HELP! BG 680 1hr before PM shot, time for increase or panicky liver??

[naturalborncatter]

Hello!! My name is Maggie, and my cat I adopted as an 8wk old runt 18 years ago was recently diagnosed with diabetes. I’ve had her since I was like 8 so of course this has been incredibly overwhelming, despite the fact that around her time of diagnosis I actually started working reception at our vets office, so I have lots of access to techs and the doc as far as general questions.
A little bit of history around her developing the disease: she developed some GI symptoms (chronic diarrhea) we think just due to age and maybe some IBD at the beginning of the year. We tried several conservative approaches to treatment, but nothing was helping so we did a week long treatment with prednisone. It was clearly too much on her old tiny body, physically and mentally it just messed her up. It ended up not helping her GI symptoms, but we discovered that the formulation of Hill’s Science Diet sensitive skin & stomach fixed those fairly quickly.
During the pred trial she started drinking OFTEN and urinating equally often and in large amounts. Since this is a side effect of pred (we checked with the vet) we assumed it would subside as she went off it. It didn’t, so we brought in a urine sample and from the amount of ketones the vet concluded she had developed the rare pred side effect of diabetes (though to be fair, based on her age she very well may have been prediabetic). We brought her in the next day, and they did a blood panel and her glucose was in the 400s.
So two weeks ago today, we started her on 1 unit of glargine (the cool clicky pen) twice a day. Almost immediately her mental state seemed to improve somewhat. One week later we brought her in for a spot glucose, her numbers were in the 500s, so we continued 1 unit 2x a day for another week and yesterday repeated the spot glucose and her numbers were still in the mid 400s (but she regained 0.2lbs after having lost a pound through the diabetes). So my vet instructed me to up her to 2 units 2x a day. I’m planning to try that tomorrow morning since I have the day off to monitor her, but I have a few concerns/questions. She’s only 10.6lbs and glargine is long acting, so I’m worried if I pushed her into a hypo at her age, with the immense backup in our only local vet er, that it could be it for her. My vet said I could always rub karo on her gums if she’s hypo but I’d probably take her to the er if I suspected it. It’s also worth noting that due to her age, she’s always unsteady on her feet and fairly lethargic, so I’m not sure how easy it would be to tell if she was hypo. I’m thinking of seeing if I can pick up a glucometer at petsmart today but I doubt they’d have that. Another concern is, our vet switched her to a strict diet of only the Purina DM canned, which of course with carbs makes a ton of sense BUT even though we switched her slowly, it has completely messed with her GI thing, and she’s back to having chronic diarrhea and is really uncomfortable. I don’t know if anyone thought it might be alright to supplement the wet with like two teaspoons a day of Hill’s sensitive stomach dry food to help her old tum, or if there is perhaps a diabetic friendly food with less by-products and a similar composition to hills. My vet is adamant no dry food, even diabetic-designed ones, because he thinks we could get her into remission (I don’t think that’s likely based on age, and I don’t want her to spend her last year or however long in terrible stomach discomfort). Anyways, I appreciate any advice or direction to pertinent threads, and any assurance that we will figure this out and I’m not putting an old cat through weeks of discomfort for nothing! She doesn’t really mind her injections though, and she’s a voracious eater always so that isn’t a worry, I’m not sure if it’s okay to feed her several small meals throughout the day which is what we usually do with her, from what I understand with glargine that should be okay? I don’t want to upset the eating habits of such an old kitty. All around I just need some hand holding haha!

 

[Bron and Sheba (GA)]

Hi and welcome Maggie and kitty (name?to the forum.
Yes, I would strongly suggest you go out and buy a glucose meter to test the blood glucose. I would suggest a human meter as they are much cheaper to run and are just as good as a pet meter. Most of us use human meters here. Can be bought at Walmart or a pharmacy.
I would also buy some insulin syringes and start using those instead of the pen. That way you can go up in 1/4 unit increments
As you are using glargine (Lantus) you will need a U 100 3/10 ml 30 or 31 gauge 6 or 8 mm insulin syringe with 1/2 unit markings
These can be bought from Walmart if you live in the US or a pharmacy, or from a pharmacy elsewhere.. I will show you how to draw the insulin from the pen below.
I would increase by 0.25 units up to 1.25 units (1 1/4 units) it is much safer. To get that you draw up the insulin between the 1 and the 1 1/2 unit mark.
Post and ask questions if you are uncertain.

I would set up a spreadsheet so we can see the BG and be able to help you. Also if you could set up the signature and tell us about your kitty
HERE is a link that includes the link to the SS and signature.

