Hello from a newbie!

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Michelle & Dusty

Michelle & Dusty

Member Since 2012
This is my first time on the board. My lovely 15 YO cat, Dusty, was diagnosed today with diabetes. She had blood work in the morning and by this afternoon I was in the vet's office learning how to give her insulin. She's on three units of Lantus twice daily. We're going to see how she does on that and then talk about changing food. She's a little heavy (13.5 lbs, perhaps should be about 11.5-12), but otherwise healthy. (Well, save for underlying Valley Fever.) I was so worried that she'd be diagnosed with CRF that hearing it was diabetes was actually a bit of a relief!

Mostly what I'm worried about is hypoglycemia. I don't know how I'll sleep tonight worried about Dusty getting sick while I'm not awake to watch her. To that end, can anyone tell me when, typically, there is the low point for blood sugar after an injection? She got her first injection at about 4:30 this afternoon (four hours ago). Since then she had 3/4 a can of the Fancy Feast. Should I perhaps feed her a bit of extra food before dinner to avoid super low blood sugar? About an hour ago she was wandering about and seemed a bit uncomfortable, but then jumped up and fell asleep on my lap. At the moment she's grooming herself and seems pretty alert and generally fine. I worry, though, about crashing.

As for future plans: I'm going to give her the Lantus and she'll be heading to the vet on Thursday for a glucose curve. At that point I think I'll talk to the vet about getting my own testing supplies to keep an eye on her levels at home. For now, I'm just spending a lot of time online reading as much as I can about this. And keeping both eyes on my dear Dusty, letting her know how much she's loved. nailbite_smile
 
Hi Dusty's Mama,

Can you find out from the vet how he arrived at 3u as a starting dose? I ask because that is higher than "normal". Most cats are started at 1u twice a day, or even less. But there may be a logical reason for 3u, like a condition beyond just diabetes?

The AAHA guidelines for dosing use a weight based formula (see link page 218) of .25u per kg of lean body weight. That would put your kitty in the 1u twice a day range I think.

I the Fancy Feast she's eating is one of the "classic" varieties, that is a perfect food for a diabetic cat, so you might not need to worry about changing her diet. Is she eating any dry food at all?

If you are worried about the blood glucose going to low, it typically takes 3 hours or so for the Lantus to "onset" and typically it peaks about 6 hours, give or take, after a shot. You can feed more food at any time in the first six hours to slow the drop in BG down. Once you start home testing (and I wouldn't even wait until the next vet visit, I'd do it tomorrow), you'll be able to tell at any time where her BG is, and will be able to intervene if you see a big drop in BG numbers. We usually recommend not feeding for two hours before shot time, so that you get a "fasting" BG number when you test her before giving any insulin, but other than that, multiple small meals rather than just two meals a day works really well for most cats.

My opinion, but I would cut the dose back to 1u every twelve hours until you can get a meter and test her before any shot. It's safer to start low and increase as needed (unless the vet can tell you why 3u is good to start off with), and will cause you less stress and worry (which is natural when you first start dealing with all of this).

Carl

sorry, forgot to give you the link to the AAHA guidelines that you can share with your vet!
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
Most cats are well regulated on insulin at 0.5 U/kg q 12 hours, with a range of 0.2 to 0.8 U/kg.
The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight. This equates to 1 U q
12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours.
Click to expand...
 
Thanks for the really helpful reply, Carl! I'm not at all sure why the vet recommended what she did. I was in the vet's office within 20 minutes of hearing that Dusty had diabetes and hadn't had any time to do research for myself. She received the 3 units in the office while I was with the vet and I didn't know to ask about the amount. I didn't even have the presence of mind to ask the vet what the initial BG levels were! (Which I'm kicking myself about now.)

I think I'll head to Walmart tomorrow, brave the Christmas shopping crowds, and pick up testing supplies. I think I'll also drop her to 1 unit for the weekend until I can call the vet on Monday. Better to have slightly high numbers than a crash. The vet said that I caught it pretty early and I'm sure a weekend won't hurt anyone.

