Have a diabetic cat

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barbp

barbp

Member Since 2014
Hello all and thanks for the website. I already had a good experience in that I found the carb listings for Fancy Feast on this site from a Dr Pierson. My vet had provided another listing, that by Janet and Binky, which did not have much Fancy Feast. And also thanks to the poster who instructed about the needle opening being downwards towards the body. After I read that I do recall that information from the subq experiences with a kidney cat.

We start our injections etc tomorrow Sat, March 1.

Berkeley Girl is a tabby torti somewhere around 7 years of age. She was trapped June of 2013 and turned out to be a spayed declawed cat and weighing about 16 pounds. She is friendly to humans and hates other cats. She also was ravenously hungry and attacked the food like she had never eaten before. Oddly enough, her original bloods in June were OK. I got a rescue group to agree to take her (she is in the adoption program but waiting for cage space) and then she got ringworm from a set of kittens that were also in the garage with her. And then the bad weather came.

She went for a vet check in mid December and weighed in at 18 pounds and I worried that she could become diabetic. Vet agreed. She actually was eating a 13 oz can of Friskies whitefish and tuna during the day and then another 13 oz can during the night. And not that much exercise in the garage!

Well, during February I started to notice that she was drinking the water bowl DRY! I actually wondered if she was spilling it and put out a second ceramic dish of water. Both dishes would be dry the next morning. So what with storms etc I finally got a urine sample to the vet last week and she was diabetic and then last Thursday we went for a vet visit and the blood test was 568.

I started her on fancy feast fish & shrimp flaked (high phosphate ignored) and oddly enough today she has not drank that much water. She had been taking in 12 oz during day and about 8 oz at night. Today she has had 3 cans of Fancy Feast (7am, noon, 4 pm) and only had about 6 oz of water. I plan on giving her another can at 8 and then at midnight. Just chatted with vet and she suggested that I vary the fancy feast etc to avoid too much of the phosphorus.

The rest of the blood test items were normal. Vet said the white blood count was slightly out of line but blamed in on stress. As she also did for the high blood glucose count, saying that cats elevate their blood glucose levels when stressed at the vet etc. She mentioned one other item from the blood test which she blamed on internal parasites or fleas but since I do not think we have fleas and indeed just put frontline on Berkeley Feb 14, she asked for a stool sample.

Berkeley Girl is to have one unit of lantus. I am told to get urine sample in morning, compare to ketodiastix chart and if
green if one unit, if brown give one unit but after 2 days of brown color, increase one unit. If blue decrease by 1 unit. So if it is blue on the first day, I guess I panic? Cause that would mean no units and she needs insulin obviously. I am to repeat the testing and the insulin 12 hours later. Also to keep a chart of date, urine dip results and units of insulin give and comments.

I forgot to ask the vet about the feeding. The printed material is for dogs and cats. Says to give 1/2 the daily food after the urine dip results and then give insulin shot. Berkeley Girl does not eat that fast! And I see from the forums that people often give the shot while the cat is eating.

Lantus label says refrigeration not needed below 86 degrees F. Vet says to roll bottle in hand, not shake, says I can fill needle and wait a bit so that it warms to room temperature.

Have orange cap needles, 1/2 inch (12.7 cm) length and 29 gauge. There were also 30 and 31 gauge with 15/16 inch short needle (is not 15/16 almost an inch and longer than 1/2? Maybe recall is off.

thanks for reading. Barb
 
Hello and welcome

Food - Janet and Binky is a good site but a little out of date - our listing is more recent http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf. Fancy feast classic pates are a good choice - as are some others but watch the gravy ones!! And don't feed fish every day - twice a week at most is best.. too many toxins in fish otherwise.

Testing - Has the vet mentioned home testing her glucose? The problem with just relying on urine is that its based on how much water they drink, when they last peed etc so its not a very accurate way of seeing whats going on. Its much more preferable to test her blood - and its not as hard as you may think. A quick pin prick to the ear which they barely feel ( few nerve endings in the ear) and you are done! As many cats can go into remission, home testing will prevent an overdose plus give you and your vet much better idea of whats going on. We can advise more on this as its pretty important.