I will post this and we can talk about the food later which is a big concern for you.
Can you remove the GA from the subject line please as it means gone ahead or guardian angel….we use that when a kitty passes away.
Bron

These are the syringes. You can get a different brand but get that size. Ask for the ones with 1/2 unit markings on them

This is how you get the insulin out of the pen

 

[Bron and Sheba (GA)]

Here is the link to hometesting https://felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

[naturalborncatter]

Hi and welcome Maggie and kitty (name?to the forum.
Yes, I would strongly suggest you go out and buy a glucose meter to test the blood glucose. I would suggest a human meter as they are much cheaper to run and are just as good as a pet meter. Most of us use human meters here. Can be bought at Walmart or a pharmacy.
I would also buy some insulin syringes and start using those instead of the pen. That way you can go up in 1/4 unit increments
As you are using glargine (Lantus) you will need a U 100 3/10 ml 30 or 31 gauge 6 or 8 mm insulin syringe with 1/2 unit markings
These can be bought from Walmart if you live in the US or a pharmacy, or from a pharmacy elsewhere.. I will show you how to draw the insulin from the pen below.
I would increase by 0.25 units up to 1.25 units (1 1/4 units) it is much safer. To get that you draw up the insulin between the 1 and the 1 1/2 unit mark.
Post and ask questions if you are uncertain.

I would set up a spreadsheet so we can see the BG and be able to help you. Also if you could set up the signature and tell us about your kitty
HERE is a link that includes the link to the SS and signature.

I will post this and we can talk about the food later which is a big concern for you.
Can you remove the GA from the subject line please as it means gone ahead or guardian angel….we use that when a kitty passes away.
Bron

These are the syringes. You can get a different brand but get that size. Ask for the ones with 1/2 unit markings on them
View attachment 62094

This is how you get the insulin out of the pen

View attachment 62095

Thank you so much! Yes, I was thinking of getting some syringes (I know my compounding pharmacist says the other pet owner who uses the Lantus pen uses syringes with it- I just wasn't sure if creating a pocket of air in the pen by removing with syringes would affect it's longevity) to if nothing else go up by a half unit. I'll see if I can get my hands on some syringes and needles tomorrow, I've been using 4mm 32G, do the 30/31G come in a 4mm? I was under the impression human meters would give an inaccurate reading since cats and humans have different glucose mechanisms, does it not matter as long as you know how your tester is calibrated?

 

[Bron and Sheba (GA)]

I've been using 4mm 32G, do the 30/31G come in a 4mm?

I would get the syringes I suggested. They need to be U100 3/10 syringes to give the correct dose.

I was under the impression human meters would give an inaccurate reading since cats and humans have different glucose mechanisms, does it not matter as long as you know how your tester is calibrated

The human meters are fine. Most of us use them here. They just read a bit lower than the pet meters but our dosing methods are based on the human meter.
Until the pet meters came into existence several years ago, all vets used the human meters.

I just wasn't sure if creating a pocket of air in the pen by removing with syringes would affect it's longevity) to if nothing else go up by a half unit

Don’t inject air into the cartridge when you remove the insulin.
If you keep the insulin in the fridge, it should last for up to 6 months.

When you start testing, always test before given the dose of insulin. Initially if the BG is below 200, STALL, DONT FEED, AND RETEST ON 20 Minutes. And post and ask for help.
As Glargine is dosed on the lowest point in the cycle, try and get some tests in during the cycles…both am and Pm cycles.
I’ll link the Lantus information which can be found in the yellow stickies at the top of the Lantus page. You will continue to post here until you are managing the testing and are sorted out and then we will redirect you to the Lantus page. Have a look at the yellow stickies at the top of this page
HERE is the Lantus page

 

[a_rose51]

I’m pretty new to all of this (going on a month in now) so can’t really offer you advice, but just wanted to welcome you and say how grateful I am to the whole community here. Everything was so overwhelming at first and I didn’t feel like I was getting enough support from the vet and was super stressed. Listening to suggestions from members was astoundingly helpful and I felt like I could finally breathe. We just switched over from a pet meter to a human one. Saw a bit of a difference in numbers, but overall still understandable and the cost savings are huge. More importantly, I wanted to be able to run to Walmart and get strips if I need them in an emergency. Glad you joined! And don’t worry. You aren’t alone!

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

Just an FYI - Lantus is pricey in the US. Many people here order their insulin from Canada (Marks Marine Pharmacy). The generic, glargine, is now available at a much more reasonable price and you are likely able to purchase one pen. The generics/biosimilars are either Semglee or Basaglar. I would call around for pricing.

Your instincts about the dose increase are on target. We increase doses by 0.25u. A tiny amount! The pens will only dispense in a full unit so the syringes that Bron described are essential. Petsmart doesn't have medical supplies but Walmart or other pharmacies do.

