George, newly diagnosed

Been lurking since George's recent diagnosis. Lots of information to learn, which at times seems overwhelming!

We think we caught his diabetes early, he quickly went from a healthy orange tabby to having a bony back. No personality changes, still my lovable Velcro boy.

Vet has had success using Freestyle Libre to help regulate his diabetes. He's had the sensor since Tues and we've been closely tracking his blood glucose pretty closely.

Yesterday his blood sugar dropped to 78 which had me very concerned, so we gave him some corn syrup. I had given him his first insulin injection of for the day when he was at 178. In addition, I suspect he didn't eat quite enough prior to his shot. He isn't very food motivated to begin with, and his interest in food is really waning. After we gave him the corn syrup yesterday, several hours later his blood glucose was 350. We gave him his second dose of insulin, and his blood glucose was 128 this morning. He has been between 120 and a high of 200 very briefly today so far. He also didn't eat that much, we've been trying to entice him with tuna, chicken and various treats with limited success. I'm concerned about giving him his first dose today, his blood glucose has been reading 170-180 last couple hours.

Also, how important is keeping up with the 2 shots 12 hours apart? Meaning, I'm concerned about shooting him at 180 but if he spikes to 300 should I shoot him even if it's not at his scheduled shot time?

 

Welcome to FDMB I am not going to be much help for you as I'm new to this world and driving on this steep learning curve myself still but I wanted to let you know that you're in the right place for help. I'm sure someone with more experience will be on shortly to help you come up with what to do next.

Have you started working on your SS yet? I know that it really has helped others help me to be able to see my Lou's info at a glance.

Sorry I'm not more help but just know you and George aren't alone here

 

Hello George's person! It's super important to keep to the 12 hr schedule. Even if you skip a dose, or think you did a fur shot and he didn't get his dose. Better to have higher numbers for a day than risk a hypo reaction.

You've got him on a good diet. His appetite should pick up as he gets better regulated. Many sugar cats have trouble putting weight back on until the insulin is having a good effect.

78 isn't problem in itself, nice normal BGL, unless it drops further. At 78, I would just try to get George to eat something, then test again in an hour to make sure it comes back up. If his interest in food is waning, you might want to talk to the vet about a nausea med. And don't worry about the spike after a normal reading like that 78. A sugar cat's body is used to running on high blood glucose. When the cat drops down lower, even though it's a good thing, the liver can freak out, thinking the blood sugar is crashing. Then it released a ton of stored sugar, to bring the level back up. It's called bounce, and that plus the corn syrup easily explains the high 350.

You don't have to do anything about bounce. It will clear itself up.

In the beginning, before you really know how George will react to insulin in any given situation, advice is to skip the insulin if the BGL is under 200. There are also a couple other things you can do. You can stall, by waiting 20 minutes without feeding and then test again to see if his BGL is over 200. Or, you can give a reduced dose, half or a quarter of the regular dose. Some people even just give a drop. However, if he's under say 150, I would skip or stall. Remember if you stall, it will change your shot time later as well.

I don't know much about Vetsulin. Let me take a moment to study the stickies and I'll be back.

 

All right. I'm sill no Vetsulin expert, but here goes. Since George had that drop to 78, I really recommend reducing his dose for a few days to see how he does. The change to wet low carb food can have a big effect, as can George not eating as much as he should. Are you using a pen or syringes? If a pen, I think your only choice is to go to .50. If syringes, I suggest .75 or a unit. The low reading suggests that George's pancreas is at least thinking about making it's own insulin, and a dose reduction will help protect him from a dangerous hypo, which is a very real concern for any sugar cat, but especially for a cat on a fast acting insulin like Vetsulin. While other insulins are sort of time release, Vetsulin hits all at once.

Vetsulin really isn't a good insulin for cats. Don't get me wrong, it's a great deal better than nothing, but you may want to talk to your vet about Lantus or ProZinc insulin. Cats have a much better chance of full remission on these insulins.

