Help Please - Nothing Works!

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Haptowns

Member Since 2012
Am now in full panic mode about my 12 year old cat.

He was 10 when diagnosed with diabetes in Nov. 2010. He was put on Prozinc insulin and strictly Fancy Feast food under 10% carbs and no gluten (mostly Classic). In April 2011 he went into remission which lasted until Jan. 2012.

2012 was a nightmare. He was put on Glargine and his doses have been from 1 to 4 at various times of the year. I have had him into the vet every single week this year for a check. His glucose was up and down with some short term regulation in the summer, but this fall everything went crazy.

In Sept. he was keotonic, had to be put on fluids for several days at the vet, that followed with me bringing him in several times a week for fluids. During this time we switched him back to Prozinc insulin but that didn’t help so he’s back on the Glargine.

Then he got an upper respiratory infection (which spread to my other 3 cats) and was back in the hospital on fluids, antibiotics, shot and Orbax. He was so sick for 3 weeks I had to force feed him to give him the insulin. During that time he started losing fur on his back end near the tail, it’s all bare. My thick gray kitty is now skinny with thinning hair and some bald spots. Vet thought that was just him pulling his fur (as he does on his stomach) but it was rashy. Eventually she gave him an antibiotic shot for that (which seems to be the answer for “everything.”) Didn’t help.

Because we were practically living at the vet, she said we could start testing him at home so we bought a home testing unit which is painful (for us and the cat). We puncture his pads on his feet for the blood and it kills me every time. Did it twice a day for quite awhile until I realized the test strips are $1 each and sometimes we would use 4 trying to get it. His sugar is all over the place, cannot regulate him. It can go from 50 to 450 in a day. There has to be some other answers but I can’t find them. He’s still on Fancy Feast. I read on here you could feed Friskies Special Diet, some flavors and tried that but today was his highest ever reading, 573.

Needless to say this is breaking the bank. My husband is 70 and needs to retire, but we can’t retire and keep up these vet and food expenses. I have 4 cats, 3 dogs, most are on special diets and 4 are on daily meds. I have to feed all cats Fancy Feast so the diabetic one doesn’t by chance get something that’s not good for him. I need my kitty to feel better!

If anyone at all can shed some light on solutions, I would be grateful.
 
Hello,

Oh, poor you, it sounds like you've been having a truly terrible time... :sad:

You say that you've been testing your cat's blood glucose at home and he's going from "50 to 450" in a day..? Well, it's a possibility that your cat has been dropping lower than is comfortable for him and then swinging up into high blood glucose as a sort of 'safety mechanism' (it's called 'rebound'). This may not be what's happening with your kitty but it is possible, and if it is rebound then it can certainly be resolved.

Can I ask...why are you using the cats paws to get blood from? Most of us here use the outer edge of the ear. Did your cat not tolerate that?

Oh, and welcome to FDMB!
 
Hi and welcome to FDMB,

It sounds like you have had a rough year. Take a deep breath, you have found the best resourse of information for your extra sweet kitty.

Lantus is an excellent insulin. We have a Lantus Insulin Support Group, at the top of their page they have sticky notes with great information about the Tight Regulation Protocol. That will be a great place to start.

Wow all those vet visits would break the bank. First off you can go to Walmart and buy a human glucose meter, Relion Confirm, Micro or Prime for under $15.00 dollars, the test strips are anywhere from $9 to $20 for 50 strips, the Prime are the least expensive.

Good for you for home testing, most of us here test the kitties ear, there are videos on You Tube showing you how to do it. Be sure to give a treat after every test and the kitty will associate the testing with the treats and will come running for a test and treat whenever it is time.

Sorry, I'm on my phone or I would link everything for you but someone else will be by shortly and do that.

Remember to breath.
 