I'm a little concerned about what your vet said about ketones. I'd suggest you pick up some Ketostix when at the pharmacy. You can test them where ever you get your other supplies. They are a urine test so you will need to stalk your cat to the letterbox.

Regarding the GI issues: S. boulardii is a probiotic that is wonderful for helping with diarrhea in both cats and humans. You start with 1/4 capsule mixed into food twice a day. You can gradually increase the amount. This website on Raw Feeding for IBD Cats was an incredible help with my IBD kitty. Even if you don't want to consider a raw diet, the information on supplements, managing diarrhea, etc. is very helpful. They also have a Facebook page if you have questions.

 

[naturalborncatter]

Welcome to FDMB!

Just an FYI - Lantus is pricey in the US. Many people here order their insulin from Canada (Marks Marine Pharmacy). The generic, glargine, is now available at a much more reasonable price and you are likely able to purchase one pen. The generics/biosimilars are either Semglee or Basaglar. I would call around for pricing.

Your instincts about the dose increase are on target. We increase doses by 0.25u. A tiny amount! The pens will only dispense in a full unit so the syringes that Bron described are essential. Petsmart doesn't have medical supplies but Walmart or other pharmacies do.

I'm a little concerned about what your vet said about ketones. I'd suggest you pick up some Ketostix when at the pharmacy. You can test them where ever you get your other supplies. They are a urine test so you will need to stalk your cat to the letterbox.

Regarding the GI issues: S. boulardii is a probiotic that is wonderful for helping with diarrhea in both cats and humans. You start with 1/4 capsule mixed into food twice a day. You can gradually increase the amount. This website on Raw Feeding for IBD Cats was an incredible help with my IBD kitty. Even if you don't want to consider a raw diet, the information on supplements, managing diarrhea, etc. is very helpful. They also have a Facebook page if you have questions.

Thank you! We've tried FortiFlora and I was planning on getting more of that, but I will definitely check out that site, it seems pointless to keep the diabetes under control at the cost of her GI tract, she's in a lot of pain when her IBD stuff flares up and at her age I don't want to put her through that so getting it back under control is really important to me! And yes, Ketostix are on my list! The compounding pharmacy was able to sell me a single lantus pen (300 units) for around $60 so since she's quite old I'm okay with that price for now. Especially once I pick up syringes, I'll waste 4 less units per day priming the pen needle so it'll last a while.

 

[naturalborncatter]

I have a question about curves, I haven't made it to the drugstore yet but am hoping to do at least a partial one today when I do. Does it not bother the cat to be poking the same spot on the ear every hour? I know the "sweet spot" is fairly small, esp on the Kitten (her official title) because she has shrively-18-year-old ears. I also only really have the left ear to work with, she gets chronic itchy ears (probably her food sensitivities- planning on finding her a more high-end predator diet once we've done boiled chicken for a bit to get her indigestion under control) and the right ear is too itchy to mess with right now, she flattens it. On the other hand, giving ear meds and cleaning her ears fairly regularly means she's used to (and usually enjoys) having her ears messed with!

 

[Sienne and Gabby (GA)]

With a curve, you don't test every hour. Curves are done every 2 hours for a 12-hour cycle or every 3 hours for 18 hours.

I largely test4ed Gabby on one ear. If you look at her spreadsheet, you'll see I was a testaholic. Once your cat gets accustomed to testing, it should be fine. However, it can sometimes take a bit for a cat to get used to testing and it can take some time for the ear to "learn" to bleed (i.e., the capillary bed along the edge of the ear needs to build up).

If she's having issues with IBD, you may want to consider a novel protein. I used to feed my cats only chicken and turkey. Now they get rabbit, lamb, and pork.

 

[naturalborncatter]