I've not been very selective about the Fancy Feast, choosing whatever seemed fine at the time. I'll definitely be getting the classic from here on out, though.

Thanks again for your really helpful advice. It's such a relief to know there are kind and knowledgeable people out there to help us newbies navigate this very scary phase.

--Michelle
 
hi Michelle

there are some good youtube videos on home testing and giving the shot.
Find a low carb treat that Dusty loves - I use about a quarter or less of Fancy Feast Appertizer or Purebites freeze-dried chicken.
At first, you'll be all fingers and thumbs but it does get better :-D and you are doing it for Dusty's health so that's all that matters.

The general guideline for lantus is to test, feed and shoot as close together as possible. She should have something in her stomach for the shot. Several smaller meals a day are preferable to 2 larger ones and I've heard that cats may lose weight more easily on wet food - remember to add water to it as well to keep her even more hydrated.

This sticky explains what to do in case of a hypo but there often aren't any symptoms so the only way to know is by blood sugar testing:
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

Also, Thursday seems a little early for a curve. My vet suggested a week also but the advice on the lantus board was to wait 2-3 weeks and just get the before shot test am and pm and some spot tests to get you both used to testing and to build up the data. (we all use this spreadsheet to record the data: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Also, in my opinion, do the curve yourself at home. You will save a lot of money and the results will be more accurate as Dusty won't have vet-stress.

Post as often as you want - to ask questions or just to tell us how Dusty is doing. We are all cat lovers and are happy to help if we can.


Denise
 
Hi Denise,
Thanks for the great advice and links! We made it through the evening just fine (hurrah!) and I've got the information for hypo printed out and have caro and maple syrup at the ready.

I'll definitely watch the videos to figure out how to test. It seems impossible, but then again so many people are able to do it that I'm heartened to give it my all.

One quick question: should I skip Dusty's morning insulin since I don't yet have the testing supplies? I can either feed and dose her this morning and then immediately head out for supplies and errands, back before the projected nadir. Or I could skip the morning dose and get everything ready in time for her evening dose. FWIW my vet gave me the option of picking up the insulin either yesterday (which is what I did) or Monday. So she didn't seem to think getting dusty started immediately was absolutely necessary. That said, I know how important routine is and since Dusty has already had a dose of insulin yesterday then perhaps it would be best to keep it as regular as possible?

My many thanks again to you, Denise and everyone else for their really lovely help!

--Michelle
 
If you are getting the meter today, skipping this morning is okay, I think.
Think about what times of the day/night will work best for you considering your schedule. You will be giving a shot every 12 hours, so you want an AM and PM time that makes sense with the rest of your daily routine.

Once you get a test, let us know what you see,
Carl
 
Hello Michelle,

Here's a link to some hometesting pics (with nice clear explanations). I learned to test from this page: http://www.sugarpet.net/bloodtst.html

It is important to always reward your cat for a test or even for an unsuccessful test attempt. Your cat will soon learn to associate test times with treat giving. Having your cat's cooperation will make everything much easier!

Good luck! :smile:
 
Thanks! I skipped this morning's dose and went out and bought a meter, some test strips, and some super delicious bits of diabetic friendly salmon jerky. I came back, read the manual and the slideshow about drawing from a cat. I made a rice sock thing, got everything assembled, and then lured Dusty into the room with treats. Got her in my lap (she's not normally a lap cat) and purring and happy. Did the ear warming thing with the rice sock and then tried to draw blood with the lancet. 'Try' is the really optimal word there, because I saw not one sign of blood. No drops and also no wetness of the ear that would suggest there was bleeding at all. I tried many times (7? 10?) before Dusty's patience wore out. And who could blame her. So I'll try again in an hour or two and hope that it works then. I hadn't watched the youtube videos before, which is a shame because they were really helpful. I think I was trying to draw from too far away from the edge. That and I didn't lightly pinch the ear after the prick to get the blood to pool. And I didn't have vaseline. *sigh* the list of things that I didn't do right is growing long. But that gives me hope that next time maybe I'll actually get the blood and see how her glucose levels are doing.

