

Because of the mercury contamination, PDBE's, often high phosphorus and magnesium levels, high allergy potential of fish, addiction of cats to fish flavors, it is not recommended to feed cats a mainly fish based diet more than 1-2 times a week.

You have lots of flavors to choose from. Your kitty can turn his nose up one day to what was a perfectly acceptable dining choice only the day before. Having multiple flavors to offer is important. ;-)
 
Hi,
I put together the spreadsheet! Thanks.

I think my vet advised me not to check every day/every shoot because she didn't want me to feel stressed/crazy about the numbers. A little background... I'm a Pediatric Critical Care Nurse... these numbers have been freaking me out. The first vet visit I was asking about urine ketones, doing middle of the night blood sugars, and checking "pre shoot" very time. I'm thinking she was trying to make things easier for me... I'm more than willing to check blood sugars as often as necessary and I'm more than willing to check ketones. The one thing that does occasionally happen, as you can see from the spreadsheet, is that I'm not always exactly 12 hrs apart on the dot.... I'm trying.

Shadow will be on Clavamox until atleast today when we get the urine culture results back.

I feel like I've already messed up with Shadow by giving too much insulin and not checking sugars enough... I just want what is right for this boy. Thanks for all your help.
 
No, you have not messed up. You have rescued a kitty who probably would have died in the shelter. This is a complicated process and you are pedaling as fast as you can. :mrgreen:

Yes, you do want to get a preshot test always. It will let you know of the amount you are planning to give is safe. With Lantus, a midcycle test lets you know how the dose is working. You get it when you can and analyze the data when you have enough. Ketone tests are important with high numbers to avoid the possible of DKA. We had to put out a clean litter box filled with gravel to get him to pee without us watching. Other people put some clear wrap in the litter to catch the sample.

Keep reading and asking questions and do what you can, as you can. We're here to help.
 
Just did my +5 test... the numbers just seem weird... I feel like the insulin isn't working?? Will be doing a +6 test in 1 hour...
Thanks again for everyone's help.
 
these numbers have been freaking me out
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First of all, please take a deep breath, hold, release. Repeat the deep breathing as many times as necessary to help your frayed nerves and relieve some of the stress. Or have a glass of wine or a piece of chocolate- my favorite. ;-) Managing this sugardance for your cat Shadow is a marathon, not a sprint. It will take time.

You are already doing so many wonderful things for him. Home testing, a better diet, loving him, loving him some more. You did a very, very good thing to take in Shadow. It shows you have room in your heart and home to take care of a extra sweet kitty. I commend you for it.

I took on a diabetic sugar hunk myself back in the middle of January. He was just not doing very well in the shelter because they were not able to restrict his food, give him the insulin consistently, were not BG testing much, no overnight monitoring, he was stressed with all the other kitties around. The shelter had been looking for a foster home for Wink for 3 months. When I lost one of my very ill kitties, Libby, to CHF, I found room in my heart and home to take in this special extra sweet kitty. A change of diet from high carb dry to low carb wet, more consistent dosing, trying very hard not to every skip a shot, more monitoring of BG's with more tests, Methyl B-12 to help the diabetic neuropathy, learning to shoot the low numbers, supporting his pancreas to heal better with micro-dosing and especially lots of love and attention has gotten Wink in so much better shape that he is OTJ (diet controlled), shiny silky fur, his fur has grown back in so there he doesn't look so bald, brushed to remove the horrible mats he had, walking almost normally not on his hocks anymore because the diabetic neuropathy was treated, eating well. My goal fro Wink was always remission because I read that is possible with proper diet, long lasting insulin, proper dose but I would have been very pleased to simply get him regulated.

He is my success story. Shadow will be your success story. Believe it, OK?

