Help! My cat was just diagnosed and I am freaked out!

Status
Not open for further replies.
jacereske

jacereske

Member Since 2014
Eve went into the hospital Thursday morning. She was diagnosed with DKA and a UTI. We almost lost her Thursday night but thankfully they saved her and we brought her home yesterday (Sunday) morning. She is on a special diet now canned food only - we're trying both Hill's m/d and Purina d/m. Right now she is only getting insulin once a day but that will probably change in a day or two and she'll be getting 2 a day. Her vet is coming tomorrow and will bring the testing kit.

I'm freaked out about giving the shots. What if I hit a vessel, what if I hit muscle, what if it comes through the other side and I don't get enough in??

Also, I gave her a 1/4 of a can of the Purina this morning and she only ate 1/2 of that. Is that enough to still give her the insulin? Should I leave the rest out for her to graze or try giving it to her mid-day? The recommendation is 2 meals a day 12 hours apart but I worry that she won't get enough to eat.

Heeeeelllpppp!!
 
I knowmthis is scary and overwhelming but we will try to help.

First, what kind of insulin? Insulin in cats need to be given every 12 hours twice daily. (their metabolisms are faster than dogs) so I am wondering about the once a day direction from the vet. We urge new diabetics to start low (.5 to one unit of insulin twice daily) and go slow (increasing the insulin in small increments as hometesting dictates). It may be that your vet wants to start with a little higher dose because of the DKA.

Lots of cats won't eat the Purina DM. (I am assuming it's the wet variety). It's mainly liver and they don't like the taste. Maybe add a little warm water and make a gravy and see if it is more appealing for her. Most of us feed Friskies or Fancy Feast pates. You might try some of those. What was she eating before? If dry food, you can crumble up some of that and put it on top. Is there something she likes to eat - tuna packed in water or chicken? Sometimes they will eat meat baby food (beechnut is a good one, without spices or salt)

Yes, I would leave the food out for her. You want her to keep eating.
 
Thank you for your reply.

The insulin is Lantus. I think we will be going to 2 injections a day tomorrow after her vet comes to see her and we test her. The once a day was the instructions from the hospital not her vet. I think the reason the hospital discharged with those directions is that her BG was coming down a bit lower than they wanted when they gave her 2. And they knew her vet would be coming to see her within a day or 2 and that we would start the home testing then.

She was a good eater before she got sick. She didn't like a lot of different things but what she did like, she really liked. She ate Felidae (grain free) dry 3 times a day and Tiki Cat Ahi tuna. But she started getting fussy and now I know it is because she was sick. I don't want her to go back to dry. She would eat some Fancy Feast - not the pate but she did like the ones with gravy.

If I try the Fancy Feast how much should I feed her?

She does not like any people food at all - even tuna.
 
I'd give her a can and see how much she eats. (there is a formula for how much to feed, but since she has had DKA, I would just see she eats for now). If she likes the gravy type Fancy Feast, I'd definitely add warm water to the pate and make a gravy.

Glad it's 2 times daily. And it sounds like your vet will help you learn to home test. That's fantastic. If money is tight, you don't have to buy the pet meter (if that is what the vet has). Most of us use human meters because the meter and strips are less expensive and readily available in drug stores. Since you won't start with testing till tomorrow, you could get her acclimated today. Pick a spot where you will test (blanket or towel on the floor, couch, bed or counter). Take her there and mess with her ears, give her lots of praise and a treat (is there one she likes?) and let her go. Then add warming her ears (you can use a lightweight sock filled with raw rice and heated in microwave until very warm or a prescription bottle filled with very warm water.), praise, treat and let her go. When the vet comes, take her to the same spot, lots of praise and treat after.

Breathe. :mrgreen: You are doing all the right stuff for her - good insulin, wet low carb and hometesting.
 
I just posted this on another thread, so I thought it would be helpful to you as well. The "prescription" cat food that the vet recommended is higher in carbs then what you were previously feeding...


I just wanted to share my story with you to help you feel encouraged.

My cat Skipper went to the vet on December 19, 2013 very close to death. He had diabetic Ketoacidosis. He didn't get to come home until Christmas Day. There were several times during that extremely expensive stay that I wondered if I was doing the right thing trying to save him. The vet was never able to get his BG into low numbers, but then they were feeding him a prescription cat food that was 26% carbs! The day he came home his BG was in the 500's and they had given him 3 units of Prozinc. While he was at the vet, I found this message board. So before he came home, I was armed with low carb food (we started out with Fancy Feast), testing strips, lancets and a meter. The vet did encourage home testing, but maybe not to the extent that I planned on doing it.