A couple more things for you to think about. And do take your time taking it in, we all know how overwhelming this can be. I'm trying not to throw too much information at you at once. There is one important thing though. If you have to skip a dose of insulin, and sometimes you do, the cat can be in danger of keto-acidocis. Testing ketones is important when skipping doses. If a cat has too many ketones, they need medical intervention. If you test for ketones, now is the time to do it. If you don't, please consider going to the pharmacy and getting some Ketostix. They are very inexpensive and test urine.

Are you feeding George many small meals or two times a day? Many vets rec 2x a day, but cats do better on multiple meals. With Vetsulin, most members feed freely for the first half of the cycle, then withhold food the second half.

When you have time, a spreadsheet will help us help you. Click on Billy's link in my signature. Having a spreadsheet saved his life on day five. Without the good members here, I would have not been testing and blindly followed my vet's instruction. Billy would have gotten 2 units of insulin when his BGL was only 52. The spreadsheet is super easy to do, and the instructions are here.

I'm going to tag @Deb & Wink, as she has more experience than I do. I want her to double check my advice and add anything I've forgotten.

When it gets overwhelming, remind yourself that you are awesome. You are in here learning all the things! George will have a happy and healthier life because of it. It does get easier as you go along, I promise.

 

NO.

 

When in the dosing cycle that 78 occurs is important. We need context.

Do you have screen shots of the Libre readings you can post?
With some sort of indication so we know when the insulin dose was given?

We count hours from the time the insulin dose is given.

+1 is 1 hour after insulin, +2 is 2 hours after insulin, etc.
What time is + hours was that 78 BG reading?

 

The Freestyle Libre is a CGM (continuous glucose monitor) worn on the cat's body.
There is software on a smartphone, to "pull" the information from the sensor and download it to the tracking software on the phone. You have to get your smartphone close enough to the sensor to pull the data from the CGM. Every 8 hours I believe.

That is the data I would like to see.

 

Would you tell us please what food George was eating before the diabetes diagnosis?
Would you please tell us what flavors and/or styles of the Fancy Feast that you are trying with George?

Cats on vetsulin should eat at least 20-30 minutes before the insulin shot.
That is so that the fast onset of the Vetsulin insulin intersects with the food being digested. As the glucose gets into the bloodstream, it helps to keep the BG (blood glucose) levels from dropping too far to fast.

Even with a CGM, it's a good idea to get a handheld meter. Most folks here use a human glucometer for BG testing. Walmart line is often recommended.

Libre CGM's do come lose or stop working. The tissue glue can come lose and the monitor could stop working. Good idea to have a backup method of home testing the cat's blood glucose levels.

Since you called the insulin Vetsulin, you are most likely in the USA.

Would you share your first name with us please? So we can call you something besides CLM1975.

 

Hi, my name is Carrie, thank you thank you thank you, this forum is truly a godsend!!!

Unfortunately my brand new Google pixel 4xl is not compatible with the freestyle Libre smartphone app, I had to buy the reader. The first sensor didn't work so I haven't had a chance to explore how I'm going to download off the reader into some sort of electronic format I know there is a way to do that. that is a priority for me to get all of the data electronically.

I have the other freestyle meter and test strips etc to do the actual blood glucose readings. I haven't done that yet. Do you recommend I start?

George had been on a fairly low carb diet to begin with. We stuck to mostly the Fancy feast Pate, some Purina pro plan plus and then he did get a small amount of blue Buffalo senior dry food.

The 78 blood glucose reading came +2 yesterday.

Today he has been holding steady 180. Based off what everyone is telling me it makes sense to give him a half dose at his p.m. shot time.

 

Hi Carrie, Thanks for introducing yourself.

How long until your first insulin dose for today? Tell us how many hours away that dose is from right now.

Yes, I recommend you test with your hand held freestyle meter. Do you know how to do that?