I feel like I've already messed up with Shadow by giving too much insulin and not checking sugars enough... I just want what is right for this boy.
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We know that there are so many things to learn in this new sugardance. You are doing your very, very best and have not messed up. I am certainly far from perfect and see many areas in my life where I can do things better. Our advice and suggestions are, just that, maybe ways to do tasks a little differently to help improve your life and that of your foster kitty Shadow. Adding a test here and there to see some additional numbers and increase/decrease dose based on those nadirs.

is that I'm not always exactly 12 hrs apart on the dot.... I'm trying.
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With your work schedule, we don't expect you to be on the strict 12/12 schedule. Sorry if you did not realize that there is some flexibility in the dosing times with Lantus. Yes, 12/12 is what we try to do but we know that is not always possible for people that have so many other commitments in life. Life is busy. You have to work around your other commitments and do what you can.

I think my vet advised me not to check every day/every shoot because she didn't want me to feel stressed/crazy about the numbers.
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Well, your vet is right that you do not want to feel stressed/crazy over the numbers I think a lot of vets feel this way. The majority of diabetic cat owners do not home test, taking their cat to the vet frequently for curves. It gets expensive and if only done every two weeks or so, we feel that something can be missed. We on this message board and other diabetes message boards are in the minority in advocating home testing. Yes, there are some vets that support home testing but not many from what people have posted on this board, even actively discouraging their clients from home testing. Would equate not testing before at least the pre-shot to driving with a bag over your head. Not safe. If your cats BG was really low, insulin could drop the numbers into hypo territory. That is one reason we like people to home test for each pre-shot.

I put together the spreadsheet! Thanks.
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Yeah! a spreadsheet in your signature link. Thank you so much, it really does help us to help you better.

Please take some time for yourself and the rest of your fur family. You need to stay healthy so you can keep everyone else in your family healthy.
 
It takes time for the insulin to settle into his system. So you need to relax, put on your patient pants and let the process take its course. I know, easier said than done. ;-)

Something else to remember, if he was eating dry food all this time, it can take several days for the dry food to get out of his system and for him to start getting better numbers. Again, patient pants...... ;)

The other thing is you need to not feel bad about what you did/did not do previously. You were going by the advice of your vets and doing what you were told. Today is a new day and with that comes new knowledge that will help you to begin to learn better ways to work with this cat to treat his diabetes.

Before you purchase the Innova brands of food, please note there is a recall on some of the products. While this may not affect your food choices, you may want to research this and decide if you want to use this brand at all. http://www.innovapet.com/recall

Again, the more you know the better you can help the cat.
 
Just did my +5 test... the numbers just seem weird... I feel like the insulin isn't working?? Will be doing a +6 test in 1 hour.
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1.You did get a 85 point drop in 3 hours so I do not think you gave a fur shot. Did you give a partial fur shot? Did you feel the fur for wetness after the shot? Or smell the scent of insulin after giving the shot, lantus smelling like bandaids according to some people. This can happen if the insulin needle went partially through the area you are sticking or sometimes the insulin leaks back out the shot area for a little. You could try leaving the needle in for a count of ten. I never did though but I have read of others doing this.

2.You may have a cat with an early nadir. My foster Wink nadired around 4.

Here is a typical Lantus curve. Remember, ECID(every cat is different) and your cat may not follow the typical pattern. Mine did not.
Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
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Jen just wanted to say you are doing a marvelous job! You have the best of the best helping you. Thank you so much for helping this kitty, he sure is lucky to have found you!
WELCOME to the best site on the planet to help you help this kitty!
Keep up the good work,
jeanne
 
Re: Fostering a diabetic cat- what to do at PMPS reading??

Got a 9+ sugar-331... it's back down a little from the 5+ which was 341...

I'm wondering what to do at the PMPS reading (5pm)... If he's above 300 still do you still think I should give 1unit?
 
Got a 9+ sugar-331... it's back down a little from the 5+ which was 341...
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Here is another mini-lesson for you today. Meters are allowed to vary by as much as +/- 20% and are considered to be accurate. It's called meter variance. I'm attaching a couple of graphs that member BJM made up a while ago to give you an idea of the range the number can fall in and still be considered to be basically an equivalent number.