Dosing - Also Lantus is best dosed consistently - the same dose twice a day - I worry your vet may be a little out of date- mixed dosing like he suggests is not going to work well.

Storage - Lantus lasts up to six months if you keep it in the fridge - but only 30 days if you don't. Since most humans need higher doses they get through it in less than a month so it doesn't matter.But since you are using it on a cat, you won't get through it that fast. So keep it in the fridge. Don't give it longer than 30 minutes to warm up as it will react with the lubricant in the syringe.

Feeding - We advise to hold off on feeding for two hours before the shot, then feed right after. You can feed through the day too - I free feed my boys. Some people feed 3-4 mini meals

Syringes - Your 1/2 inch needles are fine but if you find she twitches etc you can switch to the shorter 5/16inch needle.

let us know if you have more questions!!

Wendy
 
Thanks for your comments.

This morning was a bit of a bust.

Firstly, Berkeley has changed in the eating and drinking department since I started her on the fish & shrimp and decreased her total food consumption. She had been eating minimum 15 oz Friskies liver and chicken wet up tp 26 oz a day. And had been drinking 12 oz to 18 oz of water.

Since she has been on the fancy feast, which is only since Thursday afternoon, she eats 6 cans or 18 oz of food and only 12 oz of water per day. Still urinates frequently.

Last night, Friday, I strip tested the urine (have no recollection of when she last ate prior to that) and she was in the brown are(500 per ketodiastix) and negative ketone. This morning I tested her (assuming had not eaten in the last 2 hours as I fed her the 3 oz can at midnight and the plate was clean this morning at 6:30 am). This time the test was green 250.

So now to the injection or rather lack of! Manage to pop this little purple lid off the bottle. Then great struggles with the needle, not so much the orange cap but the orange needle covering was hard to remove. (I used to stick myself with the subq needles removing the cover). Then discovered it seemed to have a lot more little black lines than the one the vet showed in her office. So I will be heading there today to discover what the one unit line is.

Guessing 1/2 unit markings? Anyhow, the needle has large lines for 5 10 and on up to 30. Then 9 smaller lines alternating like steps from needle opening to the 5 line. To be on the safe side I only filled to the first little line which was hard to do and cheerfully wasted some insulin seeing how few drops came out. Figured if I was only giving a 1/2 unit it was better to be wrong that way.

Between eyes and fingers it was darn hard to see the lines, pull the needle plunger accurately and the to determine where the needle opening was as to how to stick in the cat. Finally got all set up, gave the cat her food and grabbed the skin . Found it hard to find the skin under all the hair, decided I had it, stuck the needle in and pushed the plunger. Felt the hair and no wetness so briefly happy.

Then came back to the light and saw that it seemed as if needle was still with liquid. Depressed plunger and out popped at last 2 drops. I guess some how I did not get plunger to work when I had the needle in her?

Decided not to try again and wait till this evening.

Thanks for having this website.
 
Here's some information with regards to setting up your spread sheet. This is required so that those of us can look at Berkeley's #s and advise you on what to do next.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

It's very easy to set up; just simply take your time in doing so and follow the steps.

I also suggest keeping a log book (spiral bound type used for school works perfectly) as well so that you can log the information required; (i.e. date, time, amount of insulin given, amount of food given, and any other information like vomiting if it happened, etc.) Plus, this book will also provide you with the information to be placed onto the spread sheet. Yes, it means more work, but it's worth it.

Unless Berkeley is currently overweight, and it's suggested by your vet to decrease her food, decreasing the food right now isn't advisable as they need the extra calories until they become regulated. If Berkeley's #s are currently high, she's going to eat, and be ravenous for a while. The main thing is to try and get those #s down for her, and eventually she'll be feeling better, and will be eating and drinking less. What you can do is add a bit of water to her meals to ensure that she's getting plenty of fluids. This will probably make her pee more, but that's ok. I could be wrong, however, I think the more water they drink, the less ketones will appear (to the more experienced person reading this, please correct me if I'm wrong here).