Do you have any readings from the Libre CGM you can share with us?
Even if you can't download them, you should be able to tell us what the readings were at particular times.

So AMPS is the reading before you give the insulin, +1 is 1 hour later, +2 is 2 hours later, +3 is 3 hours later etc.
We have a standardized spreadsheet, with a template you can copy to create your own version.
Would you be willing to set that up for us please?
Directions on how to do that SS setup are here. Detailed directions for setting up the spreadsheet using a pc, tablet, smartphone.
FDMB Spreadsheet Instructions

What it means is here.
Understanding the Spreadsheet/Grid
I'd like to see at least a few days of data before suggesting a dose of Vetsulin.

 

Sorry to pile more work on you. But we are trying to help some cats with DKA (diabetic ketoacidosis) also right now.

 

Sounds like a good plan with the half dose.

The low low reading at +2 makes sense with the Vetsulin. It does hit all at once and tends to have really early nadir readings because of that. (Nadir just meaning lowest reading of the cycle.)

I know right now you just need to get George to eat, and I understand that. The Blue buffalo senior is quite high carb. When you feel you can, I would cut it out altogether. If George prefers kibble, there are two that are lower carb, Wysong Epigen 90 (I used to feed my ferrets that because of the high protein and the cats liked it too) and one called Dr Elsey's.

In my opinion, it would be a good idea to start getting used to home testing. Like Deb said, WalMart's ReliOn meters are inexpensive and have cheap strips, if you find the Freestyle strips too expensive.The Libre's are convenient, but so much goes wrong with them and they are so expensive. Practicing home testing with strips now can let you double check the Libre's readings, and give you an option if you ever want to discontinue the Libre.

 

So I filled out the spreadsheet, couldn't quite figure out how to publish the link. Will work on figuring it all out. Read more here, still so much to learn.

Have wimped out on doing the ear pricking, just feel bad because we're always poking and prodding at him lately.

 

Are you testing for ketones daily? Please do if you are not doing that already.

Thank you for entering the data in a spreadsheet for the last 3 days.
Libre CGM is nice, gives you readings every hour.
Actually gives BG readings more frequently than that I know, but hourly readings are plenty to look at.

Did get the pdf link to open in Google, so I could look at it.

I think I'd suggest you try for 0.5u, both day and night for now.
Let's see if that evens out the BG levels a bit.
Insulin likes a bit of consistency.
So changing the dose every cycle can make it more difficult to interpret what is going on.
Skipping a dose does the same thing, makes it more difficult to interpret.
Reading spreadsheets can be as much an art as a science.

I look for patterns.
Could you hold the 0.5U dose for at least 3 more cycles? (A cycle is a 12 hour period.) (Unless he drops low again, then 'tag' me)

George was "bouncing" a bit, both from dropping lower than what his body is used to. But also from the skipped dose.

Please tag me to look at George's SS in another day or 2. It's the @ symbol followed by my user name, to tag.
@CLM1975 There. I just tagged you.

 

Woke up this morning and suddenly George's back legs we're flopping all over. Called in to the vet and they had me bring him in. My vet loved the spreadsheet! Apparently his blood glucose is trending low, vet thinks that he is over sensitive to the insulin and he wants to keep us on .5 units moving forward. I'm bringing him back in on Tuesday for a weight check and to see what's going on w his back legs.

They did a ketone urine test, because his blood sugar is trending low there were absolutely no ketones nor was there any glucose in his urine. No fever or other signs illness, so we're going to wait until Tuesday to take any next steps. He mentioned using this appetite stimulant that you rub on his ears potentially but we are going to see hopefully if getting him regulated and steady on the .5 units of insulin twice a day, that restores his appetite and fixes the other things that we're seeing.

Whew!

Also, Freestyle readings have been very close to blood glucose tests, so a relief that the Libre is accurate.