This first one is glucometer value. Find your BG number in the middle of the two lines. Then move your cursor up to the red line and you will get the number +20%. Moving your cursor down to the lower line will get you the number -20% https://docs.google.com/spreadsheet/ccc?key=0AgYqouyQhh_BdEVkX0JyRXBRSmJEcm8tTGtwOHlSckE#gid=1

This second doc has two tabs, "Test Value Ranges" and "Testing When and Why" The test value ranges are like the graph in link one, but instead of a line, you have a table of numbers. https://docs.google.com/spreadsheet/ccc?key=0AgYqouyQhh_BdHRUR2VzdWlHR2c4NGF2Zm5NSU1TWHc#gid=0

ETA: Whoops! Forgot to answer your question on the PMPS shot. Yes, I do still believe Shadow is bouncing high from too much insulin. I would like you try to at least reduce the dose from the 3 units you have been giving for the last 3+ weeks.

You did not like the suggestion to reduce to 1U. Would you feel more comfortable reducing to 1.5U?
 
PS there is a second page to the graph sheet; you may need to adjust your zoom smaller to see the tab at the bottom for it. I've color coded the ranges a bit differently to ID hypo territory, near hypo, ideal, below renal threshold, and some other higher groupings I didn't have any specific criteria for.

here
 
Thanks for all the information!

I would feel fine dropping to 1unit. Just got another value, 295. I found the sweet spot for checking sugars. I've had a really easy time checking today! Also bought some treats- freeze dried chicken and one other to give him after his checks =)

I will see where he's at in a hour and give him just 1unit tonight. How would you suggest I check sugars through the rest of the evening/night?

Thanks!
 
get a pre-shot - pmps

+2 or +3 your choice

and then get one more before you go to bed say anywhere between +5 and +7. if you happen to be awake or wake up during the night, you could always get a test in at that time. otherwise 3 is plenty for tonight.
 
I would feel fine dropping to 1unit.
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Ok, that sounds good. We will want you to hold that lower dose for at least 3 days or 6 cycles. I'll go find the info from the lantus forum and copy it here. Here is a little bit about some general guidelines with dosing.
These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
•Each subsequent dose is held for a minimum of 3 days (6 consecutive 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.
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Just got another value, 295.
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It looks like Shadow is staying in the same general range of numbers, +/- that 20% I told you about. One word for a number being about the same from test to test is "flat", meaning not a lot of movement or difference in the numbers either up or down.

How would you suggest I check sugars through the rest of the evening/night?
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When are your normal AMPS and PMPS time?. If you would put this in terms of say 6 pm EDT or 8PM CDT then we can figure out a schedule for testing tonight to get a few more numbers and still let you sleep and go to work and things like that. We want to make the testing reasonable for you and let you sleep too. ;-)

You can get another number in 1 hour but at this point you could also give Shadow a break from testing and wait until PMPS. Your choice. Which would you like to do?

ETA: Wendy suggested a +3 and a before bed test. How does this fit into your schedule?
 
You're right, I'll give him a break =) I'll do my PMPS check at 5pm EST. My typical times are 6am/6pm... today I was woken up early by the dogs so I checked him at 5am. Maybe I should do 5:30pm tonight then get back to the 6am tomorrow.

I really appreciate everyone's help and the sharing of information. I will also be switching his food to Wellness canned tonight.

Thanks!
 
Oh gosh, I just realized something. When I posted the example of a Typical Lantus Curve", did you think you needed to test every hour? You do not and I apologize if there was a misunderstanding.

Maybe a better way to title that "Typical Lantus Curve" is "Typical Lantus Cycle".

I will also be switching his food to Wellness canned tonight.
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With that switch to the lower carb food tonight, you definitely want to be lowering the dose because a lower carb food can drop the numbers also. That food change may be seen soon or may take several days to a week to be reflected in the numbers.

Which flavors/kinds of the Wellness did you pick?

p.s. You are in the same time zone as I am, in fact we are in bordering states.
 
No, I didn't think I had to check hourly. I just wanted more data to look at today to see if I could get a better grasp at what was happening.

