Hi Ya'll on FDMB! I'm a newbie with about 1000 questions :)

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boobookins

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Hi There FDMB!

I have been reading this board for about 1 week now. My kitty Titus (He is 10 and 14.4 lbs) I noticed the last 2 weeks he has been acting strange, drinking a ton therefore urinating a ton and eating things he never would have normally ate (Titus is one of those rare kitties who hates human food usually). We took him to the vet (because I knew these were signs of diabetes) and Titus is the type of kitty who usually has to be sedated for any procedure (but we fasted him before the test for 12 hours but left water out) but he was a bit tired that morning and even though he was a fur-ball of fury they were able to get the blood test done without sedation (this was a first haha) I call back the next morning and they said everything in his blood-work looks fine (they did a blood panel) except his BG was at 511, so I have myself a sugar-kitty. We made an appointment to learn how to administer insulin (they let us try on a boarder cat the vet, but we injected water into him not insulin haha) and I also went and bought ReliOn BG monitor/test strips and lancets.

Now my boyfriend and I watched about 500 youtube videos on how to home test, because Titus is a fiesty one (don't get me wrong he is the biggest sweetheart in the world, he even does kitty kisses where he tilts your chin with his paw and licks your lips...it's the sweetest thing in the world, but he refuses to give up if he doesnt like something or want it to happen...and i cant help but love that about him too) I adopted him when he was 2.5 from an old friend, how she ever gave him up is beyond me, he's been my heart for 8 years now.

So now the current situation...
The past few days we have tried doing home testing and were unsuccessful at getting any blood, until yesterday (we learned we have to use the lancet alone, not the device as it doesn't prick enough to draw blood...so we prick his paw because he hates having his ears touched) and he was at 306. Our vet prescribed us Humulin N (I have read on these boards it's fast acting and sometimes it may be better to start with a lower dose etc) Maybe our vet isn't as good as I thought or maybe I'm reading into it wrong, but they want to start him off 4 units 2x a day, that seems high right? Last night when we finally got our first at home test done we only gave him 2 units because it was his first time on the insulin and I wanted to see how he would react (this is before I knew it was fasting-acting...I stayed up all night reading about the NPH vs Others)

Titus wasn't happy after the insulin shot but he didn't act weird, he wouldn't let us retest him, he went under the bed and hid there and we would throw (5 treats total) at him and watch him eat them to make sure he was okay...and we stayed up for an hour afterwards and kept checking on him and he seemed fine...upset with us but fine...)

Then this morning at about 5 a.m. (we gave the insulin @ 11 p.m.) he threw up a lot for him, now it can be the change of diet, we are trying to do an all wet food (Wellness pouches) and a little dry food (Evo) and it could be him adjusting to that as well.

I am just scared for him, because he isn't acting like his happy self....and it breaks my heart to see him miserable....
is NPH 4 units 2x a day safe? I want to switch over to Lantus because of all the good things I've read about it....but I don't even know how to bring that up to my vet, I feel like it's not my job to tell them what medicine my cat needs but I really truly feel deep down inside Lantus will be the most ideal for him....but maybe I am wrong?

Any advice you can give would mean the world.

I am going to start a spreadsheet for him today and try and take a curve test eventually...but Titus is making it hard to let us even touch him right now, he's being very lazy but very distant....

I refuse to give him any insulin unless I know his numbers prior and then I'd love to check his numbers afterwards as well, but how long after do we check and then when again?

Any help would be amazing. Thank you!

Titus (we also call him boobookins or tightass on his naughty days LOL) & Rachel(that's just plain 'ole me)
 

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Welcome! Its great that you have found the board already - and also for the sake of your kitty! 4u twice a day of ANY insulin is WAY too high of a dose to start with!!! I really would not start at any more than 1u twice a day - especially if you are changing the diet and having a hard time testing. Humulin N can give a steep drop within the first 4 hours or so and then the numbers will shoot back up. If you need research studies on the effectiveness of Lantus or Levemir to take in to your vet - check out the "basic FD info" link in my signature. About mid way down you will find a link to those research studies in veternary journals. I know from experience that many vets do not have the time to read and keep up with the latest research and many have simply just not heard of the use of lantus or levemir in cats.
 