My first thought would be to get a cheaper glucose meter. The Relion brand from Walmart ore very popular here, and inexpensive to operate. You can pick up the Relion Confirm Meter for around $15 and then get a box of 100 test strips for about $36. MUCH much better than $1 a strip! If online is more your style, The Arkray Glucocard 01 is supposed to be identical (and I think it uses the same strips). I shop online at Amercian Diabetes Wholesale - they have a little banner up above the forum and if you click through from here FMDB gets a little money back.

With the Relion and the Arkray, you only need a small drop of blood to test and you can test from their ears (instead of their feet). I ear test and it's pretty easy (with a little practice). The skin is a lot thinner so I think it would be easier to get blood. There's a learning curve, but it's not really hard. Treats help. My Chester comes running when I call him for testing because he knows that there's going to be a treat involved.

The fancy feast should be fine...What dose of lantus/glargine is your cat on now? It sounds to me like he might be "bouncing". That's what they call it when a cat's BG gets low and then the body overcompensates and sends it back high. There are people here far more knowledgeable than I am, and I'm sure they'll be along soon.
 
I have read that you test on the ear, the vet has never done that. That sounds very painful to kitty and can't quite picture how you do it without puncturing yourself. I will look at the videos.
 
I've been testing and dosing my Dusty for just over a month. I, too, was worried about the pain in her ears with testing. And there have been a couple of times that I have ended up bruising the ear from my forgetfulness/clumsiness. But usually Dusty doesn't really even notice that I'm drawing blood from her ear. There are various tips and tricks to make it easier (warming the ear, using a cotton ball/kleenex behind the ear, pressing both sides of the ear after drawing blood, etc). And giving a treat each time so that the cat associates test time with treat time is very helpful.

I'm so sorry you've had a rough year with your cat. I hope things get easier this year and you're able to get him regulated and back on the road to health.
 
Ear testing is actually quite painless, much easier than paw pad. I use a lancet pen that does it for me and it is super easy.

I know this has been a rough go, but testing frequently and sticking with a dose for awhile will make things so much easier for you :( I am afraid that you've been doing the equivalent of chasing your tail.

You need to be methodical. You need one insulin, one dose, consistent food and hometesting....just like a science experiment. Keep everything consistent for a few days and see what his blood glucose levels do and then figure out where to go from there with help from this message board.

What food is he eating now? the rash makes me suspect an allergen of some sort
 
He eats Fancy Feast, and I have just this past week given him some Friskies Special Diet, beef and chicken. If anyone has food suggestions that are cheaper than Fancy Feast I would appreciate that also because I am using 8 cans a day. I have 3 other cats, but he eats most of it. And by the way, his name is Freebie. Thanks for continuing to give me advice.
 
I assume if the strips are $1 each, you are using the AlpahTrak2? If so, 50 definitely is way too low, and I agree with the others that kitty's system is bouncing in an attempt to overregulate (the AlphaTrak low is 80, human meters is 50).

My cat was having a similar issue with attempting to regulate, and I knocked down her dosage down by .25U (the vet recommended 1.5 BID, now it's 1.25 BID). It helped quite a bit.

For my cat's CKD, I just started giving her Coenzyme Q10 (which might also be good for your kitty's hair loss), and one of the benefits is it is known to help regulate glucose. Since starting it, my cat's numbers have really leveled. Please ask your vet if that's worth a try as well as knocking down the insulin dosage a bit.

DZ and Sarah
 
Frugal Feline Diabetes tips: http://binkyspage.tripod.com/frugal.html


Haptowns said:
He eats Fancy Feast, and I have just this past week given him some Friskies Special Diet, beef and chicken. If anyone has food suggestions that are cheaper than Fancy Feast I would appreciate that also because I am using 8 cans a day. I have 3 other cats, but he eats most of it
Click to expand...

Those little 3oz cans add up in cost over time, especially with a diabetic who may need 4 or more cans per day. One suggestion is to buy a brand that comes in larger sized cans, like 5 oz or even 12 oz. That's more economical, especially for multi-cat households. Have you tried Wellness? That is available in large can sizes and pretty affordable. Petco often has it on sale. Other small chain pet stores like Pet Supplies Plus may sell Wellness. There is a Friskies variety that is available in a 12 oz can size. I'm not sure which one it is, though.