I wasn't that great at testing at first but I got better. Sometimes he still gets mad at me but he snuggles with me later so all is well. Skipper loves PureBites freeze dried shrimp cat treats for his reward. I basically tested 3 times per day and set up a protocol of dosage based on others charts, and help from people on the PZI message board. Check out Skipper's chart.

So here we are now 7 1/2 weeks later and Skipper is off insulin and diet controlled. The important thing for us is that we keep contraband out of his reach...crackers, popcorn, and pizza crust. We also need to make sure that he is fed at regular intervals. This can be tough when you have things to do, so I am looking into getting some timed wet food feeders. Skipper is very sensitive to carbs. I find that even the Friskies Mixed Grill is too high for him so we stick with Turkey and Giblets and a few Poultry platter because Walmart doesn't usually have enough Turkey and giblets. I buy the big size cans and store in the refrigerator until used up which isn't long since we have 3 cats. I switched all our cats to the same food and feeding schedule. They all did great and look healthier. It amazes me how they do not need much water now that they are off the dry food. They use to drink a ton.

Hang in there! You can do this. It is not as hard and overwhelming as it seems. You definitely do not need to be paying a vet to test your cat and change your dose. We were told that we would have to go back to the vet and pay for a curve around $284.00 (this is after a $1387 bill from his stay), but we never did. It wasn't necessary. He hasn't been back to the vet since. I do text the vet occasionally and let her know how he is doing. Oh, and I bought my needles from American Diabetes wholesale and they came with a disposal container. I use the ReliOn Ultima meter and the lancet thing that came with it. I also have a Onetouch Delica lancet system which I like better but the lancets are really expensive."

Rae Ann
 
Thank you both for your responses. I'm so happy your Skipper is in remission!!

A little background - things in our kitty household have been very challenging this past year. Our Sugar was diagnosed with mammary cancer in Jan. 2013, had a unilateral mastectomy, then a lumpectomy 3 months later for a local recurrence. She finished her fifth and final chemo in August. At the end of that month our Chai was diagnosed with small cell GI lymphoma. She was responding well to chemo and pred but in December her liver enzymes were sky-high and we finally got that resolved by changing her to a new steroid last Monday. Then just 3 days later Evie went into the hospital with DKA and almost died. So I'm pretty frazzled right now.

That said, I know that I need to get a grip and not let fear motivate me. I also know what I need to do is educate myself. I'm just so worried that I'm going to do something to make Evie worse rather than help her.

She seems to like the d/m OK - when she starts eating it she really chows down. It's just that she stops before she has finished 1/4 can. So I'm not sure whether to keep her on that or switch to Fancy Feast. I might try as you suggested and thin down the d/m with some water to make it more like a gravy. Maybe I will try that around lunch time. She is on a potassium supplement that I mix in her food, so I really do need her to eat it.

Money is not an issue. We have pet insurance and we can afford whatever Evie needs in the way of food or supplies. I am humbly grateful to be able to say that.
 
Hey sugarsweetie Eve and poor stressed out Eve's mommy!

Theo was in this almost exact same situation on January 24th. He went into the hospital desperately near death with DKA, an infection, and stupidly high BG. He'd never had diabetes before. He went from being a 15.8 lb cat to barely over 12 lbs and he wouldn't eat for 3 days straight. Even when I took him home, his BG was in the 500 range. We had such a fight with his electrolytes we couldn't start an intensive fight against his diabetes at first. He was so weak and looked so starved it broke my heart to look at him. I really doubted my vet's advice when she said to feed him twice a day with such small amounts of food... But I gave him half a 5.5 ounce can in the morning and the rest at night, with a 3 ounce can left out all day, watered down for his nibbling joys...

Here was him the first night I took him home, so tiny and pathetic:

09qF4mS.jpg


Annnd here he was last night:

By5RDgp.jpg


Insisting mommy stop writing her paper and go to BED!

LuV9hAo.jpg


It's a little hard to see, but he's already back to being a fine, healthy fellow. :-D
 
The DM us only 3% carbs unless it is the savory selects. Those are 10% which would be too high for my cat. So if your cat lines the DM and you don't mind paying for it, then it seems like a fine option.
 