 

Appetite stimulant can be compounded into a transdermal form. At least the mirtazapine can be.
It also comes in a pill and can work better that way.

2 common appetite stimulants are cyproheptadine and mirtazipine.

You do not want to wait too long, before trying an appetite stimulant if your cat is not eating and eating well.
Not enough food + not enough insulin + infection/inflammation can lead to ketone and DKA very rapidly.

Happened to Chloe007 just this last week. Her cat Oscar is only home from the hospital the last 2 days, and he should still be there, but she could not afford to pay $1000 a day to keep him there longer.
Oscar is home and she is trying to treat the high ketones, assist feeding him, giving him various medications. Managing him the best she can. It's still a bit touch and go if he'll be able to pull through and survive.

One day he was fine, the next in the 24 emergency vet clinic where he spent 4 days in intensive care.
It's why we urge people to test for ketones. DAILY.

If you link your SS in your signature, we could look at it too. See what is going on with George.
Right now, it's only in that PDF in the previous post, #13, which does not update when I look at it.

 

Steps to link the SS (spreadsheet) in your signature are here:
FDMB Spreadsheet Instructions

The specific steps you need to do are the steps to get the SS in your signature, where it will be "view only " for us.
7. Google will ask if you are sure you want to "Publish this selection". Click "ok". A link will be provided; before you copy this link, scroll down and click on "published content and settings". Be sure the box next to "Automatically republish when changes are made" is checked.



8. Copy the link and close the text box.

9. Follow the instructions below to paste the Spreadsheet link into your FDMB Signature block.
Instructions for pasting the SS link in your FDMB Signature block:

1. Login to FDMB and click on your user name in the upper right corner.

2. Select "signature”. The signature block is limited to three lines. If you have a lot of other information in your signature block, please be sure you place the spreadsheet link so it is easily located by other members (i.e. please don’t stick it at the very end of a long, detailed description of medications).

3. Put your cursor in the text box, type in your kitty’s name with the word “Spreadsheet” (e.g. Furbaby’s Spreadsheet), highlight those words, and then click on the “hyperlink" icon above the text box:



4. A text box will open that states "link"; paste your link into the box next to “URL” and click on “insert”.



5. This should result in the highlighted text turning light blue which means it is now a hyperlink to the spreadsheet and anyone clicking on it can see the spreadsheet.

6. Click "save changes" and you're done!! Great job!!!!

 

Ok, I think the SS link works.

His BG are all very low/in the normal range. Skipped his last shot, he's shortly due for another but don't know what to do!

He has started eating a bit more, just need to bring food to him rather than wait for him to go to his bowl and he will eat. He's very happy and himself this morning, and seems to be walking fine.

 

Vetsulin is a tricky insulin. With numbers below 90, you want to reduce the dose by 0.25u. I think you're vet is correct -- I would not give George more than 0.5u.

Just to make sure, more for my peace of mind -- are you feeding George 30 min. before a shot? Vetsulin needs to have food on board before you inject. It is what we term a "harsh" insulin given that it can cause numbers to drop quickly. Thus, feeding your cat and giving the food some time to get into George's system is critical. Likewise, it may be useful to give George snacks, although his numbers look great!

 

Yes, we are feeding prior to shot. So I should be giving him .25 as long as he's above what number?

Thank you!!!!!

 

Yes! SS link in signature is working fine now. Good job getting that link done.
And appreciate you entering more data on the spreadsheet.

That's a good question on the dose.

Do you have a hypo tool kit ready? I think you do, since you mentioned in the SS Remarks for 2/26/20 that you gave George some corn syrup, to bring the low number up.

Do you have plenty of test strips for your hand held meter? In case the Libre CGM has a problem?

We don't usually suggest you dose insulin unless the pre-shot BG (blood glucose) number is >150.
As you gather data, that number can be lowered.