Just got off the phone with our vet. I mentioned I'd like to drop down to 1 unit and see how he responds. She was a little hesitant, but said she was ok with it. =)

Yes, I had read about how much of a decrease in sugars you can see with a change in food. I bought multiple flavors- all grain free. Salmon & Trout, Beef & Salmon, Turkey & Salmon, Turkey, Chicken & Herring. Hope those were ok choices.
 
I just wanted more data to look at today to see if I could get a better grasp at what was happening.
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It doesn't hurt to have more data. Glad to hear Shadow is still cooperating with the testing. Does he like the freeze dried chicken treats?

I bought multiple flavors- all grain free. Salmon & Trout, Beef & Salmon, Turkey & Salmon, Turkey, Chicken & Herring. Hope those were ok choices.
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Yes all those are fine. They are all grain-free except for the Salmon & Trout which does have a little rice in it. It is still only 8% carbs. All the others you picked are in the 4-6% carb range. We recommend something under 10% if possible and you did that. Now, here is hoping Shadow likes all those flavors! ;-)

I feed the Friskies pates which also have some rice in them and my cat Wink did just fine on them. Lots of other members here also feed the Friskies pates.

Just got off the phone with our vet. I mentioned I'd like to drop down to 1 unit and see how he responds. She was a little hesitant, but said she was ok with it.
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Nice to see you talked with your vet. I think it is always important to talk with your vet about the changes you are making in the management of Shadow's diabetes.

With those high numbers that Shadow has gotten and the fact you are still giving an antibiotic for possible lingering infection, it is important to get a ketone test every day.

Are you fostering Shadow for a local shelter or DCIN? Curious and only answer if you want to share.

ETA: Would you make one tiny improvement on your spreadsheet (SS)? I noticed that on some days, you do not have anything entered in the units column. Was this because you skipped the shot, or missed the data entry? For a skipped shot, you can either enter 0U or "skip", your choice.

ETA: You can shift your test, shot feed cycle up to 30 minutes once a day or 15 minutes twice a day.
 
I wanted to be open with the vet. I like having a good relationship with the vet- find it's very important. Not only do they see my two dogs, but they're also the vet that sees all the foster dogs.

I work with a local foster home based rescue. We are an all dog rescue, but pulled this guy from the shelter we usually pull dogs from because he has such a great personality.

Gave the first 1 unit dose =) Can't wait to see how things unfold from here! Shadow loves the treats I bought and is very happy with his dinner. He isn't a picky boy! Plan on getting a +5 & +7 tonight.

Tomorrows goal will be ketone testing. Need to get approval to start testing and get the strips.

Shadow's urine culture is negative... Will be trying to get a repeat urine tomorrow morning to recheck for blood because his last urine was so bloody. It was a cysto- vet is wondering if the blood was from the needle insertion. Vet is also wondering if there could be a correlation with his sugars and him being on the clavamox. He was on it from 4/16- 4/25 & then restarted 5/3 in the evening. Maybe there's an infection that we haven't isolated yet...

Thanks!
 
Re: Fostering a diabetic cat- BGs post decrease to 1u- is it

BG PMPS 352, +3 447, +5 452

Is this ok? How high do I tolerate? I know I should allow 6 cycles before making any changes, but these numbers make me nervous...

Thanks!
 
Here are some general guidelines that may help. I know it is hard to see these high numbers, but you only changed the dose 1 cycle ago. I would give 1 unit again this morning, and see how he does during the cycle. I will ask if some others can come over and provide suggestions.



"General" Guidelines:

- Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).

- Each subsequent dose is held for a minimum of 3 days (6 consecutive 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 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

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

- After 3 days (6 consecutive 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.
 
Are you around today to get one or more of these numbers? +5, +6, +7 We are trying to find Shadow's nadir.

Yes, those high numbers are scary but we needed you to try a lower dose of insulin because it looked like Shadow was bouncing.