Here are printable food shopping lists:
Dr. Lynne's Wet Food list
List of low carb gluten free Fancy Feast
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=84885
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=81687
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=84512

Here are the more extensive food charts:
Dr. Lisa's new food chart http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf
Binky's canned food charts
Pet Food Nutritional Values list
Hobo's Guide To Nutritional Values

Look for foods under 10% carbs on the above four charts.

Do the dogs eat dry food? Do the cats have access to the dry dog food? If your diabetic cat eats the dry food, blood glucose levels will become really high.

Haptowns said:
I have read that you test on the ear, the vet has never done that. That sounds very painful to kitty and can't quite picture how you do it without puncturing yourself. I will look at the videos.
Click to expand...

Ear testing doesn't hurt at all. Some cats are annoyed at first with their ears being handled and poked but many get used to it. You hold the "rice sock" or a folded tissueor cosmetic square/cotton ball under the ear to prevent the lancet from poking your finger and to firm up the ear so the lancet will poke the skin.

Here are the testing tips and videos: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

What is the current dose of Lantus? Do you test before giving each insulin injection?
 
To answer questions for those of you trying to help me, the cats do not have access to the dog food so that isn't an issue.

As I said, we were testing before each feeding but at $1 a strip (and yes, it's AlphaTrak) we changed to a couple times a week. Since the 50 reading I am now testing once a day and giving 2 units of Glargine, although gave 2 1/2 this morning with the 573 reading. Freebie is drinking water like a fiend and the litter boxes are always solid. This has to be taking a toll on his system. I don't know what to do first.
 
You're using Alphatrack?
Then with a reading of 50 your cat has almost certainly been dropping too low. You really need to reduce that dose......
 
I have 3 cats - 1 is diabetic and 1 is hyperthyroid (unregulated) so he goes through a lot of food but I still need low carb in case Honey gets in.
I get Fancy Feast but also Friskies Poultry Platter (favorite) in the large 12 oz cans for 82 cents. There are about 5 flavours in the large cans - I'm in CA and we have PetClub Stores but I'm sure you can get online also.

Testing on the ear doesn't hurt - no reaction at all if kitty is asleep. If any reaction, its generally because they don't like being kept still and/or are aware of your nervousness.
I test multiple times a day and believe me, my cat would let me know if she wasn't happy - she swiped me yesterday for wiping her eyes :roll:

The ups and downs (bounces) in numbers are horrible to deal with but if you follow advice from the dosing experts on this site, there's a good chance that you can get him past this and he can start to settle down.

Switch to a different meter - Relion Prime is the cheapest, as mentioned. Its from Walmart. It reliable and easy to use.
The Relion Confirm is a little more expensive for strips (50 for $35) but requires a little less blood than the Prime.

Start testing on the ear - just get everything you need together, make sure you have a littl of his favourite treats (Fancy Feast Appertizer, Freeze dried chicken) for reward, make sure you warm the ear well (as if he's been lying in the sun) and go for it.
You can poke a couple of times if necessary and try both ears as 1 usually bleeds more than the other.
Don't hestitate or take too long, just poke and remember its for his health you're doing it.

And also, if at first you don't succeed....I didn't for the first week or so - intermittently successful, but then, it just becomes easy.

Keep posting!
 
Hi there, I am new here but I also have a cat with diabetes, he is on Lantus x a day I do his blood 1 x a week some times 2 I was taught to do it in the ear by a very good vet... less painful for u and cat..just find a vain and prick....my cat doesn't even kno i'm doing it..if ur cats level is above 300 that is wayyyy bad,...
 
Testing along the edge of the ear is actually one of the least painful places to test. There are fewer nerve endings. As long as you give your kitty a treat every time you test, whatever discomfort there will be will be offset by a treat.