The risk with giving no insulin, is that a cat can develop ketones if they are not eating well.
Not enough insulin + not enough food + infection/inflammation (bad teeth, UTI) can lead to a cats body burning up fat to produce energy. That burning up of fat reserves can lead to ketones which can lead to DKA (diabetic ketoacidosis). One day cat is fine, next in crisis mode and emergency visit to the vet.

So we highly recommend you test for ketones daily because of that possibility.

We've had 3 cats in the last 2 weeks with DKA, 2 of them with HL (hepatic lipidosis) also from not eating well, not eating enough. It's why we are trying to highlight the importance of ketone testing daily to folks.

It's very important that George eats enough.
1. to stave off ketones
2. to help him gain back some weight.

I'd suggest you give him some more food around 1.5 to 2 hours after insulin.
And then maybe another snack or 2 during the day.
Hand feed him if you need to.
Give him different foods to try, if he doesn't like one variety or flavor.

 

Food at nadir (the lowest point in the 12 hour dosing cycle) can also be helpful.
With all that data from the Libre CGM, you know when the nadir occurs.

Would you please make some notes on the spreadsheet (SS).
I'd like to see notes in the Remarks column on food and when you are feeding. Having that in the + hour format will help.

How is George feeling today? Still not very hungry? Appetite improving?
How are the 5 P's (purring, preening, playing, peeing, pooping). It's a quick condition report, those 5 P's and the appetite.

Just as importantly, how are you doing?

 

Just dropped in to say that you are doing great! Love the spreadsheet. Love the info in the signature. And look at the pretty blue numbers! Looks like George may be telling you he might not need that insulin much longer. If George's pre-test reading is above say 120, but below 150, you could consider using a small or drop dose. Just enough insulin in the syringe that you can barely see it. Keep up the awesome work and I've got my fingers crossed for George going into remission.

 

A good way to let us know that you have read our posts, is to click on the word "Like". It's located in the lower right hand corner, between the post number and the word "Reply"

For example, Juls and Billy did a post. It's numbered #23 Like Reply

Sometimes we will read a members post and not feel that a response is necessary. In that case, I simply click on the word "Like" to let someone know that I have read their response.

 

He's never been especially food motivated or a big eater. He's eating okay, if you bring him food he'll eat but he's not going to his bowl often. Since we figured that out (yesterday) we're going to make sure we're bringing him food every two hours, then withholding for 3-4 hours pre-shot so he'll eat something.

Five P's, just okay. Still keeping his coat on top shape, peeing fine. Always drank a lot of water, maybe slightly more now but not any crazy difference. Pooping slightly less, he only pooped every 2 days normally. Now his poop is really dry and hard and once I had to help him, and 2-3x I found poop nuggets in his scratcher that he probably loosened up after laying around.

Not purring barely at all. Still very snuggly and affectionate. He's an old cat so he slept most of the day anyway! Spirit seems good. Lack of purring concerns me.

I was doing better before my husband started crying yesterday. Now he keeps turning on the waterworks, I need that to stop! We're supposed to go away for 4 nights next weekend, I really don't want to go. Our pet sitter is the manager of our vet office, I am leaning towards boarding him there if we go. Then, what to do about his sister, who is perfectly healthy but I don't want feeling abandoned w us and her brother gone. She has 3x daily visits when we're away, but I think she'll be anxious the whole time and I can't come up with a scenario that won't stress Shelby out. And me, lol!!

 

Just spent an hour outside with George in his tent. Realized his is definitely favoring his right hand leg. His Freestyle sensor is on the left/seemingly injured leg, not sure if that could irritate? And, at one point this morning we heard George miss a jump, but he had a bit of a problem yesterday that the vet couldn't figure out. Going back to vet Tues so unless something dramatic happens will just monitor the situation.

 

I attached to my upper arm a sensor I had left over from my cats. I could always feel the filament that went into the skin. After about four days the sensor came off. I was always hitting the sensor on things like a door jamb.