Thank you Theo's Mom - he looks wonderful!

Would Theo eat 1/2 can of the 5.5 oz size? Eve ate about 1/4 can last night and only about 1/8 this morning.
 
Would Theo eat 1/2 can of the 5.5 oz size? Eve ate about 1/4 can last night and only about 1/8 this morning.
Click to expand...

Not at first! At first I had to hand feed him small amounts of wet food with a tongue depressor every few hours. If your Eve is eating of her own volition, I think it's a great. :) Theo's appetite built up slowly over a few days and now he's back to being a little garbage disposal - if I don't wake up on time, he opens the cupboards and helps himself to the bags of very expensive freeze dried chicken liver treats we use for blood testing. T_T Jerk.

If you can I'd try to give her many small meals during the day... If you can't, a lot of people here on the board free feed their kitties with wet food by adding extra water so it doesn't dry out. There are a few expensive, fairly low carb dry foods that you can find. Generally no dry food is going to be better for your kitty long term but when I took Theo home the vet told me with DKA the goal was just to get him to eat. Eat... anything. The blood glucose could be better controlled once he wasn't starving. I went home from the vet with a baggie of the Purina D/M dry food and every few hours I'd hand feed him a few kibbles. I dunno if it helped much, but it made me feel like I was doing something and he thinks anything in mommy's hands is a treat. xD Ridiculously easy to pill that cat.
 
Free feeding is difficult because we have 3 other cats and they will eat her food if I leave it out.

Before she got sick Eve ate dry food 3x a day and wet food twice. I don't want to feed her dry food and we don't have to free feed - my husband has his own business is and is home a lot during the day. Plus my sister lives in our downstairs in-law unit and she is here all day. So I think I will try feeding a few the DM 3 times a day and see how that works out.

I am thinking of switching all of our cats over to wet food only.
 
Having seen Theo's turn around on the wet food, I'm a convert. It's hard to gauge how much of it is controlling his diabetes and how much is the diet change but his fur is soooo soft and sleek, a lot of his skin troubles seem to be (knock on wood) clearing up. His, um, litterbox is better too. Even allowing for the lakes that aren't getting peed, I feel like the volume of waste is lower and it doesn't smell as bad. I was just brushing my teeth this morning and realized I hadn't cleaned Theo's box last night. Or, possibly, the night before. :oops: Shame on me!

My girlfriend's talking about putting her chubby kitty on an all wet food diet, we'll see how well it treats an already healthy cat. :)
 
The 2010 AAHA Diabetes Management Guidelines for Dogs and Cats,
Published in 2010 (May/June) has this to say about feeding. You may want to print a copy to share with your vet.

##Feeding meals four times daily is ideal to prevent clinical hypoglycemia for cats on insulin. Timed feeders are useful for cats that require multiple meals per day to manage weight and control calories. Use of insulin glargine may reduce the need for timed feedings, as long as home monitoring of BG is being done. (See Insulin therapy in the cat.)

##Free-choice feeding is acceptable for underweight cats on insulin therapy.
Click to expand...

You do want to make sure your kitty has eaten enough before you give any insulin. Perhaps that is why vets say every 12 hours, to make sure they are really hungry. But, spreading out the meals helps to spread out the load on the pancreas and the need for insulin so can help to gain regulation.
 
Thanks Deb, our vet is coming today for a follow up and I will ask him about the feeding. More often seems to make sense to me but I'm new at this and still learning so much.

BTW what does OTJ mean - I couldn't find it in the glossary.

Thanks,
Jeanette
 
Hi Jeanette and extra sweet Eve!

OTJ = "Off The Juice" aka diet controlled rather than taking insulin

Couple of others are
AMPS = Morning 'Pre-shot' number
PMPS = Evening 'Pre-shot' number

WELCOME!
 
Welcome to the FDMB Jeanette and Eve!!

OTJ is "Off the Juice"...Juice being insulin. With appropriate therapy, including a low carb diet, a good insulin(Lantus) and home testing, up to 84% of newly diagnosed cats can reach OTJ (Remission) within the first 6 months and become diet controlled diabetics.

It's totally up to you if you want to use the Pet meter. The AlphaTrak is what we see most of, but almost everyone switches to human meters because of the cost. We do a lot of testing, and the AlphaTrak replacement strips are $1-$2 each! If you test 6 times a day, that's $180 to $360/month in just test strips, and they're only available at the vets...which means if you run out at 3am during a hypoglycemic episode, you're just stuck.