Again, many thanks for everyone's insight!
--Michelle
 
MIchelle,

My first try wasn't a big success either. It'll get easier though. :smile:

Carl
 
Hi Michelle! Home testing is a learning experience! I don't know what kind of meter you got but I switched to a ReliOn micro and it made things easier as I only needed a tiny drop. I gathered all my supplies, heated my sock and then got the cat! I found ear warming was the key, Make sure the ear is nice and warm, poke and then gently knead the ear if it doesn't bleed when you poke it. You'll find one ear will bleed better than the other or as others have said, the ears bleed easier the more times you do it.

Good luck! It gets easier!!

Sharon and Pepe
 
Thanks, Sharon! I just tried a second time, again without success. Closer this time, though! I have three cats, one of which is pretty new to the household. Dusty and the new guy (named Gus) don't yet get along, so I am trying the testing in my bedroom with the door closed. I had gotten everything settled well, pricked the ear and actually saw a bead of blood. Hurrah! And then, won't you know it, Gus started pawing and meowing at the door, agitating Dusty who pulled away from and would tolerate no more of my shenanigans. Alas. I'll try again in an hour or so. By that time it'll be close to when I want to give her her insulin, so I'm really hoping that third time's the charm.
 
Next time, try to scoop the drop onto a fingernail. Then you can let go and test without feeling rushed.
Carl
 
Hurrah! Success! It took about five or six pricks this time (really, Dusty deserves a medal for tolerating me) but I got my first reading! At 6 pm, about 26 hours after the only dose of insulin that she's had thus far and two hours since her last meal, her glucose reading was 320. Which is high but not, it seems, terribly scary high but also clearly in the diabetic range. I'm not planning on giving her insulin until about 8:30 tonight. Can I safely assume that her GR won't be much lower by then? I'm hesitant to force Dusty to do this again in the next couple of hours, especially since this will be the first time I'm also giving her the shot at home and because I'd like to get a test at about 10:30 - 11 tonight to get a sense of how she's handling the insulin.

Thanks for the encouragement and suggestions! You all are wonderful! :-D
 
Her number should not be lower at shot time because you hadn't given any insulin for 24+ hours. What dose are you planning to give?
Carl
 
I gave her one unit of the lantus at 8. It was strange injecting her because there was so little in the syringe that it didn't feel like I was actually injecting anything. It also wasn't as easy as I had hoped - I tried grabbing her skin at the back of the neck and she immediately stopped eating (some boiled chicken - her favorite) and tried to back away. I eventually took the chicken away from her and held her in a more secure way, injected her, and then gave her back the chicken. She seemed perfectly fine once the chicken was back in front of her. I imagine we'll both get more used to it and things will improve with time.

I'm going to take a glucose reading at about 10 and then, if I'm awake, perhaps midnight. I didn't sleep well last night, worried about her reaction to the insulin. I'm comforting myself with the thought that she did OK last night with the three unit dose that she got that afternoon, so she should be OK with the one unit dose from tonight.
 
Please see my signature link for Secondary Monitoring Tools for info on urine ketone testing, plus other tactics for monitoring your cat's health. Ketones form when the body can't use glucose, so it breaks down fat for energy. The presence of ketones is a warning sign for diabetic ketoacidosis which, untreated, is fatal and is very expensive to treat.

And welcome to the vampire club!

I notice her ears are partly dark in the photo (tortie, right?). You may find it helpful either to shave a small area of fur or to test on the inside of the ear if you can see there better.

Magnifiers may help when drawing up the insulin; I got eye glass clip on magnifiers from See It Bigger.

It helps to practice the gentle scruffing in the context of a kitty massage when not giving the shot so she doesn't associate that with only shots.
 