You will always have a small amount of insulin inside the needle itself once you have administered the insulin. The main thing is is to give the amount that's in the barrel of the syringe, and not depress any more than that into Berkeley.

Wendy has given you wonderful advice to work with. If you don't already have it, get a human glucometer and strips. Walmart has some very cheap... I use the Relion Prime monitor and strips (strips are $9.00 box/50). Testing is easy, and most, if not all of us on here will poke an ear to get a small sample of blood. Lancets come in various sizes... The most commonly used are the 33 gauge, which are very fine, and you don't need to poke it in too far to get a sample. Walmart also carries a wide variety of syringes. Some of us use the 31g, 3/10 cc, 8mm with 1/2 unit markings for dosing 0.25u doses (0.25 is between the 1u and 1.5u for instance).

Anyway, that's a lot of information there for you to work with. You WILL get the hang of it. Please feel free to ask questions constantly if you're not sure, or are uncomfortable with anything. We're here to help.

I look forward to seeing her spread sheet, and seeing how she's doing.
 
The plunger is kinda flexible so it always retains a very small amount of insulin so there is a good chance you did indeed get some into her.
 
To get the cap of the needle, twist it a few times, then twist and pull. That seems to help break the friction.

Miss Myopia here - I hear you on the tiny lines. Check out our shopping pasrtner Amazon for magnifiers. Since I wear glasses, I use Carson Clip and Flip magnifiers. They clamp on to the glasses and flip out of the way when not needed. If you don't wear glasses, there are visors magnifiers and stand magnifiers that may work for you. A good light may be helpful, too.

See my signature link for some additional assessments you wish to make, such as dehydration checks, and tips on urine collection.
 
thanks for all the advise to date.

Can someone tell me exactly what to order, please. I found the testing kit link at the top of the page and after a bit of confusion finally found the walmart link . When I went to order there were several choices of meters and monitors etc.

Just treat me as unable to make a decision at this point, and tell me the order numbers etc for meter, lancet, strips. This way with no decision on my part I can order and pick up Tuesday at the store. Really hoping that this snow storm fizzles out and we get only a dusting.

I got to the vet yesterday and the tech straightened me out as to the markings on the needle. The 29 gauge that I have has 1/2 marks and 1 unit marks. But I have chickened out as to treating till after the snow. I have gotten all the low carb Fancy feast that the vet wanted Berkeley to start on and have gotten her on a 400 + diet of five cans of FF a day and a max of 15 carbs a day. The second day on FF and her b/ms seem to have adjusted and I am hoping that by day 5 (Tuesday) when I start the insulin all will go smoothly.

She is alert and interested in what is going on in the house and when let out for her 1/2 a.m. and p.m. strolls, she explores the house and hops on furniture etc.

So I have my fingers crossed that my delaying insulin treatment I am not causing any death issues.

I think I added information to my signature line-maybe ?
 
WalmMart ReliOn Confirm/Confirm Micro or Prime.
Confirm uses smallest blood drop; Prime has least expensiive test strips.

Get matching test strips.

Lancets - get 28 gauge or lower number.
 
Getting started shopping list!

1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

Its a good idea to delay the insulin and test food - her insulin needs may drop due to the food change. This means of course testing becomes key so you don't overdose. For now get her ready to test - rub her ears and give treats to get her used to them being played with - do it every few hours.
 
well.
I just got the relion confirm meter and the strips but unfortunately I got the 33 g lancelets.

I have the karo syrup ( the store only had light karo-hope it is the same-

I have needles and insulin

have polysporin for me -do not think I have seen it with pain medication added?

Need to get cotton balls but have non stick wound pads-Is there that much blood from the ear sticking?

vet tech told me to put sharps tuff in a soda bottle or lidded container and bring to their office every so often

I am assuming that with the flashlight I put it light side into the inner ear and I stick the lancelet into the vein on the outer ear? I think someone wrote that there is youtube videos, Heading over there now.