Most of us use the Relion meters from WalMart. They're about $15 and depending on which one you choose, the strips are $36 for 100 (Confirm or Micro), or $9 for 50 (Prime) As you can tell, that's a big difference in cost.

Keep asking questions...We're all here to help you!
 
What the test numbers mean:

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]


* * * * * * * * * * * * * * *​
How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

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.)
 
Jeanette,

Hello and welcome to the board. I just wanted to ask you if Evie is a Siamese mix? Her picture looks like my diabetic cat Lilly(GA). She is a very pretty girl.
Sounds like you sure have been through a lot with all your kitties lately. Sounds like you have a good vet on board if they are willing to come to the house.
Hope Evie is eating well today and feeling good.

Terri
 
Thanks everyone for your kind posts.

Terri, Evie is a Siamese mix, a Lynx Point. She is a beautiful little girl and she is blind - not related to the diabetes - she was blind when we adopted her 3 1/2 years ago. She was very close to being put to sleep because no one wanted to adopt a blind kitty and I found her on the internet. She looked just like my Chai and I had to save her.

I am getting less freaked out. This morning I put on my big girl panties, went for my morning walk and came home and gave my first insulin injection. I was nervous but it went very well.

Around 10:30 our vet arrived and we got our lessons on the Alpha Trak. Eve was at 200 BG while he was here. I tested her tonight and she was at 250 BG. Our vet told us not to give insulin tonight if she was below 350, so no shot tonight. We will test again tomorrow morning.

Thankfully we have good insurance and they may pay for the Alpha Trak and the supplies. If not, we can handle the cost so I think we will stay with it for now.

Thank you again everyone.
 
Jeanette,

It puzzles me why your vet would tell you not to give Evie her shot if she is below 350. That puts her at risk of ketones again. I am going to ask for help from the Lantus forum for you and Evie. The people on that forum have been using Lantus for years and many of their kitties are also DKA survivors.

Terri
 
Jeanette,

Hi! I don't have any experience with DKA but wanted to pop over and say hello! My mom adopted a deaf cat about six years ago and she too was at risk of being out down because no one wanted a deaf cat either. She is such a sweetheart, and unlike most cats, loves the vaccuum cleaner!

I'm also curious why your vet would say not to shoot under 350. Lantus is a depot insulin so it is highly unlikely that it would drop Evie's BG that quickly unless she is really sensitive to it. It works best shot every 12 hours. Also, as Terri said, it puts her at risk of ketones again. If you get a chance, I'm sure we'd all like to know his reasoning behind that!

Our no shoot number is 200 for new members. But it's because people on the board will stay with you to make sure everything is ok when shooting at or below that number, until you know how your cat will react to the insulin.

Good luck. You are in good hands with the people in LantusLand!

~Suzanne
 
What dose did you give?

The estimated starting dose is based on :
The lower of current weight or ideal weight
In kilos (pounds divided by 2.2)
Multiplied by 0.25
Rounded down to the nearest quarter unit for safety.

If you look at the previously posted chart,you'll see that 350 mg/dL on any meter is considered too high. I would strongly encourage you to reconsider the vet's no shot advice, and give a modest amount of insulin, either based on the dose formula above, or start low with 0.5 units and hold that dose for 3 days. Normal glucose levels for a cat using an AlphaTrak range from about 80 to 150 mg/dL. Not giving insulin puts your cat at risk for diabetic ketoacidosis and/or hepatic lipidosis; both are conditions which may be fatal and are expensife to treat.
 
Terri asked a few of us who are denizens of the Lantus Board to stop by. I'm scratching my head about your vet's instructions, as well. We typically suggest that if you are new to using Lantus that you post and ask for help if you get a pre-shot numbers of 150 or lower. (This board uses 200 as the ask for help number.) There are a couple of reasons why I'm curious as to your vet's reasoning. As others noted, skipping a shot when a cat is in high numbers, especially a cat that is post-DKA, is increasing the risk for ketones developing again. It also leaves your cat in high numbers for at least one cycle (12 hours) where the numbers are clearly above renal threshold. Diabetes is hard on the kidneys so we all do what we can to keep our cats in numbers below (roughly) 200.