So, a little update. Kitten started acting weird on Sunday, hiding under the bed and once she cried und went under the bathtub, which she used to do before she threw up (when we used to feed her a lot at once). Took her to the emergency vet on a hunch, and her bg was 640. She was in the ICU for three days. Because they had to give her more insulin to reverse the ketosis, she then went in the other direction and rapidly dropped which worried the ICU vet. She stabilized back to around 440 (I know thats still high) and we brought her home Wednesday night. She also had a fever and they suspected based on the diarrhea she had some sort of infection. She got IV antibiotics and is on oral ones as well, we also under advisement of the vet switched her back to the Royal Canin PR wet food. Her poops are solid again and she's acting like her new-normal diabetic self, so I'm assuming whatever infection/irritation she had has passed. I wanted to give her a few days before upping her insulin, and the ICU vet advised against going up to even 1.5 units based on her response to them increasing her to 2. However, I started home testing today (she's well behaved but cries even when the poke is in the sweet spot ) and at +6 hrs she was 572 on the AlphaTRAK2, which freaked me out. So I tested her again with the FreeStyle Lite (my backup) and it was 410. I just tested her again at around +8 with the AlphaTrak and she was 473. I didn't want to poke her twice so I didn't take one with the FreeStyle. Based on these high readings I'm worried she's heading back towards ketosis, and unfortunately the ICU stay was $2400, which I just can't manage a second time, I literally do not have the funds. My regular vet agreed with me that consistent readings of 440 are still too high, should I risk giving her 1.25 tonight and then based on a +2/3 test decide if I should stay up to monitor her? I figure a hypo is more easily managed at home than a hyper (which isn't at all) and I really don't want to be forced into putting her down or (if I can find the funds/get carecredit) put her through hospitalization again for ketosis. I'm starting to worry she's one of those unfortunate cases where the insulin response just won't allow me to keep her stable and comfortable.

 

[Judy & Fritz]

So, a little update. Kitten started acting weird on Sunday, hiding under the bed and once she cried und went under the bathtub, which she used to do before she threw up (when we used to feed her a lot at once). Took her to the emergency vet on a hunch, and her bg was 640. She was in the ICU for three days. Because they had to give her more insulin to reverse the ketosis, she then went in the other direction and rapidly dropped which worried the ICU vet. She stabilized back to around 440 (I know thats still high) and we brought her home Wednesday night. She also had a fever and they suspected based on the diarrhea she had some sort of infection. She got IV antibiotics and is on oral ones as well, we also under advisement of the vet switched her back to the Royal Canin PR wet food. Her poops are solid again and she's acting like her new-normal diabetic self, so I'm assuming whatever infection/irritation she had has passed. I wanted to give her a few days before upping her insulin, and the ICU vet advised against going up to even 1.5 units based on her response to them increasing her to 2. However, I started home testing today (she's well behaved but cries even when the poke is in the sweet spot ) and at +6 hrs she was 572 on the AlphaTRAK2, which freaked me out. So I tested her again with the FreeStyle Lite (my backup) and it was 410. I just tested her again at around +8 with the AlphaTrak and she was 473. I didn't want to poke her twice so I didn't take one with the FreeStyle. Based on these high readings I'm worried she's heading back towards ketosis, and unfortunately the ICU stay was $2400, which I just can't manage a second time, I literally do not have the funds. My regular vet agreed with me that consistent readings of 440 are still too high, should I risk giving her 1.25 tonight and then based on a +2/3 test decide if I should stay up to monitor her? I figure a hypo is more easily managed at home than a hyper (which isn't at all) and I really don't want to be forced into putting her down or (if I can find the funds/get carecredit) put her through hospitalization again for ketosis. I'm starting to worry she's one of those unfortunate cases where the insulin response just won't allow me to keep her stable and comfortable.

@Bron and Sheba (GA) @Sienne and Gabby (GA) can you help?

 

[Chris & China (GA)]

You only have data on the spreadsheet for today and I'm trying to figure out how long she's been getting the Lantus. Is today the first day she's been on it? Was she on Lantus when she was at the vet? Do you have any test results from that time?

Lantus takes 5-7 days before you will see the full effect of the dose which is why I'm asking

 

[Bron and Sheba (GA)]

Hi Maggie and Kitten,
I am so sorry your kitty has had DKA. There are several things you need to e doing to ensure Kitten keeps recovering.
First of all, if you could set up the spreadsheet and enter any data you have that would be great. Stick to either the alphatrak meter of the human meter. Don’t try and use both of it will send you bonkers. Here is the link to the spreadsheet, if you have any trouble I’ll tag @Bandit's Mom ti help, as we need to get it up and running soon.
SPREADSHEET
ETA….I see you have the SS up. …..sorry!
The recipe for DKA is not enough insulin, not enough food, and an infection or an inflammation.
So the treatment is to ensure there is enough insulin, enough food and any infection it inflammation is being treated.

• don’t skip any doses of insulin. If the BG is too low, stall dont feed and test again in 20 minutes. Post and ask for help and change the subject line to reflect the problem….‘stalling, BG xxx, PLEASE HELP’ that will get attention. Initially if the preshot BG is under 200 stall.
• You need to be feeding 1 1/2 times as many calories as you would normally feed. So feed at the preshot meals and then give snacks every couple of hours. Don’t feed for the 2 hours before the preshot BG.
  