Thanks SO MUCH everyone for all the guidance. Now to hope that we miss a lot of snow cause I am tired of shoveling!
 
Check the ingredients but as long as the karo has sugars in it, and no xylitol you should be good.

What kind of polysporin is it? Needs to be the ointment. Neosporin with pain relief is good too.

The 33g might be too fine but try and see, you can get thicker ones if you have no luck getting blood with these.

The cotton balls are to use to press and hold the wound after you take blood. Won't be more than a drop of extra blood. Not sure what the wound pads are. Even a tissue will do.

Put the flashlight inside the ear edge and poke from the top surface. U can then use it to press against. Go in at a 45 degree angle and aim between the ear vein and the edge. Don't forget the treat!
 
You said the vet told you to roll the bottle of Lantus. There are no particles in the Lantus insulin that would require you to do this, to re-suspend the particles in the liquid. You only need to roll the cloudy type insulins, not the clear ones like Lantus.

Diet change as a first step is a great one. Some kitties never need insulin with a diet change to low carb food. Many still do need some insulin for a short time.

p.s. No, still don't see anything in your signature.
 
One week later and I am not sure what I have accomplished for Berkeley.

Still chicken about the insulin and learning that it is difficult to decide on a routine for the insulin and feeding.

To date-upon rising around 6:30-7, I get her litter box and get urine sample (so far only one day not successful in the morning), then I feed her FF fish & shrimp. This is roughly 8 am. I try to feed her 1 can then at 2 the third can at 8pm and then at 10-midnite (depending on how late I will be up) , I put in 2 cans of FF for the night.

I started a few days with FF fish and turkey, but the rascal refused to eat the turkey so I had switched to Fish & Shrimp and savoury salmon. This being a very low carb diet -3-4 carbs per day and about 450 calories. Now she is refusing to eat the salmon and only wants fish & shrimp, which ignoring long term issues of fish daily, would leave her with 0 carbs.

When I let her out of the cage, she gleans over the floor to pick up any dropped dry food from the other cat's dishes, so the lack of interest in wet food, other than fish & shrimp seems to be preference, not lack of hunger.

She averages 10 0z of water during the day and is pretty consistent with 4 oz of water overnight.

So far the urine strips, (morning is generally fresh urine, during the day within 15 minutes of going and the night time before bed, sometime I miss completely as it is all absorbed.) But there have been no ketone and the urine sample is just changing from 250 to 500 at the 30 second mark consistently.

So I need some guidance on how to proceed for the needle part of this-
From what I have read here, (those 5 steps!) I need to continue the urine tests when I start the BG readings.
What is a good schedule and where does the free feeding fit in? Do I do urine, test blood, give insulin and food and then leave food during day as usual, then night, do urning, blood and insulin?

My vet seems sort of non-committal-I had told her I had panicked over the first insulin shot and had not continued but had changed diet. OK from her but gave me no idea on how long to do the diet change before doing the shots. I also said that since she had gone from a fairly high carb diet (18 + per day) to almost none, I asked her if I should start with 1/2 unit instead of one or if I should bring her in for another test of their BG. She said she felt what ever dosage I started at 1/2 or 1, was both low and OK. I think I like to be told what to do and she is not really doing that (but then tells me to call as often as I have questions!)

Thanks to all of you-
 
Its test the blood, feed, and give insulin, all within about 15 minutes. If you're not yet giving insulin, its just test and feed.

We really need to get you testing blood glucose as urine test strips only indicate what happened since the previous void, thus making them very imprecise.

We suggest using an inexpensive human glucometer with pet-specific reference numbers. One many of us use is the WalMart Relion Confirm, or Confirm Micro, which is also sold at American Diabetes Wholesale as as the Arkray USA Glucocard 01 or 01 Mini (same manufacturer - Arkray USA). It uses a tiny blood droplet and the cost is significantly lower for test strips (like $0.36 each).

