Hello from Belle and Sam

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There could be other reasons for a high bg number, if it was just one test in the vet's office. What was the number? NDid he do a fructosamine test? That's the definitive blood test for diabetes. (it sounds like that might be the results you are getting today.)

The diet sounds good. It 's true we usually see new diabetics on a high carb diet, but there could be other factors.
 
There could be other reasons

1. any steroid use?
2 any signs of infection? urinary tract? ear infection?
3. Hows his teeth? Did the vet look at them? dental infections can also cause the issue.

Wendy
 
Hello.
It sounds like you're doing all the right things. Maybe he's just diabetic? I mean, lots of people have diet and exercise problems that lead to diabetes and then some people "should" be healthy and end up diabetic anyways. Maybe cats are like that, too. Sometimes there are other, physical things going on that can elevate BG levels as well - bad teeth, UTI's and such. Stress also raises BG levels.

I definitely agree that one test may not be the whole picture. Go ahead and get a meter and start testing at home. Those numbers are generally better and more accurate than tests done at the vet's office. Less stress on the kitty and a normal environment. Testing is going to be essential to managing this, so why not jump right in? Walmart has some very good reliable meters, and the strips are the cheapest around. You could also shop through our partner site American Diabetes Wholesale. The Arkray meters are very good and quite inexpensive. Human meters ARE good enough for cats. They don't read exactly the same numbers as pet-specific meters, but they work just fine. I have both a pet meter and a human meter and the numbers aren't different enough for me to worry at all.

Testing is also pretty easy, after you get the hang of it. Just make sure to provide lots of treats. My Chester knows the phrase "Test and Treat!" and will come trotting over to the couch to wait for me to get it all ready. He doesn't really like the ear poke, but he's more than willing to put up with it for the treat. He loves freeze-dried chicken!
Welcome on!
 
Thanks for your replies, Sue and Oliver, Wendy&Tiggy, and MbMinx.

Sue and Oliver
That's interesting that there could be other reasons. The number was based on the urine sample I brought in, which I collected just before the appointment. The glucose was at 4+, on a scale of Norm, 1+, 2+, 3+ and 4+. So the glucose in the urine was very high. The density was 1.036, which the vet said was a bit dilute, but not terrible. She will call me back with the blood results today, and I will ask if they did a fructosamine test. I'm also having some sort of other test done where they culture the urine, which takes a couple of days.

The most obvious culprit to look to for diabetes is diet, or at least it's the first thing you'd look at. The only other thing that has changed in Sam's life is that 6 months ago I had him and his brother vaccinated, as this was the only way the vet would clean their teeth. His brother had his teeth cleaned but Sam didn't. I also gave them a course of cartrophen (4 injections) for greater joint mobility.

Apart from the raw diet, Sam gets human-grade lysine for his rhino. And I give him a lysine treat that has DMG. And that's it.

I'm at a loss to know what to do about his diet.

Wendy&Tiggy
The vet looked at his teeth, and although he has a bit of tartar, they're not in bad shape, and Sam always enjoys his raw quail bones. But I am going to ask more about this. He's never taken steroids, and doesn't seem to have a UTI. Thank you for mentioning that it can be other things than diet. I can follow up on these. His only real problem is his rhino, which he's having a not so great time with right now. He's getting lots of lysine and the humidifier is always on.

MbMinx
Thanks for this. I like your attitude, and I'm glad, or hopeful, that I can be an active part of helping Sam.

Thank you again, everyone.
 
An update...I just heard back from the vet and she said that she didn't do the fructosamine test because Sam's glucose level is so high that she doesn't have any doubts that he has diabetes. She said he is at 27.3, and the normal range is between 3.9 - 8. He also has a slight elevation of the eosinophilus white blood cell, which could be caused by gastrointestinal parasites, or allergies and inflammation.
 
Just like people, sometimes there is no obvious explanation. IT would be nice if the obvious things were there, because they can be fixed quickly - diet, dental, infection. There may be a component of autoimmune/inflammation to the pancreas losing its ability to secrete enough insulin. Giving insulin may allow the pancreas to return to a working state or not. Start at a low dose (0.5 units) and use home testing to monitor and adjust the dose safely.

Avoid the use of harsh insulin such as Humulin, Humalog, Novolog, as these last only 8 hours or so in the cat and you'd need to test and dose every 8 hours for good control.