• If the vet did not give you any antinausea medications on discharge, please ask your regular vet if you can have some cerenia and ondansetron to have at home. Many post DKA kitties are nauseated and need medication for a week or two.
• If you are not doing so already, you need to be testing daily for ketones. You can buy a bottle of Ketostix from Walmart or a pharmacy and test the urine. This is really important and will tell us if she is getting enough insulin and enough food.
• Encourage extra fluids. Put a teaspoon of warm water in to each snack of food to add more fluids. Did the vet suggest sub Q fluids?
• Test the BG before every shot to see it is safe to give the insulin and then test during the cycle to see how low the dose is taking Kitten.
• Make sure you give all the antibiotics until they are finished.

Keep posting every day, multiple times if you need to and ask questions and tell us how she is going.
I am assuming she is still having the Lantus insulin since discharge.
Are you using the U100 3/10 insulin syringes with the 1/2 unit markings?
Bron

 

[Bron and Sheba (GA)]

I'm starting to worry she's one of those unfortunate cases where the insulin response just won't allow me to keep her stable and comfortable.

It takes a few days for the depot to stabilise. She may need to have the dose increased, but first we need to see data. I am sure we will be able to help you get Kitten sorted out.

 

[naturalborncatter]

You only have data on the spreadsheet for today and I'm trying to figure out how long she's been getting the Lantus. Is today the first day she's been on it? Was she on Lantus when she was at the vet? Do you have any test results from that time?

Lantus takes 5-7 days before you will see the full effect of the dose which is why I'm asking

She's been on it for about three weeks now, I only got my hands on testing stuff today which is why there isn't much data. The data from when she was in the ICU isn't available to me and was probably kind of off because she had an infection.

 

[Bron and Sheba (GA)]

She's been on it for about three weeks now, I only got my hands on testing stuff today which is why there isn't much data. The data from when she was in the ICU isn't available to me and was probably kind of off because she had an infection.

Ok. We all have to start somewhere. Keep testing and we will watch the data.

 

[naturalborncatter]

Hi Maggie and Kitten,
I am so sorry your kitty has had DKA. There are several things you need to e doing to ensure Kitten keeps recovering.
First of all, if you could set up the spreadsheet and enter any data you have that would be great. Stick to either the alphatrak meter of the human meter. Don’t try and use both of it will send you bonkers. Here is the link to the spreadsheet, if you have any trouble I’ll tag @Bandit's Mom ti help, as we need to get it up and running soon.
SPREADSHEET
ETA….I see you have the SS up. …..sorry!
The recipe for DKA is not enough insulin, not enough food, and an infection or an inflammation.
So the treatment is to ensure there is enough insulin, enough food and any infection it inflammation is being treated.

• don’t skip any doses of insulin. If the BG is too low, stall dont feed and test again in 20 minutes. Post and ask for help and change the subject line to reflect the problem….‘stalling, BG xxx, PLEASE HELP’ that will get attention. Initially if the preshot BG is under 200 stall.
• You need to be feeding 1 1/2 times as many calories as you would normally feed. So feed at the preshot meals and then give snacks every couple of hours. Don’t feed for the 2 hours before the preshot BG.
  
• If the vet did not give you any antinausea medications on discharge, please ask your regular vet if you can have some cerenia and ondansetron to have at home. Many post DKA kitties are nauseated and need medication for a week or two.
• If you are not doing so already, you need to be testing daily for ketones. You can buy a bottle of Ketostix from Walmart or a pharmacy and test the urine. This is really important and will tell us if she is getting enough insulin and enough food.
• Encourage extra fluids. Put a teaspoon of warm water in to each snack of food to add more fluids. Did the vet suggest sub Q fluids?
• Test the BG before every shot to see it is safe to give the insulin and then test during the cycle to see how low the dose is taking Kitten.
• Make sure you give all the antibiotics until they are finished.

Keep posting every day, multiple times if you need to and ask questions and tell us how she is going.
I am assuming she is still having the Lantus insulin since discharge.
Are you using the U100 3/10 insulin syringes with the 1/2 unit markings?
Bron

Thanks Bron! Yes, I've switched to the needles you suggested but thought I'd keep her at 1 unit until I have more data, especially because her curves they did at the vet sounded pretty all over the place. I'll stick to the human meter since that's how the spreadsheet is set up for the site.
As for feeding, she's the definition of a chowhound! She basically camps out in front of the kitchen (even before diabetes) and she eats many snacks throughout the day so I'm not worried about her caloric intake, but will try to keep her from eating 2hrs before her PM shot as well as the AM. Even if she is nauseous (she's not showing any signs of nausea) she would still eat. Maybe the dietetic food just wasn't enough calories for her, either way she's off that now and her GI symptoms seem to have resolved.
They didn't suggest fluids, just to come back for a glucose curve in two weeks or sooner if she acted distressed at all. But I'm starting to test when I can and will set aside Sunday for a 12hr curve at home. I'll add more water to her meals as well.
There is a specialist internal medicine vet in my area who deals with a lot of diabetic cats, she isn't currently taking on new cases but my vet/my boss is going to see if he can pull some strings and get a consult or at least some guidance on a treatment plan.
I used a ketostix test today and it looked negative for ketones, and she has gained .2lbs in the weeks since starting insulin so I'm hoping things will work out!
I appreciate the guidance!