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Then, once you start testing, you record the data on our spreadsheet - a grid for storing the numbers. Instructions are here.

Understanding the spreadsheet/grid:

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

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

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

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

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

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

It is merely a grid for storing the info; no math required.
 
I suggest once you start blood testing that you test her urine for ketones 1-2 a week and whenever she is over 340. It doesn't have to be done as often.

Its been a week now so it would be good to test her blood to see where she is, and if she is high (which i suspect she will be with those urine readings) start her on insulin.

We usually use ideal weight to judge starting dose. Whats her current weight and would you consider it ideal?

Wendy
 
I am progressing, perhaps too slowly? Concerned about ketones from decreased food and not treating with insulin yet.

Today, after using about 4 strips and 3 lances, I got blood monitor system down. This cat is PATIENT! Or else her prior owners have been testing her for years. Will never know the answer until she learns to talk.

Even pricked my own finger by accident!

Well, her blood reading was 403 at 11:30 am (she ate Fancy feast fish & shrimp), entire can around 8 am. Called vet today and back in Feb 27 their reading was 528 and she weighed 16 lbs 14 oz.

What brought me to finally starting the blood glucose readings was I have not gotten urine readings for the past three days. She is not flooding the box as in the past and I have not been coordinating the litter reduction in order to get the liquid and ended up with absorbed urine and no free liquid.

Yesterday evening and this morning I took the urine strip and just rubbed it against the urine spots on the litter box bottom. Both of these readings seem to indicate a trace of ketones. Ketones is measured only via the urine strips?

Now, she has been on an extremely low carb diet since Mar 1 and I read on dr Pierson site that weight reduction diet, reduction of carbs can lead to high ketones and death. So maybe this is a reflection of her getting protein versus carbs? But not making me feel good. She also has been out of the cage for about 3 hours a day in the past two days so more exercise than in the past.

Am planning to go to vet for weight and a comparison of my monitor reading to theirs. Will also leave an empty litter box in cage for another testing this afternoon.

Thanks to all of you for advice. I will likely need to go to the technical forum to figure out the spreadsheet with your help!
 
I believe the instructions for urine ketone testing require fresh urine as it degrades after leaving the body. Check the instructions. There are meters which check for ketones in the blood; they are expensive - ex. Nova Max.

Rapid weight loss causes fat to be burned for calories as does starvation and diabetes. Breaking down fat creates ketones as a by-product.
Insulin allows the glucose to enter the cells and be used. Not enough insulin and the body relies on fat breakdown.
Cats can make glucose from protein and fats, as well as from carbohydrates, so feeding low carbohydrate is OK.
 
FINALLY starting lantus insulin-I had been doing the blood testing since March 14 and she was consistent at average 405 and then March 17 her levels rose to average of 450 and she is drinking more water, so I steeled myself and have set 9am and 9 pm as her shot times. The initial morning shot seems to have gone well today (Friday Mar 21).

Routine I am trying for (based on advice given here and my understanding of it), around 8:30 morning and evening, I get her blood tested, then I do the shot by 9 and then I feed her. Collect urine around same time period and test for ketones etc. I am starting her on 1 unit of insulin (per vet) which I think I got into her well, between reading the needle marks and sticking in needle to cat- I am to keep this pattern for one week (going slow). She is on a low carb fancy feast wet , 370 calorie diet since March 1, I try to keep her exercise periods out of the cage to the same number of hours a day-

My current questions-
Is her sugar levels going to fall dramatically over a period of x hours? Or is this procedure slow acting and I will see a few point drop but stay above 400 by the end of the week?
How much leeway is there to my shot time of 9.
Other than feeling for a wet spot after the insulin shot, how do I know that it is going where it should?
Anything I should watch for or worry about?

My thanks to you all-I promise to try to work on the attachable spread sheet but a quick reading about google account is leaving me clueless. I guess there is more directions In the tech forum.
 