Preferred insulins include Lantus, Levemir, ProZinc, and in certain locations, PZI, due to their extended duration in the cat. Around mid-summer, Caninsulin may return to the US, but this does not work well in cats (duh, it was designed for dogs!).
 
Thank you, BJM. My vet said she'd use Lantus (which I'd read is good), starting at 1 unit, twice a day. I don't know if that was 1 unit split over the whole day, so 0.5 units each time. She said she's conservative with insulin, and starts with the lowest possible amount.

We're in Canada, so I can't get the great Walmart meter that seems to be recommended; I'll see if I can find the Bayer one that was recommended to me on the glucose meters thread.

Thank you, BJM, and everyone who has responded. It is such a comfort not to be alone in this.
 
Hi Belle (and Sam)
Just wanted to say welcome and best wishes. I only arrived here myself a bit over 3 weeks ago and have found this site to be SO helpful! I was so nervous about injections and testing and wasn't getting much support or information from my vet. A few weeks later and I'm much more at ease and ever-so-grateful that the people on FDMB are so generous with their advice and their time. It's quite a remarkable community.

Cheers,
KJ
 
Lantus is nearly always dosed twice a day in cats.
My vet started me on 1u once per day but I switched (after advice on this site) to twice per day.
A cat's metabolism is twice as fast as a humans or dogs so the insulin doesn't stay active for as long.

However, you need to have a dose that you can give safely twice per day. For most cats, 1u is ok but for some it would be less.
I
 
What is Sam's ideal weight and is he underweight? The initial dose suggested for Lantus is lean weight in kg * 0.25. So you take the lower of his ideal weight, or if underweight, take his current weight and multiply by 0.25, then round to the nearest half unit.

You'll need U-100 syringes that are 3/10 cc (aka mL), 30 to 31 gauge (needle thinness), and probably the short 5/8" needle. Most of these have half unit markings. If buying locally, insist on the half unit markings and if necessary, inspect them for this before purchasing. Its really difficult to dose small numbers without the half unit markings!
 
Thanks so much for your messages, BJM, Denise & Honey, and KJ&Alfred.

KJ
That's terrible that your vet wasn't supportive or being helpful with information. It's great to hear that things have turned around for you thanks to the nice people here. There is a lot of info, and people seem to very involved in helping one another. Lucky us!

Denise & Honey
The vet said it would be twice a day, and she starts off with the lowest dose possible, which I believe for Sam she said would be 1 unit. I'll find out on Thursday when he gets his first dose. Fortunately, they have already taught me how to do injections, as I gave Sam and his brother a course of cartrophen. Going to the vet stresses them, and I thought it would be a great skill to learn how to give injections, in case they're needed in the future. My neighbour is a vet tech, and she and her husband used to give their cat subQ fluids, and I thought it was so much nicer for their cat to get this at home on the lap of someone she loves.

BJM
Sam weighed 5.47 kilos yesterday when we weighed him. He's lost a bit of weight since he was last weighed 6 months ago at 5.5-ish kilos. The vet said he should lose a bit of weight, but he's just kind of big, and not chubby.

I *so* appreciate the advice about syringes, thank you! I was wondering about that.
 
I had another thought - does he ever get outside?

Let us know when you get the meter and we can advise on how to test, set up a spreadsheet etc.

Wendy
 
He goes outside on my deck, but doesn't roam the neighbourhood. The deck's enclosed, deliberately, for that reason. Why do you mention it? If there's some factor involved I'd like to know what it is for the sake of my other cats.

Y'alls are just to wonderful to give help with the spreadsheet. Gosh, I landed in a good place.
Thank you so very much.
 
That's very Sherlockian, BJM! I'd never considered that, but for people who let their cats out, this is definitely a consideration.

I feed my cats a raw diet using the premix from Feline Future, which I've done for 14 years, and the owner of FF, who is wonderful, assured me that the diet I feed by using her premix "is as low in carbohydrates as you can go, containing 1% or less carbohydrates. Even a mouse has more! (2%). Traces of glycogen are found in liver and muscle meats, which is stored glucose for use as energy by the cells. It is sometimes referred to as "animal starch". There is no way to omit that from the diet, because all animals store glycogen in their liver and muscle tissue.

If you intend to increase the amount of fibre in Sam's diet, make sure you are not adding carbohydrates with that. Fibre is typically from plant source, and if you add vegetables, bran, flax seeds, psyllium, or similar, you will also add starches and other plant sugars to the diet.