Vets are notorious for wanting to keep cats in numbers that are higher than what we would consider "tightly regulated." Many vets, unlike yours, discourage home testing. If you test at home, you are able to monitor and keep a good watch to make sure numbers don't drop dangerously low. This is what vets fear and are often concerned that they would be at risk for malpractice. As long as you have your glucometer and food to steer the numbers, you are in control.

You might want to take a look at the starred sticky notes at the top of the Lantus board. The information there will help you to better understand how Lantus works, what the Tight Regulation Protocol is all about, etc. Here are the links:

  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

Please let us know how we can be of help.
 
Thank you all for the info - I am new at this so I don't know what my vet is thinking. I do consider consider him to be a good vet and he has a very good reputation. I think he is trying to see where she is at because her body is still equiliberating. But I'm lost and on information overload.

She was at 396 this morning so we gave her 1 unit.

I've contacted our vet to see what I should do with her 7 PM reading.

Jeanette
 
Jeanette, even the best vet can't keep up on the latest, best treatments for every disease in every animal they see. It's almost impossible! The people here deal with nothing other than feline diabetes and the diseases that come with it, so you won't get any better advice anywhere! There's no such thing as a vet that specializes in diabetes either.

Our number 1 rule is to keep kitty safe, so we'll never risk Evie's safety. 1 unit every 12 hours is a good starting point.

It would help us (and once you learn more about it, you too) if you'll get a spreadsheet up and published so we can follow along with you during her treatment. This way we can help advise you on what you need to do as far as increasing or decreasing the insulin. Here's our How to get a spreadsheet directions. This is a very valuable tool and once set up, very easy to keep up with. If you have problems with it, let us know. We have people who can help you get it started if you need help!

The other nice thing about the spreadsheet is that if your vet wants to keep an eye on her, you can share the link to it with them and they can look anytime they want to.

Good luck to you both, and we look forward to working with you! We understand the learning curve here is steep, but we'll all be here to help you learn it!
 
Hi Jeanette:

I just wanted to add my welcome. My kitty, Cinco, is also blind. He contracted a Bartonella infection, which led to glaucoma, and before we caught it, his optic nerve was irreparably damaged. This has all taken place over the past few months, so we are all, including Cinco, getting used to having a blind kitty.

Cinco was near death, with a BG so high the glucometer couldn't even read it, severe dehydration, and dka when we took him in to the vet (he was a stray I'd been feeding in our yard) in July of 2011. After a few days of treatment he only got worse and the vet suggested we euthanize him. But Cinco didn't want to die, so we kept fighting. I found the board through a friend who had a diabetic cat, and although I was reluctant to go against what my vet said, I followed the suggestions of the people on the Lantus board. They saved Cinco's life. He went OTJ two months later. He came out of remission a year after that, but as mentioned above, there are other factors at work with him. We are getting him back under control, and I thank God every day for the FDMB.

I know it's a huge leap of faith to trust a bunch of people you don't know, especially when what they are telling you differs from what your trusted vet says, but I urge you to consider everything that you read here. Feel free to discuss it all with your vet. Only you can decide what to do, but I can assure you that the people on the board know what they are talking about, and there will always be someone available to answer questions and hold your hand. Most of us have an attachment at the bottom of every post, usually described as a profile (mine is Cinco's Story), and it tells you about their cat and how they got to where they are now with FD. Read a few and you'll see you're in good company. I was horribly overwhelmed at first, too, but I printed out some of the starred posts at the top of the Lantus board and reread them over and over (I still do) until it started to sink in.

I wish you good luck with Evie, and your other kitties as well (many of us also have other cats with special needs - I have three others). I hope you will become a part of our Lantus family and let us help you. :-D
 
I'm one of the biggest worry warts here and my cat was diagnosed last Friday. If you read my thread there is so much info and I ask so many stupid questions lol.

I was really worried and thought I would fail, but I started giving insulin Monday and wow it isn't bad at all.

I'm very new so im probably the last person to listen to but if you read my thread there is very good information that is easy to read and will make you feel better im sure.

Wease's Original Post
 
Thanks again everyone. I really appreciate the help and support.

I have started a spreadsheet - one my vet sent me and I'm attaching it to this message. There isn't much on it since we just started monitoring on Tuesday.

Background: Evie came home from the hospital on Sunday, with instructions for one shot a day (they knew we would be seeing our vet in a day or two and get our monitor and her BG was going a little lower than they liked with a second shot). So she had a shot at 8 am Monday morning, then one at 8 am Tuesday morning.