If you do not have ketone test strips to test the urine, you can smell his breath. Does it smell like nail polish remover? or have a sickly sweet fruity smell to it?

ETA:
Tomorrows goal will be ketone testing. Need to get approval to start testing and get the strips.
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Yesterday you said you needed to get approval to ketone test and get strips. Is this because this is a foster kitty and the shelter/rescue organization will be providing the ketone test strips?
 
Hi,
Yes, I'm around today. I have gotten a +3 & +7....still high. =(

Yes, I need to check with the rescue about ketone testing. Because he's not "mine" I have to get approval for everything. Clean catch urine today still had red blood cells.
 
Yes, the numbers are still high. Does his breath smell like nail polish remover or a sickly sweet fruity odor?

Remember, you also switched him to a lower carb canned food which can also drop his BG numbers.

Can you get a +9 today?

ETA: Yup, I understand where you are coming from on the rescue telling you one thing, the vet saying something different, then all of us here giving you advice. Please, take a few deep breaths and don't drive yourself crazy.

Wink is actually not "officially" mine either, being a foster from my local rescue. I pushed back at the shelter recommendations on the food they wanted me to feed (high carb W/D dry or Hill's m/d), home testing more (they didn't want me to test too much, only at pre-shot because of the cost), convincing them to let me use a meter with lower cost test strips, not the Alphatrak with it's pricey $$$$ strips (finally got them to let me buy a Relion Confirm meter and lower cost test strips and they reimburse me), so many other things. Tried to teach them more about the current research on diabetes, the AAHA guidelines, etc. So many times I felt like I was pounding my head against a brick wall but kept pushing back pushing back hard, to get Wink the best care possible. He went officially OTJ on 3/12/13.
 
Just got another test. The timing actually ended up being a +7.5 & a +9.5

Don't get why he's dropping so late?

No he doesn't a have a fruity DKA smell.
 
They don't always smell fruity or of nail polish remover when in DKA.

Depending on your budget, you might get the strips and make a donation in kind to the rescue, which'd make it tax deductible for you if they are 501(c)3.

Ask them what their decision would be if he were in DKA - euthanasia, or treat to the tune of a couple thousand dollars? And it'd be a lot cheaper to treat the cat pre-emptively both fiscally and emotionally.

p.s. Instructions on How to Conditional Format a Cell in your spreadsheetand get them color-coded automatically.
 
No he doesn't a have a fruity DKA smell.
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Good. Since you did not have ketone urine test strips that is another way to check for ketones, the breath smell. But see BJM's note above on the smell can be missing.

Ketone test strips do not need a prescription ever. Pick up at the pharmacy. Around $11-12 for 50

Don't get why he's dropping so late?
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It could be because he hasn't had any food lately and his body is not trying to process the food without enough insulin.
He could be a kitty with a late nadir.
It could be meter variance.
Some kitties dip around +10 +11.
The insulin shed/depot is still draining from the 3U.
He is a cat! :shock:

Are you meal feeding or free feeding?

Do you have syringes with half unit markings on them? 3/10 cc capacity syringes or something else?
 
Over the counter
If you get the ketodiastix (or generic), you also get if the glucose is spilling in the urine, in addition to presence of ketones.

See my signature link Secondary Monitoring Tools for tips and tricks on urine testing, plus supplemental assessments you can make for minimal effort.
 
no prescription needed for ketone strips - usually sold in the diabetes section of pharmacy - sometimes may be behind counter and they aren't expensive - about $10 or so a container, depending on name or generic.
 
Will pick up stips to check for ketones/glucose in the urine. Can't hurt to have another point of information.

I'm meal feeding 6a/6p

I have Terumo 29G 1/2" -3/10cc syringes/needles. No 1/2 unit markings on them.
 
You may find that feeding 4 smaller meals helps smooth out the glucose levels a bit - ex at shot time and +3.
An option, not a mandate.
 