There are a few issues with Lantus use. How Lantus is dosed is very different than PZI. It actually requires that you think very differently about dose. Lantus dosing is based primarily on the nadir. The pre-shot value is important only to the extent that you know it's safe to shoot. You do not adjust your dose based on your pre-shot numbers. When you change a dose, the dose is held for at least 3 days, unless a dose reduction is indicated. This is because Lantus is a depot-type of drug. The insulin depot needs to stabilize. Doses are raised or lowered usually in 0.25u increments.

Because dosing is based on nadir, you need to get at least 4 tests per day -- your two pre-shot tests and at least one additional test per cycle. Dose reductions are based on your cat's numbers dropping below 40 (or 70 on an AlphaTrack) because your cat is a longer term diabetic. From what it sounds like, due to numbers dropping quite low, your cat is then bouncing into higher numbers. This is not unusual. Essentially, this is a response to low numbers or fast drops in numbers that signals the pancreas and liver to dump a stored form of glucose (i.e., glucagon) and counterregulatory hormones into your cat's bloodstream. This causes the numbers to spike upward. It can take roughly 72 hours for a bounce to clear. My cat has gone from the 400s at pre-shot to the 40s at nadir and bounced back to the 400s by the next shot time.

At this point, I think you need to try to change the way you are thinking about insulin. Get test data. Here's a link to the spreadsheet template we all use. It will give you a way to record your cat's blood glucose (BG) numbers and create a file we can all see. That way, we can better help you. Take a look at the starred, sticky notes at the top of the Lantus board. I've linked them below. This will help you to have a fuller understanding of how Lantus works.
  • 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.
 
Welcome to the board. A lot of people have posted very good information here but it might be a lot to take in... I will try and summarize

1. Go to Walmart and get a new relion meter. They will save you a lot of $$ in strips alone and are more accurate
2. Once you get him regulated he will eat less since he won't be starving. Look into large cans of wellness.
3.test using the ear, it's not painful and is actually safer since its more hygienic since they aren't walking on the wound.
4. Put together a spreadsheet of his results as much as you have them in the meter, and start tracking now and posting them so we can see them, that way we can tell what is really going on and advise dosing. Sienne has given a link on how to do this.
5. Try and read all the links provided above in sienne etc emails.
6. Lantus only lasts 12 hours or so , so you really need to dose twice a day, every 12 hours. I think 1 unit, twice a day would be a good start IF you are willing to post results and always take a measurement before every shot as well as at least one measurement midday or some spot checks. what does everyone else think? We can then adjust the dose once we have that data.


Let us know if you have any questions and we hope to hear from you soon!!

Wendy
 
I'm sorry to hear you are having such a hard time of it, but you have come to a great place for help.

You could do a mix of Wellness and Friskies in the large (12.5 oz) cans. Actually you can feed Wellness from the large cans for the same per ounce cost as FF, it's the packaging that is the wallet killer. If you order a couple of cases (once you know they like it!) from an online source like Wag.com it is often free delivery right to your door! Use that link on top of the page and FDMB gets a commission to keep the site running and it doesn't cost you anything extra. Most foods are available there for a lot less than retail. These foods will be great for all your cats and will go a long way to keep the others from developing chronic diseases like diabetes or CKD.

Definitely get a different meter , you will not believe how much less it costs. We often get our strips on eBay for less than $10 / 50 strips. Without knowing how low you kitter gets it is impossible to give him the proper dose. When you do test, when is it in relation to food and his insulin shot? BG readings taken after the cat has eaten can be dramatically influenced by the food. We try to give no food for 2 hours before the preshot test to get a "clean reading" and know the cat is not too low to safely give the shot. During the cycle one or two tests are needed to see how low the insulin takes his BG. Again, if he has eaten more than 15 minutes before the test you are going to see results influenced by the food, so try to test before you let him eat.

Also where do you live, City/State? There may be a member nearby that can come and show you how to test.
 