Our vet came Tuesday around 10:30 so we did our first BG at 11 am. The first reading was around 200 (sorry I did not write it down). Our vet seemed a bit surprised that it was that low. On Tuesday night her BG was 250 so she did not have a shot.

Yesterday at 7 am her BG was 396 so she was fed and had her shot (1 U). Last night at 7 pm her BG was 160 so we re-tested and got 143, so no shot. She ate and at 9 pm we tested and her BG was 402. I have not tested her yet this morning.

This is not quite what I expected. Our vet told me there is a very small percentage of cats that only need insulin once a day. Could she be one of those cats?

Or could she be going into remission??

I would appreciate your thoughts on these numbers so far. Thank you!
 

Attachments

Lantus works best when it's given twice a day. So you want to find a dose that can be shot every 12 hours. If she only needs 1 unit a day, you'd want to split that dose into two and give .5unit twice a day. The goal is to keep her low all 24 hours, not just 12 hours. Lantus' dose is also based on the nadir, not the higher preshot numbers. You aren't shooting for what Evie's is at, you're shooting for what she will be at.

You also want her numbers lower than they are. Most vets attempt regulation, not remission. 160 and 143 are shootable numbers, once you have the data and knows how your cat reacts to the insulin. Lantus can create a nice flat curve, which is great for a cat's pancreas. Since her numbers are in the higher 300s, she's not in remission yet.

Stick with it! The people here have a ton of experience. Feline diabetes is all they do!

~Suzanne
 
Thanks Suzanne! We are slowly getting it figured out. I'll be glad when we have some numbers to work with and can get her regulated.
 
She was at 452 this morning at 7 am so we gave her one unit after feeding.

I should mention that she also has a UTI right now and is taking Amoxicillin. Not sure if that has any bearing.

Thanks everyone.
 
Jeanette,

Yes the UTI could cause her BG to be higher. I agree with Suzanne you might want to drop to .5 units twice a day and see where her numbers go from there. Lantus works bets given every twelve hours. I sure do hope her numbers start to even out soon.
How much does Evie weigh?

Terri
 
Hi Jeanette!

We'd sure appreciate if you'd use the spreadsheet we have put together. It automatically color codes the cells depending on the test results, and when deciding on dose, it's more important to watch for "patterns", than it is the exact numbers.

Also, the one you have requires people to have Excel, and not everyone does. If your vet wants to follow along, you can give the link to our spreadsheet and anytime they want to look, it'll be there!

As others have already said, Lantus requires twice daily injections for the best chance at obtaining remission. We try very hard to get kitties OTJ,(off the juice) not just controlled, and the protocol we use has been proven to get up to 84% of new diabetics OTJ within the first 6 months. Not all cats will be able to go OTJ, but we want Eve to get the best chance she has!

Keep asking questions if you have any. We really only want the best for your extra sweet Eve!
 
Here you go Jeanette!

How to get your spreadsheet

It's a Google spreadsheet, so if you don't already have a Google account, you'll have to get one, but then it's really easy to use. If you want to see what they look like, China's spreadsheet link is included in my signature box below.
 
Thank you Chris. I have a Google account so I will do this now.

Right now can you give me some guidance? Eve tested even lower tonight 87 and 94 (re-test). We didn't give her a shot and fed her and tested again 2 hours later and she was at 217. I am looking at this trend of it getting lower at night and higher in the morning and it worries me. I'm not sure what to do tomorrow morning.

I've attached an updated Excel spreadsheet - can you look at it? I will get the Google one up and running as soon as I can.

thanks,
Jeanette
 

Attachments

Sorry, I can't open Excel since I don't have the program on this computer.

Good decision not to shoot! We recommend a "no shot" limit of 200 on this board. As you get more experience and more tests, that limit drops to 150...and eventually much lower, but it's too soon in Evie's journey to worry about that part.

Most cats do go lower at night though, but what I think might be going on is that you need to be giving shots every 12 hours instead of once/day. Lantus does best with every 12hr dosing.

If you get an AMPS (AM Pre-shot) test that's over 200, why don't you go ahead and try giving .5 unit and then 12 hours later, at PMPS, give another .5 unit and lets see how she does.