You should see a drop of more then 50 the first day. Lantus is a depot insulin so it usually takes 3-5 days to see full effect.
Wee recommend that you setup and use a spreadsheet to record the BG,dose and other things, For how see:
viewtopic.php?f=6&t=50130
I its best if the shot time is +/- 1/2 hour
 
Hi Barb and extra sweet baby!

My current questions-
1) Is her sugar levels going to fall dramatically over a period of x hours? Or is this procedure slow acting and I will see a few point drop but stay above 400 by the end of the week?
2) How much leeway is there to my shot time of 9.
3) Other than feeling for a wet spot after the insulin shot, how do I know that it is going where it should?
4) Anything I should watch for or worry about?
Click to expand...

Larry gave you the link above to the spreadsheet instructions - just dive in, it's truly not hard and will be about the best tool after your test meter/strips. Let me see if I can answer at least some of your questions:

1) Every cat is different (ECID) - remember, insulin is NOT a chemical 'take 2 and call me in the morning' medicine, it's a hormone that is supposed to be secreted by the pancreas. Many things can affect those numbers - food, stress, exercise, even seeing a strange animal outside. As you test, you'll see how YOUR cat reacts....

2) Lantus works best when consistently dosed at 12 hours apart for cats. You can wiggle 15-30 minutes each cycle, more than that will affect the depot already in their body. I can wiggle 30 minutes with one of 'da sugarboyz', the other one needs that 12 hour schedule. They react very differently to the same insulin. I know this because we test at home...

3) Lantus smells like old bandaids - you can feel for wet spot but smelling tells me more. If I suspect a partial fur shot, I smell the area....if no smell, it all went in.

4) Ketones - test for ketones especially when they're in higher numbers. I see in your very first post that you already know about the KetoDiaStix. Also carbs in food, consistently dose and home testing!

BIG HUGS! Hope this helps a little bit...
 
One thing my vet did was shave a roughly 2inch by 2inch patch at the injection site so I could "see" that the insulin needle was in without the fur being a distraction. It really helped me a alot. You could also take some small scissors and cut the fur so it is at least very short. Cat might look funny - just think of it as "punk style". As already mentioned, the sniff test works, too.

Sorry if I missed this, but are you pinching up the skin / making a "tent" before injecting? That is important, too.

Between learning the injections and learning the glucoise monitoring it can all be a lot, but you'll be a pro in no time.
 
Hey there

If you go to this forum and read the "stickies" at the top it should answer a lot of your questions and prepare you! http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

1. One key thing to note is be ready for a hypo and have your hypo kit ready just in case http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887. Many cats go into remission and you want to watch for that so you don't overdose.

2. As a newbie we advise you don't shoot under 200 for now until you have enough data to know what to do - instead come on here and ask for help. Its important to not feed for 2 hours prior to the shot so that the shot number isn't influenced by food. More info on shooting low: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

3. Over time though you will need to learn to shoot under 200 so you need to get data ready before then and a spreadsheet set up! I usually recommend 3-4 tests a day

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



Wendy
 
Thanks Wendy and all of you- I have figured out a schedule now for my shots-

9 am (before I feed her breakfast) Only issue may be that sometimes if I feed the turkey FF for dinner I will find some still left in plate, So I do not know when she actually put food in her stomach last,

Between 2 and 4 pm to check to see how long she is going-I generally feed her a can of FF about that time so will make sure I test prior to the food

Then 9 pm at night and here is a real problem-I always feed her a can after the shot and then one for the night as I go to bed around 10 or 11. So if I test her then, the results will be off due to food?

Now I actually just went and refilled a needle and then shot it on a tissue and there is insulin coming out of the needle. And when I shot her am and pm today I smelled the area and did not smell insulin or feel wetness and had a pretty good tent. So I am fairly confident that she is getting the 1 unit.

But her test results have been 451 and 478 day 1 and today, day 2 459 and 514. Have not done the urine strip testing and she is walking OK, eating and cleaning herself, but why are the numbers not going down?
 