Thanks! Yes, I have been playing with the click of the lancet gun so she won't think anything of it, but I'll also remember to start incorporating scruff ruffling into cuddle time. I have some of the ketone testing strips that I grabbed at Walmart when I got the glucose monitor. I just haven't caught her in enough time to actually use them. I have some out at both of the litter boxes and hope to grab a check either tonight or sometime tomorrow. Never thought I'd be racing in to not just watch my cat pee but participate in the process. :-) Ahh the things we do for love.

Dusty is indeed a tortie. I rescued her from the humane society nine years ago when she was sixish. Looked into her lovely eyes (which were terrified as she doesn't do well with strangers) and couldn't say no. :) I thought about how much easier it would be to see the blood if I shaved part of the ear, but can literally not imagine trying to shave her ear. Maybe I'll try it on the inside if I keep having problems on the outside.

Thanks for the advice!
 
Many do the ear prick free hand. I felt like I had more control, I could get the droplet on my fingernail, plus apply pressure to the spot to reduce bruising and scabbing.
 
I think I'd worry about poking through the ear if I did it freehand. That said, I may try it as Dusty is Very Not Happy with the process as it stands right now. (We just did a two-hour-out testing. Down from 320 to 287.) I think her ears are pretty sore from my various attempts to learn today. Hopefully an overnight rest will do us all good and she'll be more amenable tomorrow.
 
Well done, you, for getting those first tests! :smile:

It WILL get easier.

As you have a cat with dark ears you might find it helpful to put the teensiest smear of vaseline on the edge of the ear. It helps the blood to 'bead up' without it disappearing into the fur and also helps you to see the blood droplet more clearly. I did this in the early days with my cat until his ears 'learned to bleed' more easily. They really do seem to 'learn'. Honestly!

And always press on the test site - firmly - for a few seconds after getting blood (with a little bit of cotton wool or tissue). It'll help to reduce bruising. I do that with one hand and scratch the top of Bert's head with my other hand. The sensation of the head-scritching means that he doesn't notice me holding onto his ear!
 
Thanks Elizabeth! This morning it was a one-jab test. Hurrah! And I even remembered to press firmly on the ear while giving lots of praise and cuddles. I may actually get the hang of this! Still not great with giving her the shot, but that will come with time, too.

Thanks for your help and wisdom!
--Michelle
 
Welcome Michelle and extra sweet Dusty!

You're doing WONDERFUL!!! You've already got lots of this under your belt already! You'll both settle down into a routine quickly.

Just fyi, there are other areas you can use for injections than the scruff if that is a problem. I use the loose skin behind KT's front legs, in front of the flank can also be used. He seems to prefer the right side front underarm most of all.

GREAT JOB so far!!!! BIG HUGS TOO!!!!
 
I sort of rolled my wrist to do the prick which seemed to give me better control over depth.
 
Lyresa - thanks so much for the kind words! They really do mean a lot! Today has been better. EXCEPT that I think that this morning I didn't actually *inject* my cat with insulin. No, instead I'm pretty sure the needle came out and I just injected the fur. Good times. (Tonight I was certain to get it in properly. I suppose that's a mistake you only make once!)

BJM - thanks for the advice! After writing about my worries, I realized I'm probably being silly. I do cross-stitch, so am quite used to being precise with a needle. I'm doing much better with the gun thing but may try the bare lancet once I get up the courage.
 
actually fur shots happen even after shooting for a while every now and then Boomer would move just as you shot and fur shot
 
Just to make sure -- is the insulin a bit sticky? Because it almost felt like Dusty had some sugar syrup dropped in her fur.

Also, when you're sure it's a fur shot, do you just give your kitty another dose?

Thanks!
 
No - don't give a 2nd shot. Some insulin may have gone and then you'd be double dosing.
Just note it as a possible fur shot - we've all done them!

Great news on the testing. I poke on the inside of the ear - the fur doesn't get in the way. Also, her ears will start to bleed more and that will make it easier too.
And you will get more confident and relaxed in doing this and that really helps :-D

Well done on taking control of her diabetes - you are really helping her.
 
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