If at all possible, get at LEAST a test somewhere between +5 and +7 (5 hours to 7 hours after the AM shot) and at LEAST a "before bed" test on the PM cycle. Lantus dosing is based on the nadir (the lowest point in the cycle) NOT the pre-shot tests, so it's important to get those tests during the cycles. We need to see how far down the .5 dose is taking her. If it's possible, get tests even more often. There's no such thing as too much data, and the data you collect will help to show you how she's really doing as well as tell us if she needs more or less insulin.

Also, when you first start Lantus, it takes 5-7 days (10-14 cycles) to "fill the depot". Each time you shoot, some of the insulin goes to work, and the rest of it goes "in the depot". That's how Lantus works and can give more gentle control that some of the other insulins. A rough example would be something like this: You give 1 unit, .75 goes to work, .25 goes "in the depot". Next shot, .75 goes to work, .25 goes "in the depot", etc. etc.....after several more shots, the depot is "full", so you start to get the full benefit of a 1 unit dose as the depot starts to "release" it's stored insulin.

Right now, since you haven't been giving it every 12 hours, there's just no way to tell how well it's doing.

Remember, Evie didn't get diabetes overnight. It will take time to get her regulated, but the protocol we use gives her the best possible chance of getting into remission. We have a saying here "Better to be too high for a day, than too low for a minute".....High numbers do their damage slowly. Low numbers kill quickly.

We all look forward to helping you.
 
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.
 
OK I've got her SS posted in my signature. I haven't done today's BG but will in a few minutes and will add it when I do.

I heard from her vet - I sent him her PMPS for last night and he still wants us to keep with 1 U until we get more data even if it means only once a day for now. I don't know why and it's 6:30 am so I can't call him. But I'm really afraid to do that because her numbers went so low last night and I won't be here to watch her today.

I plan to do a curve tomorrow. I work full time so getting those mid-day numbers is not something I can do today, I wish I could. I will have Sat - Tues off so I will be able to be more attentive for those 4 days.

thanks,
Jeanette
 
Jeanette,

A lot of people work full-time on here. We understand that. Grab the tests you can.

I know I'm curious why your vet is stuck on the 1 unit once a day. It isn't good for Evie to bounce around...too low to shoot at night, really high in the morning. Her pancreas is having to work hard during those extra hours. A lower dose, but every 12 hours will help with that! A lot of us have had experiences with our vets telling us one thing, and us doing another because of the guidance we've gotten here. Personally, if I had listened to my vet, Cobb would still be on dry food and his numbers in the 500/600 range. I was very hesitant to do anything the vet didn't tell me to.

Lantus is a good insulin, but it only lasts 12 hours in a cat's body. Some people only have to use it once a day, but cats are different. A lot of people have had great success with the tight protocol that's posted on the Lantus page, and a lot of cats have gone OTJ because of it!

A lot of times you have to trust your gut when making these dosing decisions. You said you're afraid to keep her on the one unit of day because her numbers went so low. Cutting the dose in half and giving it twice a day might be exact what she needs. It could keep her numbers in a low, safe range thought the entire 24-hour period.

I look forward to seeing where she is this morning. You've got the home testing down, which is great!

~Suzanne
 
I don't think our vet intends for her to stay on 1 shot a day or necessarily 1 U per day. I think for now he is just trying to see how her body reacts to the insulin. Here is how he responded when I asked if we should go down to 1/2 unit per day:

More values would help to answer whether we should go down to ½ a unit…
But I wouldn’t necc. do twice a day yet, till we seem more values, ie: a glucose curve…

This is a hard place to be in right now - our vet saying one thing and people like you with a lot of practical experience saying another. Also, it is not just my decision - I am married and my husband has a say as well.

Not my happiest of Valentine's Days but hoping it will get better.

thanks,
Jeanette
 
Hi again Jeanette and extra sweet Eve!

On the spreadsheet, you need to change the privacy settings so we can see it. Go to the top right where it says "Share", and click. A pop up will come up with "Sharing settings". Under "Who has access", change it to "Anyone who has the link can view", and click "Done"

You may have saved Eve's life last night by listening to your instincts. Giving a unit of Lantus when her pre-shot test was 87 could have been tragic...BUT, once you have enough data to know how she reacts to both insulin and food will allow you to give insulin safely at those lower numbers! We call it "shooting low to stay low", and it's very effective, but it's way too soon for you to be trying that.