Although cats eat a diet nearly void of carbohydrates, their cells need glucose for energy nonetheless. The main source of energy for cats comes from protein, and glucose is produced via gluconeogenesis during the breaking down of protein. It is a dysfunction of the adrenal gland or the pancreas which throws off Sam's blood glucose levels and not the carbohydrate content in his diet.

I don't think you can do anything dietary, except for, perhaps, trying supplements which may help regulate blood sugar or help restore adrenal and/or pancreas function. You will need the help of your Veterinarian to try and regulate Sam's blood sugar and determine if he has become insulin resistant or if his immune system is destroying insulin-producing cells in his pancreas."

I'm posting this here in case any of the other members find this information useful. The owner of Feline Future is a very caring person, and is a personal hero of mine for her work on biologically-appropriate diets for cats.

Anyway, I've got my Contour meter (thanks to Wendy&Tiggy) and the rest of the kit, and will go learn how to take care of Sam at the vet's later today.

Thank you everyone for your kindness, friendliness and support.
 
Hmm I wonder if its too low in carbs - I saw that mentioned before with one cat although I am not sure on the logic.

Anyway let me know how you get on with testing!
 
That's really interesting! I'll have to look into that.

We just got home from the vet, where I learned how to do glucose testing. Sam's reading was 20.7 mmol/L - I don't know what that means, except that it's high, but not as high as the 27 the vet got from his urine sample on Monday.

I gave him his first insulin injection when we got home, 1u of Lantus, twice a day. I had his lungs x-rayed because he's been coughing and wheezing sometimes, and he'll have a course of antibiotics and vermifuge. So much action for one little guy. And a week from now I'll do his first blood curve. It's all doable. I just hope he feels better soon!
 
Thank you Wendy&Tiggy. I will set up a spreadsheet for sure - it is so wonderful having this support. Thank you so much.

Geez, I was all excited about 20 being lower than 27; do you think my vet is taking this seriously enough? She told me to do a blood curve in 5 - 7 days, and not worry about testing Sam's blood before then, because it wouldn't tell her anything and the dose of Lantus is so low that it's not going to make him hypoglycemic, so not to worry about it.
 
Sorry, I just meant that we need to work to get him into a better range. Vets can be a bit jaded with this but so far she isn't doing too bad, she has got you on a good insulin and is ok with you testing, that's not always the case with vets!!

However Your vet doesn't know how the one unit will affect him. My bailey had a hypo on 0.25units so you never know.. Best to test to be safe than sorry..
 
You're right - thank you for the good advice. I'd rather be on the safe side.

I told my vet about this group, and she thought it was great. If she isn't doing anything right, I'd change vets in a heartbeat.
 
The spreadsheet has columns across the top
Date
AMPS - morning pre-shot glucose test
A column for the dose to be recorded
+1 through +11 columns for recording any tests the given number of hours since the shot. This is because we are in different time zones, which would be confusing to translate on the fly.
Ex, a test 2 hours after the insulin would be recorded in the +2 column
A column for PMPS - evening pre-shot glucose test
A column for the evening dose
Another set of columns for +1 through +11 for any tests overnight

Based on the entry, there are automatic spreadsheet rules which color code the cells.

You can edit the spreadsheet online, without having to do a download/upload process. Plus, you can be connected to the Internet anywhere and be able to access it.
 
The people here are so helpful I'm really quite blown away.
Yes, that would be great if anyone can get me started, but if not, I can muddle through and feel free to correct me.
Sam is lying almost on my keyboard as I type this, and he says a big thank you!
Oh, and I added the link to Sam's spreadsheet in my sig, but it seems to be gone now.
 
No worries, the bill is in the mail ;) Actually the only thing we ask is that you pay it forward.. help advise other new members with your experiences.. not dosing advice but general hand holding , diet advice and support is great!

Oh and maybe buy a raffle ticket ;) http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=91584

I sent Marje & Gracie a PM about your SS and she will be along to help you soon.

Wendy
 
I'm wondering, how soon can I expect to see Sam's blood glucose level come down?
He has been getting insulin since Thurs. evening. I've been reading all I can, and it seems that low and slow is the way to go, but I'm still worried about his levels.
 
I think you need to get some more tests in so you can see how low he is going during the day. Below is typical lantus action and you can see how the blood sugar starts high, drops low by about six hours after the shot and rises again.