I thank everyone for their replies to my SOS. I am trying to digest all the information. I have looked at the videos for ear testing and we have now done it twice successfully so will continue.

Freebie is on Glargine. My vet will not change it to Lantus as she doesn't feel that's an option for him, he's had it while hospitalized there with no better results. I test him before he eats in the morning and before he eats at night at this time. Previously he was getting tested once per week at the vet. I keep track of all his numbers. I just got charged $70 for 50 testing strips at the vet (while I was on vacation) and am not happy about that. It seems everyone is using human monitors so I will look into that, however am slightly confused by the videos I watched where the numbers come up at 60-66 or in the 300's and people are happy with that. 60 seems very low, like if I gave him insulin with a 60 reading he could go into a coma. We are shooting for numbers from 100-200, is what my vet has said.

Right now these past few days he is reading in the high 400-500's and I boosted his Glargine from 2 units to 2 1/2. He is drinking endless water and peeing the litter box solid.

What should I do right now to get him to a good place? I can't change everything, what would be the one best thing to do first?

Thank you for your concern.
 
They are. Glargine is manufactured under the brand name Lantus. Makes me wonder if this vet knows what he is talking about.

Your vet is playing it safe by saying 100-200. Its a safe range for a cat that is diabetic.. not too high and not too low. But saying that, its high for a normal non diabetic cat. So many of us push our cats into normal numbers (50-130) as its healthier for them and may encourage remission. However unless you are testing regularly that range can be dangerous as the low end is close to the hypo number (under 40). Nobody is happy with 300 - but it happens often when trying to regulate the cats.

What to do first? IMHO...
1. Buy the cheaper Walmart meter and test his ears more often = track it on a spreadsheet like in my signature.
2. While you are in Walmart, buy the big cans of low carb food if they have them.
3. read the links provided and participate in the forum fully.
4. look into changing the dose to twice a day at a lower dose. The links will help on dosing. Post on the forum before you change the dose for advice.
 
I guess I forgot to say that I test him twice a day, he eats and then I give him the insulin ... right now 2 1/2 units twice a day. Morning and evening, 12 hours apart.
 
Yes, Lantus is glargine. It's a brand name. Sort of like most people call all facial tissue "Kleenex"...

What should I do right now to get him to a good place?
Click to expand...

I would continue to test before every shot, but also try to get at least one test during the AM and the PM cycles in between shots. In order to figure out which dose is best, or if a dose needs to be adjusted up or down, you have to know the "low points" of the cycle, which we call the "nadir". It's typically around the middle of the cycle, but since every cat is different, it can be earlier or later than 6 hours after a shot.

Some people can't be home to test right at +6, so they do a test just before leaving for work, or right when they get home. Another good time to test is just before you go to bed. If you set up a spreadsheet, you can easily keep track of all the numbers, and the times that you test. Over time, the data that you collect will really help you and others in figuring things out.

Carl
 
Just in case any of you are still tuned into this post, could you explain something please. You've said Lantus and Glargine are the same ... I thought Lantus was a shorter acting insulin. The Glargine I get at the vet is in a tiny, tiny bottle (like just over an inch high) and the doses are very small. It costs $62 for 100 units. When you all are talking about Lantus on the board, is this what you're talking about? Thank you.
 
Lantus is the brand name for Insulin Glargine. My vet talks about Glargine and writes me prescriptions for Lantus. Kind of like Advil is a brand of Ibuprofen.There is a shorter duration (?) type of insulin called lente - maybe that's the confusion?