 

[Bron and Sheba (GA)]

Yes, I've switched to the needles you suggested but thought I'd keep her at 1 unit until I have more data

Good idea. We can help you with the dosing once we get more data

I'll stick to the human meter since that's how the spreadsheet is set up for the site.

Good idea.

As for feeding, she's the definition of a chowhound

That is great. It is often half the battle getting them to eat after DKA

I'll add more water to her meals as well.

That will help a lot

used a ketostix test today and it looked negative for ketones, and she has gained .2lbs in the weeks since starting insulin so I'm hoping things will work out!

That is excellent news. Keep testing daily if the tests are negative and put results into the SS remarks column. If they start to show up you will need to test more often.

There is a specialist internal medicine vet in my area who deals with a lot of diabetic cats, she isn't currently taking on new cases but my vet/my boss is going to see if he can pull some strings and get a consult or at least some guidance on a treatment plan.

If you can’t get in, we can help you with what is needed for recovering from the DKA and moving forward after that.
Your main jobs at the moment are.

• Testing the BGs and not skipping doses of insulin
• Making sure she eats lots of food
• Give the antibiotics
• Test daily for ketones.
• Give extra fluids
• Keep in touch with us.

 

[Judy & Fritz]

Thanks Bron! Yes, I've switched to the needles you suggested but thought I'd keep her at 1 unit until I have more data, especially because her curves they did at the vet sounded pretty all over the place. I'll stick to the human meter since that's how the spreadsheet is set up for the site.
As for feeding, she's the definition of a chowhound! She basically camps out in front of the kitchen (even before diabetes) and she eats many snacks throughout the day so I'm not worried about her caloric intake, but will try to keep her from eating 2hrs before her PM shot as well as the AM. Even if she is nauseous (she's not showing any signs of nausea) she would still eat. Maybe the dietetic food just wasn't enough calories for her, either way she's off that now and her GI symptoms seem to have resolved.
They didn't suggest fluids, just to come back for a glucose curve in two weeks or sooner if she acted distressed at all. But I'm starting to test when I can and will set aside Sunday for a 12hr curve at home. I'll add more water to her meals as well.
There is a specialist internal medicine vet in my area who deals with a lot of diabetic cats, she isn't currently taking on new cases but my vet/my boss is going to see if he can pull some strings and get a consult or at least some guidance on a treatment plan.
I used a ketostix test today and it looked negative for ketones, and she has gained .2lbs in the weeks since starting insulin so I'm hoping things will work out!
I appreciate the guidance!

Welcome, Maggie and Kitten! I’m new as well, know nothing about Lantus, and only knew how to call for help. Bron and Chris are amazing. You two could not be in better hands. I had an 18 year old once myself and your story touched my heart. You are obviously a great cat mom. You girls will be in my prayers.

 

[naturalborncatter]

Welcome, Maggie and Kitten! I’m new as well, know nothing about Lantus, and only knew how to call for help. Bron and Chris are amazing. You two could not be in better hands. I had an 18 year old once myself and your story touched my heart. You are obviously a great cat mom. You girls will be in my prayers.

You’re so sweet, thank you! Her diagnosis is coinciding with a diagnosis of a rare autoimmune condition that’s very complicated to treat for one of my 11yr old civvies as well. It’s been a rough start but I think we might be headed in a good direction, her AM pre shot number this morning was 398 on the AlphaTrak which is better than yesterday!

 

[naturalborncatter]

Hello, a little update. So yesterday her number were the lowest they’ve been since her diagnosis, 380 in the amps and 412 in the pmps (using the alphatrak). I was thinking we’d made it over the rough patch, but tonight at 5:00pm (1.5 hrs before her PM shot) I got a reading of “HI” and did a second test to be sure and it was 680. Clinically she seems okay, she was fine all day, she doesn’t seem any different than her usual self as of late. Unfortunately I can’t afford to hospitalize her a second time in a week, and I’m not sure that would even benefit us as they didn’t help us adjust the dosage and she was only on the up and up for like three days. Could this be a panicky liver? Her body was used to 400-550 for at least a few weeks, but it still seems like a significant increase. I’m really tempted to go up from 1 unit to at least 1.25 tonight. I’m just so exhausted worrying she’s near the end and can’t figure out why it’s so high and yet she’s acting fine. She’s actually acting better today than in a long time. Okay just flung my phone to catch her peeing with a ketostix and it looks negative for ketones, so I guess that’s good. Also, unfortunately I didn’t get an AMPS test today, I was late for work and she’s getting wise to the ear testing.