So you want to get a test or two in during the day say 5-7 hours after his morning shot to see how low he is going, and again before bed to see what he is planning to do at night.. As well as a test before every shot. That way you can catch his lowest number of the day and we can decide if he needs a dose change. Generally though you wait at least a week before making a change to allow the lantus depot to build up..

+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.

Wendy
 
I'm going to do his first blood curve on Thursday. In the meantime, I've been doing a reading each morning at 10. I guess I'm expecting to see his blood sugar level go down at that point because of the insulin, but it hasn't, really. It's still in the 20s. Otherwise, Sam seems happier since he's been getting insulin. More like his sparky, opinionated self. He's also resting a lot more because he's also taking a course of Clavaseptin for whatever is going on with his lungs, and I think this may head off him getting a UTI.

I'm wondering if getting his teeth cleaned may make a difference. I hate the idea of general anesthesia, but from what I've read, a cleaning may help.
 
A curve is interesting but not critical. The issue with it is that its just results for one day and cats vary from day to day - for example one day he could be low and the next he could "bounce" and be high all day. You could miss either of those depending when you do the curve.. The four tests i mentioned above daily will give you a better idea of whats going on. His BG may well be dropping during the day but unless you test you wont see that. So he could be 20s preshot and drop to say 4 midday and back up to 20s.

Are his teeth bad? Any sign of infection?

BTW a "bounce" = When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
 
This is sooo helpful. Thank you!

My vet is asking me to do a blood curve once a week and send her the results. She said not to do the first one until 5-7 days after Sam starts Lantus, so I'm doing it on Thursday because it will be a quiet day to ourselves.

The vet said she doesn't want any more testing than that because "some people test too much and then freak out" or something along those lines. But I know from working on software for human diabetics that more testing is better.
 
I disagree and what the vet doesnt know wont hurt her ;)

You would never shoot a child with insulin without testing, and so its the same with your kitty. Its very very important you test before every shot at a minimum. Worst thing you can do is shoot them when they are low!!! My Bailey had a hypo the day after the vet told me to give a 0.25IU dose.

As well as keeping Sam safe, its good for your peace of mind to see the insulin working and checking he isnt dropping too low. As well as preshot tests every day, a test 5-7 hours after your morning shot is good (if possible with your schedule) to see how low he goes. Also a test before bed (2-3 hours after his night shot) gives you an idea what his plans are overnight and peace of mind to sleep and not worry about a hypo.

We will help you not to freak out ;) And anyway you are testing already and are fairly calm from what I can tell.

Wendy.
 
Great points, and I'm sure everyone with diabetes, or who is treating a pet with diabetes knows that it's very individual and you have to keep aware of what's going on. I thank you for all your great info, because I have been testing at the wrong time, and not enough. I was a bit shocked when the vet said that the only testing I should do is a blood curve once a week. I'm worried because Sam's levels still seem so high, but your explanation helps quite a bit, and although I'm not impatient, I'm just anxious that they don't stay high for too long and hurt his pancreas in a lasting way.

He is looking and acting a lot better, so something good is happening.
Thanks for all the support!
 
Remember that Lantus is a depot (or shed) insulin and it takes a bit to build up. As many as 5 days- hence the wait for the curve day. So give it some time. But you say Sam is acting better so it looks to be working somewhere.

Testing everyday is needful and tells us how he is doing. So keep it up.

Great on the food- I supplement with raw when she (my Sneakers) will eat it.

Here is a bug to put in your ear for later if you go a few months and there doesn't seem to be any help but going up in dose. There is a condition called acromelegy (information can be found in one of the forums on the board) that a cat still has a working pancreas but still has diabetes b/c of a pituitary tumor that produces excess amounts of GH-1 which overwhelms the pancreas like a storm hitting a beach. While the condition it is considered "rare" we have had 4 newcomers sign up in the Acro FB site this last month. There is not a place in Canada that tests for it- only one place in the states. Things to look for- big pot belly, longer back legs, needs higher doses of insulin, ravenous appetite (but so do unregulated FD's) are just some of items to keep an eye out for. Like I say- this is early yet but it is another reason a cat can get diabetes without consuming high carb food all its life or getting steroid shots.
 
Welcome, Belle and Sam!

I have a kitten diabetic, so I can definitely second hmjohnston that not all feline diabetics are created from bad food. :lol: Steroids, infections, and dental issues can also cause or perpetuate diabetes and/or spike BG levels. If they're the cause, there's a much higher chance of remission once the underlying problem is cleared up or they no longer need the steroids.