Just to clarify. It's only the pre-shot tests, the tests before you give your cat any insulin, that we like to see without any food for 2 hours before. Any other tests during the cycle, we expect there to be some food influence in the BG (blood glucose) numbers.

The no food before the pre-shot tests, is so we get a non-food influenced, more realistic reading on the BG levels. It doesn't make a big difference if your cat is in high numbers (>200), but it definitely makes a difference if you cat is in low numbers (<200).
 
getting concerned-wondering if I should increase lantus dosage even though cat has not been on it for a week? Vet said to increase 1 unit if still showing brown on the urine strip for 3 days-

BG readings week prior to insulin were 403 11:30 am, 394 11pm,
411 8 am,
409 8:30 am
409 10:30 pm
467 8 pm

BG readings since start of lantus one unit given 2x day at 9 a/p

3/21 451 8:30 am
478 8:45 pm
3/22 459 8:45 am
514 8:45 pm
3/23 463 8:45 am
339 1:45 pm
488 8:45 pm
3/24 551 8:45 am

I have her diet consistent on low carb FF and about 350 calories-her out of cage time has increased to about 8 hours during day. She is showing less interest in her food which concerns me-last night she ate only 1/3 of her night can and this morning instead of attacking her morning can she has barely eaten eaten 1/4 half hour later.
 
Which urine test strips are you using? The ones that only check for ketones? Or the ones that test for ketones and glucose?

You gave us these BG readings:
3/21 451 8:30 am
478 8:45 pm
3/22 459 8:45 am
514 8:45 pm
3/23 463 8:45 am
339 1:45 pm
488 8:45 pm
3/24 551 8:45 am

So, to put this in our more familiar format:
3/21 AMPS 451 1U, PMPS 478 1U
3/22 AMPS 459 1U, PMPS 514 1U
3/23 AMPS 463 1U, +5 339 PMPS 488 1U
3/24 AMPS 551 1U

We don't increase in whole unit increments. This is so that we do not bypass the appropriate dose for your kitty. We would increase in 0.25U or 0.5U increments.

We also make dose changes based on those lows or nadirs that happen usually somewhere in the middle of the cycle. We only have one mid-cycle number to look at, that one from yesterday at +5 (5 hours after the shot). I hope you are able to get some more mid-cycle tests to show us what is going on with Berkeley.

With only one mid-cycle test, it's impossible to know if Berkeley is bouncing off a previous days low, or if this dose is not enough for her. We really need to see a few more mid-cycle tests.

It took time for your cat to become diabetic. It takes time for the BG (blood glucose) levels to be regulated. Be patient. I know it's so hard to wait, we just want out kitties to be better as soon as possible.

You've made some great progress with Berkeley Girl with the food change to lower carb food, and the home testing.
 
We normally recommend that the cat dose is held consistent for 5-7 days before making a change at first, to allow the depot to build up. Then the dose can be adjusted. But as Deb said, you don't have enough data to know if this dose is working or not. Which is why I recommended 3-4 tests a day - so you get tests that aren't always at pre shot. Also a spreadsheet will help see whats going on.
 
getting frustrated-Berkeley spent one week at vet and came back quickly elevated from 2 to 4 units lantus- another week passed and she went back for a day at the vet for bloods and observation and curve-and they upped her to 5 units-

another week has passed and I do not see a noticeable change-

Since diagnosis (Mar 1 2014 weighing 16 lbs 14 oz) I switched her to all FF classic cans-initially she was on a diet of 4 cans/day (12 oz) but she lost 3 lbs + so vet has advised to feed her minimum 4 cans and let her eat free during the day-so now all cats eat FF turkey, chicken, salmon classics and Berk gets the addition of fish & shrimp right after each lantus shot-She is now 13 lbs 3 oz and has maintained that weight for over 2 weeks-exercise is wandering around house and outside screen porch-jumps well and even trots to her food-

the vet tells me all her bloods have come back great and the pancreatitis episode is cleared up and her follow-up bloods on that are fine-supposedly a healthy cat except for diabetes.