 

[Bron and Sheba (GA)]

Hi Maggie, can you update your spreadsheet please so I can comment on it please?
Also can you put DKA in the signature as well please.it is important that anyone helping you knows there is a history of DKA
Thanks

 

[naturalborncatter]

Hi Maggie, can you update your spreadsheet please so I can comment on it please? If

It should be up to date on the alphatrak tab of her sheet

 

[Bron and Sheba (GA)]

I can only see numbers for the 8/12 on the SS.
Also did you see the second bit I added to the above post?

 

[naturalborncatter]

I can only see numbers for the 8/12 on the SS.
Also did you see the second bit I added to the above post?

Sorry, I thought I put in yesterday's numbers. Should be up now.

 

[naturalborncatter]

Also can you put DKA in the signature as well please.it is important that anyone helping you knows there is a history of DKA
Thanks

Just as a side, they classified her as having DKA based on her high numbers. They told me she had barely any trace amounts of ketones in her blood (?) and on her discharge sheet it said "ketosis" so I really don't know if she was a severe DKA case.

 

[Bron and Sheba (GA)]

Yes I can see the SS now.
How long has she been on the 1 unit?
Are you able to get any more tests in during the cycles? It is important we can see what is happening in both cycles as she could be dropping low somewhere and bouncing up higher?
It is really good there are no ketones
Are you giving her plenty to eat with lots of snacks during the 24 hours?

 

[naturalborncatter]

Yes I can see the SS now.
How long has she been on the 1 unit?
Are you able to get any more tests in during the cycles? It is important we can see what is happening in both cycles as she could be dropping low somewhere and bouncing up higher?
It is really good there are no ketones
Are you giving her plenty to eat with lots of snacks during the 24 hours?

Unfortunately I work from 8am-6pm and don't have a long enough lunch break to come home. I should be able to do more tests tomorrow as it's my day off. My mom is home during the day and can keep an eye on her clinical signs, but she doesn't really get the seriousness of what's going on and refuses to test her for me while I'm gone. I've been meaning to try to drive home on my lunch but I've been working late into my lunches by necessity (I work at a veterinary office as an assistant) and I probably wouldn't have time even with the full hour. I'll start doing more evening tests but that won't really help me now unfortunately.

 

[naturalborncatter]

Are you giving her plenty to eat with lots of snacks during the 24 hours?

Yes she has a full "lunch" as well as small snacks throughout the day. She's a real taskmaster when it comes to food.

 

[Bron and Sheba (GA)]

Just as a side, they classified her as having DKA based on her high numbers. They told me she had barely any trace amounts of ketones in her blood (?) and on her discharge sheet it said "ketosis" so I really don't know if she was a severe DKA case.

I would still put DKA in her signature. Ketosis is DKA really……some cats get it worse than others. It’s not just the ketones in the blood. It is what happens to the electrolytes in the blood as well. The treatment is the same when you get home and ketones need monitoring.

Unfortunately I work from 8am-6pm and don't have a long enough lunch break to come home. I should be able to do more tests tomorrow as it's my day off. My mom is home during the day and can keep an eye on her clinical signs, but she doesn't really get the seriousness of what's going on and refuses to test her for me while I'm gone. I've been meaning to try to drive home on my lunch but I've been working late into my lunches by necessity (I work at a veterinary office as an assistant) and I probably wouldn't have time even with the full hour. I'll start doing more evening tests but that won't really help me now unfortunately.

if you can get several tests on the PM cycle, that would be helpful.
If your Mom can make sure she eats well, that will help a lot.

How long has she been on the 1 unit of Lantus?
The alphatrak meter always reads higher than the human meter, so the numbers look worse.
Did the vets suggest giving her some Sub Q fluids?

 

[naturalborncatter]

How long has she been on the 1 unit of Lantus?
The alphatrak meter always reads higher than the human meter, so the numbers look worse.
Did the vets suggest giving her some Sub Q fluids?

They didn't suggest sub q fluids. She's been on 1 unit twice a day since her diagnosis. I just tested her and she's at 720 now, so I just don't know if I should increase her and her shot is due in 10 mins... she seems to hit her nadirs closer to her injection time according to the vet.