I got my Lantus at Walmart. My vet wrote me a prescription and I went to the pharmacy and picked it up. Mine is a small vial about an inch and a half tall, but I don't remember how much is in it. It cost me about $150. I didn't think vets carried the stuff, but there are a lot of things I don't know @-) ! Our doses are very small - right now Chester takes 1.5 units which is about three ticks on my U-100 syringe (I have syringes with half-marks).
 
this is Lantus/Glargine
4507.jpg
 
Haptowns said:
Just in case any of you are still tuned into this post, could you explain something please. You've said Lantus and Glargine are the same ... I thought Lantus was a shorter acting insulin. The Glargine I get at the vet is in a tiny, tiny bottle (like just over an inch high) and the doses are very small. It costs $62 for 100 units. When you all are talking about Lantus on the board, is this what you're talking about? Thank you.
Click to expand...


Glarine is the official name of the insulin.

Lantus is the marketing brand name for glarine insulin. As Carl said it's like how facial tissue is often called just Kleenex.

Lantus is only available in two forms, the 10 ml (1000 unit) bottle and as a 3 ml (300 unit)
Solostar pen.

Here is what the bottle looks like:
lantus-13032_1.jpg


If your bottle does not look like the above picture, then the vet sold you repackaged insulin which may not be safe to use. Lantus in the original manufacturer bottle or pen is sterile. You have no way of knowing how your vet repackaged the insulin, if sterile technique was used, the expiration date, etc.
 
I would like to post a photo of the glargine I am taking but honestly, I don't know how to post a picture on here. Can anyone explain please? I see the "img" but don't know how to get the photo in there. My insulin does not look like you posted.
 
Its long and convoluted. Best way for quick and easy is to "upload attachment" using the link below the box you type in when you post.. i.e.
8358480337_c3f0882244.jpg


Otherwise someone can explain how to do an image that doesnt involve a ton of steps then I am all ears.
 
Welcome! You've already received some great advice here. I think most importantly, you should reduce the dose because it definitely sounds like he is bouncing from low numbers. If he drops too low, you could end up with a hypo event on your hands. As the saying goes, "Better high for a day than low for a minute."


You can also use the Img tag in the posting section if the image is from a website. Just paste the URL in between the Img /Img (which are in brackets []). For example, {Img}http://drugline.org/img/drug/lantus-13032_1.jpg{/Img} with {} replaced by [].
 
The IMG button above the text box only works for images already on the internet, you open the image in a new window and copy the web address and then come back here , click post a reply, click the IMG button and past the web address of your picture between the 2 sets of brackets. (After you click the IMG button the cursor will be blinking the correct spot, just paste the address.) This will work if you have a Picassa, facebook or other online picture storage and can up load you photo there.

To upload directly here from your computer:
  • ~~ Look for the upload attachment box under the text entry box as Wendy shows in her attachment
    ~~ click the upload attachments tab
    ~~ click the Choose File button
    ~~ a window should open showing your computer
    ~~ locate the picture file on you computer (it is often easiest to place it on you desktop before hand to save time searching for the right folder)
    ~~ click the choose button
    ~~ you will come back to your post here
    ~~ now click the Add the file button
    ~~ place your cursor where you want the picture to appear in your post
    ~~ click the place inline button that is now under your text box

It does sound convoluted but you really just need to follow the prompts.
 

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I want to apologize for not posting right back about the photo ... the instructions were GREAT and I really appreciate it. However, I kept getting SERVER ERROR and it wouldn't let me post anything, not even a message after that. I'll see if this posts today. I've tried two different computers.
 
Hello,
Looks like you are getting some great advise. We have all been there. I was horrible at checking at first because I didn't have all the tricks.
Checking their (BS) can become
a lot easier. Go purchase either a neck, arm or back warmer that is microwavable, put that on the ear to warm the area,
so the blood comes to the surface. Put the heated pad over the back and neck of cat as well. They
love the heat and will actually beat you to the room where you check the blood sugars. Make sure it's a private
area where your cat feel safe and not interupted. There are lots of links they have given to where the best veins
are on the ear. Favorite Treats help too..dehydrated chicken or cooked chicken

You will get the hang of it. Hang in there. Get on the lantus forum and they will set you up and help
you get his BS's under control. The people on this site saved me and my cat. Also a lot of vet bills.
 
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