As to worrying about him remaining in high numbers too long, what matters more is that he's not staying in high numbers. So, even if you get a couple of high numbers throughout the day, as long as he's hitting a couple of good numbers as well, then things start looking up. I didn't see it mentioned anywhere about testing for ketones? Maybe I just missed it, but this helps assure you that he's doing all right even if his numbers are higher than you'd like to see. Or, on the other end of things, it alerts you to potential DKA before it has time to get worse.
 
Thank you for the warm welcome, hmjohnston and KPassa :-)

I found out the result of Sam's urine culture today and he has a UTI. He is already on an antibiotic, so hopefully he is already getting some relief. The vet said that although he could do with a dental cleaning, his teeth aren't all that bad, and there's no need for a cleaning ASAP; he can take his time to stabilize and feel better, and then we can do that.

When I had his urine tested a week ago, they tested for ketones and there was no problem, but I understand how important this is, so I asked the vet to get me some chemstrips, and they arrived this afternoon and I picked them up today. Sam is very easy to collect a sample from, so I will be testing.

KPassa, is your icon your little kitten? What a love bunny!
 
A UTI could well explain the higher numbers. However please can you get more tests in? Shooting without testing is like driving with a bag over your head. Not safe at all.
 
Wendy&Tiggy said:
A UTI could well explain the higher numbers. However please can you get more tests in? Shooting without testing is like driving with a bag over your head. Not safe at all.
Click to expand...

Yep. A UTI can cause higher numbers. That's what they initially thought was the cause of my kitty's diabetes (till they found out the diabetes was the cause of the UTI. :roll: ) So, be aware that when the infection clears up, his numbers will drop lower! This is another reason why it's so important to test.

Belle said:
KPassa, is your icon your little kitten? What a love bunny!
Click to expand...

That was Michelangelo right around the time he was diagnosed at 6 months. He's just a couple of weeks shy of turning a year now and has gotten a bit bigger since then (~10.5 pounds now), but I love that little kitten photo of him because it really captures his personality and it reminds me how far we've both come. cat_pet_icon He was an itty-bitty, skitty-kitty at only ~4.5 pounds till he started growing again at around 7 months old (about a month after starting him on insulin). In comparison, Henry is now quickly catching up to Mikey (~8.5 pounds) and he'll be 7 months old on the 8th. :o

Speaking of which, if you like, you can create a profile for Sam (and your other fur kids) so we can see more pics! :-D
 
If his mouth is not painful, I encourage you to teach him to allow tooth brushing. Yes, really ;-)
This will reduce further tartar accumulation.

If his mouth is sore, don't touch, or he'll never let you near his mouth again.

Pop over to Cat Info - Dental Disease for information on this.
 
I'm wondering how long it should be before I start to see an improvement in Sam's levels. Yesterday they were:
AMPS: 380 22.1 mmol/L
+2 425 23.6
+6 358 19.9
PMPS: 466 25.9

He's getting 1u of Lantus every 12 hours.

I've sent his numbers to the vet, and hopefully she will - I'm guessing - up his insulin dosage. He's been taking insulin for 10 days, so should I start seeing an improvement, or is this too early?

Thanks very much for the caring and advice I'm received - I appreciate it so much!
 
Thanks! For sure there's no hypoglycemia. And the vet likes to go low and slow. I'm just wondering if he should be starting to show an improvement, or if I'm being impatient.
 
Once we get him to the right dose you should see an improvement but without more testing you wont know.

I am glad to see you are doing a bit more testing but please can you get a middle of the night test in? Many cats drop quite low at night and then shoot back up for the morning, I think you might be surprised!!!

I would like to see a test before every shot and a few spot checks for the next 2-3 days. For example midday and before bed. That way we will get a real good picture and can check for bounces (explained below)before you change dose.. I am concerned he may well be dropping low and you just arent catching it. Never assume the low point is 5-7 hours after the shot - it can vary immensely.. hence the spot checks.

Bounces : When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Wendy
 
Thanks for the knowledge and good advice, and patience! I'll be around tomorrow and can test him midday. I was assuming that the test 6 hours after the morning shot is the lowest, like that's carved in stone, so I appreciate you letting me know that it varies. For sure I haven't done enough testing. I know that, and I need more steel in my backbone, I think, to work up to testing being normal. But I know it's going to save his life and give him the best chance for remission.
 
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