Vet also said that my monitor and hers were consistent with about a 30 point difference but the difference was not that important at this stage as the good consistency.

Not caging her is nice for her but I do not get a good idea of her water consumption but from the litterbox I would say she is still drinking about 2 cups a day-the urine/ketone strips are telling me no ketones and glucose of 500/1000 which could be my eyesight and 1000 is rarer-generally 500 green brown color-have gotten blasé about strips and only test twice a week or if I note her going to litter box-have also purchased relion ketone strips thinking that might be easier but have not opened box yet.

Got the spreadsheet attached and tried some attempts at getting a nadir-

Have to submit info to vet Friday and I am sure she is going to raise her-will push for only 1/2 unit but likely she will suggest to 6 units

Only new item is Berk does not sleep in the heated beds (she did that only once since she has been in the house since Mar 1) while the others are still cuddled in-Berk seems to prefer the cool screened area or just laying on the wood floors-the house is 68 degrees
 
Even though several cats are drinking from the bowl(s), measuring the volume may give you an idea of control by a reduction in volume per day. It isn't nearly as accurate as blood glucose testing.

Urine ketone testing can identify if the cat could be heading towards diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat complication of diabetes. Ketones form as a by-product of fat breakdown for calories which may happen if there is insufficient insulin to use blood glucose.
 
Ok let's see.. The spreadsheet is very useful and helpful.

1. Her teeth are ok? No sign of infection?
2. No signs of any other infections? UTI, ear..
3. No way she can get any dry food or human food? Does sge go outside?
4. Is she on steroids?

If the answer is no to these then you should talk about a high dose condition to your vet ie acromegaly. There is a special test he would have to send to michigan.

Essentially what it means though is you will still reach a good dose for her but it may be quite high. I would start increasing more aggressively as per the protocol..every few days by 0.5 a unit depending on nadir..http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

There is also a Facebook group you can join.
 
Wendy- read the link you provided about tighter dosing. Sort of shook me as she had been on the 5 units since at least april 19 and I had seen no dropping of numbers. But suddenly April 25 and Apr 26 she seems to be having a nadir of mid 300s, seems between +4 and +7? for those 2 days. I had thought to stay on the 5 until I heard from the vet on Tuesday (she took a long weekend) before I increase to 5 1/2 (can not determine quarters) but now I am wondering if I should start sooner?

Just afraid that she would drop to a hypo state during the night if I went to high on the insulin. Can she drop from 300s to under a 100 and have hypo issues at this stage, overnight?

Other question- I am going out for the evening on May 7th and will be gone from early afternoon to midnite. I give her the shot at 9pm. what would happen if I just did not give a shot until the next morning? So far she has survived my "fur shots" uptil her being shaved, so I was thinking missing one dosage might be better than messing up the schedule?

Thanks for all your help.
 
Wendy- read the link you provided about tighter dosing. Sort of shook me as she had been on the 5 units since at least april 19 and I had seen no dropping of numbers. But suddenly April 25 and Apr 26 she seems to be having a nadir of mid 300s, seems between +4 and +7? for those 2 days. I had thought to stay on the 5 until I heard from the vet on Tuesday (she took a long weekend) before I increase to 5 1/2 (can not determine quarters) but now I am wondering if I should start sooner?

Just afraid that she would drop to a hypo state during the night if I went too high on the insulin. Can she drop from 300s to under a 100 and have hypo issues at this stage, overnight?

Other question- I am going out for the evening on May 7th and will be gone from early afternoon to midnite. I give her the shot at 9pm. what would happen if I just did not give a shot until the next morning? So far she has survived my "fur shots" up till her being shaved, so I was thinking missing one dosage might be better than messing up the schedule?

Thanks for all your help.
 
Honestly I am more worried she will develop DKA with such high numbers as opposed to having a hypo. If you take the dose increases as mentioned in the protocol I sent you, then a hypo is unlikely - but you do need to get tests in before you increase to be sure the increase is needed.

And a before bed test should give you a good idea what her overnight plans are.

Wendy
 
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