Your vet, who you might trust implicitly, just doesn't understand how to treat feline diabetes in the most safe and effective way. Look through the message board. You'll see a LOT of other people who are here ....and almost all of them thought their vet was a good one before the diabetes diagnosis. Many of them came here when their vet prescribed too much insulin and they came here when their cat was in a hypoglycemic crisis. Others came here after trying to follow their vets instructions, and still having numbers that were horribly high (Suzanne and Cobb are one example of that) Others got the diagnosis and just wanted to learn more about treating it and found a great group of people willing to explain the why's, what's and when's of this disease and somehow making it a little less scary. The people here do what they do to "pay forward" the kindness they were shown when they first came here and were scared, confused and overwhelmed. You'll find someone here pretty much 24/7 to help you, we don't charge a dime, and we'll do our best to keep Eve safe, as well as getting her regulated..if not in total remission.

We take the responsibility of advising others very seriously. We have a strict rule that nobody is to give advice "in private" (like using PM's or emails) so that everything we tell you is peer reviewed. The people here have 10's of thousands of hours of experience treating feline diabetes and the diseases that come with it. There's just no other resource like it. As much as we may trust our vets, they just can't keep up to date on the latest treatments for every disease, for every type of animal they may see.

The fact that Eve has already had an episode of DKA makes it even more important to get her numbers under control, keep her eating, and getting her UTI cleared up. There are a lot of people here who've been where you are and know how to help.

It would be helpful for you to add the information that she's been in DKA to your signature box, along with any other health issues she might have. It's very important that the people here know that she's been through it once when they help to advise you. The recipe for DKA is "not enough insulin+not enough food+infection", so we want to make sure she's getting all 3 issues dealt with.

We totally understand that there's a lot of information being tossed at you quickly, and it's easy to become overwhelmed. Don't be afraid to tell us to slow down! The learning curve here is steep, but you've got all of us to help you climb that mountain, and Eve will have gained a lot of new aunties, uncles and fur-friends along the way.

Edited to Add: You might want to share this with your vet. It's a published paper on the TR Protocol by Roomp/Rand Tight Regulation Protocol
 
Jeanette,

I am sorry but your vet is just plain wrong about the dosing, that the cat should be dosed once a day. Even humans are not dosed once a day. Go over to the Lantus board and read through the posts. Pull any of their spreadsheets up, no one here is dosing their cats once a day. That's why her BG number are so crazy.
Why not call around to a couple other vets in your town and ask them if they have any clients with feline diabetes and if they are familiar with it and how they are dosing their cats. Or even better if you have a teaching university nearby with a vet hospital maybe call them and ask them.
My Lilly was first diagnosed my vet had her dose way to high, if I would have listened to her, my own cat would had a hypo. Please don`t listen to just one vet, make a couple calls and get some more information and do a little research on here if you will.

Terri
 
Great Jeanette! Now we can all see it!

I will once again urge you to go to .5 and give it every 12 hours. It looks like 1 unit is taking her too low (and possibly even into hypo territory) and then she's bouncing back high again. "Bounces" happen when the blood glucose numbers drop either too low, or lower than the cat is "used to" and the liver thinks it's an emergency and floods the bloodstream with hormones and sugars to bring it back up fast.

It's "survival mode" left over from when cats lived in the wild...if their blood glucose was too low, those hormones and sugars released by the liver kept the cat alive. With our diabetic cats, their body has become "used to" high numbers, so even bringing their glucose down into "Normal" seems wrong to their liver now. As they get better regulated, the liver will calm down some. It's a matter of getting them used to being in normal numbers again.

If your vet wants you to give 1 unit, you'd still be giving what he wants, just half in the morning, and half at night. It might very well keep her numbers looking better without the extremes you're seeing now.

If Eve is above 200 tonight at PMPS time, I'd try the .5 unit and get a test in before you go to bed. Depending on what the result of that test is, you may want to set an alarm to get up for another test, or go on to bed knowing she should be safe for you through the night so you can sleep better.

If she's under 200 at PMPS, please "Stall", DON'T feed, and post and ask for help. To make sure we see it, edit the subject line in your FIRST post so when we're scanning the forums, we'll see it say something like "Stalling, advice needed" and someone with experience can help advise you. One thing we can promise, if one of us starts advising you during the times when Eve might be going too low, we won't leave you until you're comfortable and Eve is totally safe.
 
Status
Not open for further replies.
Back
Top