I'm meal feeding 6a/6p
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The reason I was asking about the feeding schedule is because we have found out that spreading out the meals over time can put less work on the pancreas to process all that food at one time. Spreading out the food into mini-meals, 4 times a day or so, can help to even out the BG numbers. I don't know if this would be feasible for you to do, and keep the rescue dogs away from the food.


I have Terumo 29G 1/2" -3/10cc syringes/needles. No 1/2 unit markings on them.
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I was asking about the syringes to determine how small a dose you could give. The 1cc syringes are impossible to give an accurate dose for less than 1 unit. I wanted to see if it was possible for you to increase/decrease the dose in 0.25Unit increments.

It's possible to measure a dose in increments of 0.25 or 0.5 units with the syringes you are using, but is easier if the syringes have 1/2 unit markings. Possibly another item to ask your rescue about? Insulin syringes do require a prescription in NH.
 
Hi!

So, you can see our numbers for today. I stayed with the 1 unit after the PMPS reading. I think I'll stay with the 1 unit for the next few days and see where we go. I want to stick with not making changes too often. When I talked to the vet today and gave her the numbers she really wanted me to go back up to 3 units. I talked with the rescue coordinator and she is ok with me staying at 1 unit based on what I've learned from all of you and from my reading.

Tomorrow I'll be able to get a AMPS but then won't be able to get another reading during the day- same deal with Thursday. Friday I'll be off again and able to get more readings.

I was thinking about doing timed feedings during the day. I looked online and found some automatic feeders. Will see how the next week or so goes and then consider buying one.

Thanks again for all of your help and guidance.
 
I've seen a number of people suggest making 'foodsicles' ... freezing small portions of food that you can then later leave out and let kitty nibble at his leisure (grazing) as it thaws out. So maybe a feeder won't be a necessary expense.
 
Yes, be sure to take the food out of the can before freezing it. Nonstick muffin pan cups are a great size for making cat food 'cicles.

Tomorrow I'll be able to get a AMPS but then won't be able to get another reading during the day- same deal with Thursday. Friday I'll be off again and able to get more readings.
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Understood. What is your after back home time in our + hours? Maybe get a test as soon as you walk in the door and then the PMPS and another test before bed. Would that be possible?
 
Tomorrow I leave the house at 6am and return at 8pm....I can get a AMPS and a PMPS but that's probably about it.
 
The PetSafe 5 seems to work well for several people here. Check our shopping partner Amazon if you decide to buy one.
 
you can also use ice cube trays and my favorite, ziploc baggies to freeze the food in. be sure to add water to the food and freeze. then before you leave in the morning, you can put the frozen out and hopefully they will wait to eat it and then by the time it is thawed they will be ready for it.
 
Tomorrow I leave the house at 6am and return at 8pm....I can get a AMPS and a PMPS but that's probably about it.
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Another person with an extra long work day. I was afraid that was going to be your answer.

You could still do a test before you go to bed. That is, if you do not go to bed as soon as you get home. :-D
 
Here are today's values... not too bad. We'll see what the morning brings.

Should I be starting a new thread?

Thanks!
 
Ok numbers for today.

How is his appetite? Is he eating well? Meals spread out during the day? Did you get a chance to make the cat food 'scicles and leave one out to defrost while you were gone today?

I'd stay with this thread for now. Be aware that it will go to a second page when you hit 50 posts in the thread, and you will need to select the second page to see the most up to date replies.

Another long day for you tomorrow?

Any chance of a before bed test tonight? If not, that's ok.
 
His appetite is great. He would eat more if I would let him. Still doing just the two meals a day, morning and night. I didn't know if I should change too many things at once?

I'll get one more sugar before bed. Won't be to long from now ;)

Yes, another long day tomorrow. Then I'll be off Friday, Saturday, Sunday.
 
Good Morning. Looking at the spreadsheet you'll see a +2 after my insulin last night and an AMPS. Numbers are still high. Still gave 1unit this morning. That was the 6th dose of 1unit. I'm thinking I'll go up in my dose tonight. With numbers as high as they still are, is it unreasonable to go to 2 units?

Will get a PMPS tonight.
Thanks
 
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