 

Dryer and harder poop can happen when a cat is switched to wet/canned food. That is because the canned food dose not have as much fiber in it.

You could try seeing if he would eat a little bit of plain canned pumpkin or squash. Start with only 1 teaspoon or so.
Alternatively, you can try 1/8 teaspoon of Miralax (or generic brand) added to his food. It's tasteless. But the food does get "gummy" if it's not eaten right away.

Have you tried any sort of "yummy" toppers on his food? A bit of tuna maybe?

They didn't remove the old sensor when they put the new one on?
Cats that I have seen wearing the Libre CGM sensor have a onesie or cutdown small shirt over the top of it.

 

Any chance your pet sitter that comes to your home will test and give the insulin shots?
Some pet sitters, are even willing to stay overnight.
Maybe you can board both cats in the same space at the vet clinic?

Husband losing it makes it harder on you too. He's probably crying because he has come to realize that George is not immortal.

Please, reassure him that diabetes is a very treatable and manageable disease. It takes time, and educating yourselves, but a cat can live with diabetes for many years after the diagnosis. Even a 16 year old cat like George.

Talk it over with your husband. Discuss your various options. Make the decision that is the best for the 2 of you.

 

Pet sitter absolutely is comfortable with testing and shooting, she's also a vet tech so completely competent. Just that he really needs someone to see that he's eating every couple hours, I'm really concerned about him losing any more weight. I've never boarded him, maybe I can get a secondary person to stop by opposite hours of sitter #1. If he continues to eat and have stable numbers, I might be ok leaving.

Yes, tuna juice totally entices him and apparently he enjoys dining in bed. Every 2 hours we're bringing him something and he's eating. Stopping 3 hours pre-shot to make sure not shooting on am empty stomach.

Vet attached sensor with surgical glue, removal of defective sensor would have been traumatic and we decided unnecessary. He's really good, I've caught him licking at it a bit but he's really good and isn't going after it.


I just watched him extend and clean left hind leg with gusto, seemed not to bother him. I wonder if it is the sensor irritating him!

 

George looks nice and happy about the fresh air and sunshine! How nice for him.

 

Honestly, the stress of being boarded at the vet will probably raise his blood sugar. I think your idea of a second person coming in just to feed is awesome. He'll be happier at home.

Remind yourself that it took time to get diabetes, and it takes time to get better. You, hubby, and George are making great progress. It just takes time.

 

Purring up a storm today, with numbers way too low to shoot. Haven't got to see much walking to see leg issue. Ate great for first meal.

Sigh of relief yet?

 

Those numbers are way to low to shoot.

Big Sigh of relief! and a dose of joyful

 

Oh, look at that! George is brilliant! Look how awesome he is! Finger crossed it might just be time for an OTJ (off the juice) trial.

 

I had been wondering what OTJ stood for!

I bought him a bed to make his tent more cozy...

I'm more comfortable going away this weekend in regards to George's health, but a few days in NYC really gives me pause in regards to the coronavirus. We booked the trip a few weeks ago and got a great deal on a prepaid and non-refundable hotel and flight package. It would be a bummer to lose the money but definitely not devastating. We got to NY a few times a year so it's NBD to miss this. I'm very lucky this seems to be my biggest concern!

At least Baby George seems headed in the right direction!

I can't thank all of you enough. Just an amazing resource!

 

OTJ = off-the-juice, insulin being the juice.
Also known as remission
Also known as being diet controlled.

FDMB Glossary although OTJ is not in there.
Confused about our jargon? Don't let it scare you off! You'll catch on in no time.
Until then, here's some help:

• The Official Lantus, Basaglar, & Levemir ISG Slang Dictionary - Created by lynn and bear (ga) with a little help from her friends, circa 2008; updated & edited numerous times over the years by members of the Lantus & Levemir ISG

 

George! Don't you like your new bed, buddy?

 

Lucky George! What a well-loved kitty!