 

[Bron and Sheba (GA)]

They didn't suggest sub q fluids.

Are you giving her some warm water mixed with her food to get in extra fluids?
Do you think she is dehydrated? Lift the scruff of her neck and see if it falls back quickly or slowly. Check her gums. Are they slippery or tacky?

She's been on 1 unit twice a day since her diagnosis. I just tested her and she's at 720 now, so I just don't know if I should increase her and her shot is due in 10 mins... she seems to hit her nadirs closer to her injection time according to the vet.

I would like to see some more tests in tonight before suggesting an increase in dose…….yes I think she probably does need an increase but there is very little data on the Ss to tell us if she could be bouncing. I would stick with the 1unit and get some more tests in and post and ask tomorrow.
If you can do a curve…..That is every 2 hours for 12 hours…that will give us some data.

It is very good there are no ketones. Keep testing every day and put the results in the remarks column of the SS please so we can see it easily.
I know seeing high numbers is distressing. We do need to get them down, but we need to make sure we are doing it safely. If she is acting normally and eating well and there are no ketones…that is all good news.

 

[naturalborncatter]

Are you giving her some warm water mixed with her food to get in extra fluids?
Do you think she is dehydrated? Lift the scruff of her neck and see if it falls back quickly or slowly. Check her gums. Are they slippery or tacky?




I would like to see some more tests in tonight before suggesting an increase in dose…….yes I think she probably does need an increase but there is vet little data on the Ssto tell us if she could be bouncing. I would stick with the 1unit and get some more tests in and post and ask tomorrow.
If you can do a curve…..That is every 2 hours for 12 hours…that will give us some data.

It is very good there are no ketones. Keep testing every day and put the results in the remarks column of the SS please so we can see it easily.
I know seeing high numbers is distressing. We do need to get them down, but we need to make sure we are doing it safely. If she is acting normally and eating well and there are no ketones…that is all good news.

Sounds like a plan! Gave her one unit. Yes, I've been mixing warm water in her food she's also a good drinker, less than her initial post-diagnosis days but she's in the habit of it now. She takes little drinks after each meal. How soon after the PM shot (just gave it, not a fan of the BD syringes, very stiff plungers) will I be able to see how she's responding to the insulin? I've read about 3 hrs after the feed & shoot is when the vets like to test the BG. I think I'll be up late tonight so I'll try to get a couple. She's really starting to dislike testing now that she figured out what it is.

 

[Bron and Sheba (GA)]

Yes, I've been mixing warm water in her food she's also a good drinker, less than her initial post-diagnosis days but she's in the habit of it now. She takes little drinks after each meal

That is very good. It’s important she drinks well and stays hydrated.

How soon after the PM shot (just gave it, not a fan of the BD syringes, very stiff plungers) will I be able to see how she's responding to the insulin? I've read about 3 hrs after the feed & shoot is when the vets like to test the BG

With the syringes, are you moving them up and down (with the little cap still on over the needle) to loosen it, before using?
Lantus onset’s around +2 so I would get a+2, +4, +6 and +8 if you can. With SLGS, we need to see a curve before increasing. I would set the alarm and wake up to do it…..that way, if the numbers are telling us to…..we can increase tomorrow.
I probably won’t be here for the AMPS as I live in Australia and it will be night time, so the increase will be at the PMPS.

Are you giving her treats each test?

 

[naturalborncatter]

With the syringes, are you moving them up and down (with the little cap still on over the needle) to loosen it, before using?

I am, I'm not sure what the deal is with them.

Lantus onset’s around +2 so I would get a+2, +4, +6 and +8 if you can. With SLGS, we need to see a curve before increasing. I would set the alarm and wake up to do it…..that way, if the numbers are telling us to…..we can increase tomorrow.
I probably won’t be here for the AMPS as I live in Australia and it will be night time, so the increase will be at the PMPS.

Ill get at least +2 and +4 tonight, maybe more depending how she's doing, and I'll do a full curve in the day shift tomorrow.

Are you giving her treats each test?

It's difficult, she's so food motivated that even if I hide the treat, she'll stand up and try to shove her way to the treat which obviously makes testing much more difficult. I'm trying to give her treats after we're done though but I'm not sure she correlates them.

 

[Bron and Sheba (GA)]

difficult, she's so food motivated that even if I hide the treat, she'll stand up and try to shove her way to the treat which obviously makes testing much more difficult. I'm trying to give her treats after we're done though but I'm not sure she correlates them.

You are very lucky she is so food motivated. Many people struggle because their cats won’t eat.
Let her have the treat as you do the test….that’s fine…..it will distract her.