Hi there

in all honesty most vets start at a high dose. ohmygod_smile

Do you know why your vet wanted 4u? Based on what?
Did the vet check for ketones in the urine?

You might want to try regular Wellness canned foods, the pouches tend to have a bit higher carbs, althou you'll need the higher carb if you have a low number situation that you need to bring up.

here is a link to Janet & Binky's food chart, if you go with Fancy Feast you'll find that list in the "old list" of this link.
Janet & Binky's Food Charts


Good that you're home testing! It does take a little while to get the hang of, do keep track of your kitties BG, preshot test always so you know its safe to give insulin.

Keep reading the board, lots of good info here, and ask ask ask if you're not sure.
 
Wow! You have already done a lot of research. Fantastic. And it sounds like you care about Titus and how to best help him.

There are ways to work with kitties who don't like to have their bg levels taken. One is the burrito. We put a towel down on a couch with an arm, plop the cat on the towel, wrap him up until only his ears are showing. (Or if you think it will work, better, his foot. ) If he moves, we can press him into the arm of the couch to hold him still. The other is the clothespin trick: http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick Maybe one of those will work.

You are on the right track. You have to find out what his levels are so that you can keep him safe. The behaviors you describe are worrying.

Are you sure giving him treats after you test, every time whether successful or not? Sometimes that alone will help the most difficult cat. They don't care for the test, but they will sit still for the treats.

Keep reading. Ask lots of questions. We all had, or have, a diabetic cat and are successfully treating him/her. Many of our kitties are off insulin, but we come back to help new people - paying it forward for the help we were given. Welcome. You can do this. We'll help.
 
How do you tell your vet about wanting to switch insulin? Simple!
You say "I want to use Lantus for Titus. Please write me the rx for Lantus."
It's just that simple.
Vet asks why, just tell him/her why. You don't feel that you want to use such a fast acting insulin as it will not last the 12 hours.

And about the dose of 4u BID ... way too high, at least I would think so, but I don't know that insulin. Maybe if Titus had been on some other insulin already and you were just switching to a different insulin, you would be making adjustment to the amount of one for the amount of another.
 
Hi, Rachel, and welcome to you and to Titus!

> Our vet prescribed us Humulin N (I have read on these boards it's fast acting and sometimes
> it may be better to start with a lower dose etc) Maybe our vet isn't as good as I thought or
> maybe I'm reading into it wrong, but they want to start him off 4 units 2x a day, that seems
> high right?

There are some cats who do fabulously well on each of the insulins, Humulin N included. It's also cheaper than several of the other insulins and, if your vet has had experience with folks who chose PTS instead of treatment due to the cost of the insulin, maybe he prefers to start off with Humulin N.

That said, yes, 4u twice a day is almost certainly too high. My inclination is to suggest dropping the dose to 1u twice a day, but -- did your vet say anything about Titus having ketones or diabetic ketoacidosis (DKA)? 'Cause in either of those cases, you need to be a bit more aggressive with insulin dosing. Also, does Titus have any other other health issues going on that we should know about?

Assuming Titus didn't have ketones, then it sounds like your vet is treating your diabetic cat as if if were a small diabetic dog. This is actually the way they've taught the subject in veterinary schools in the past, though that's slowly changing, so it's not necessarily something to blame your vet for. It's something we *do* see here: the initial dose for dogs is based on weight and is often 2+ units; the initial dose for cats *should* be 1u twice a day.


> I stayed up all night reading about the NPH vs Others

Congratulations on research! Also, I assume you found it, but just in case: the primer for using Humulin N in cats is here.


I'm definitely concerned that you're giving so much insulin, *and* switching to a low-carb food at the same time. If Titus doesn't have a problem with ketones, please give no more than 1u of insulin while you're switching to low-carb food. And get pre-shot tests, to make sure that it's safe to give the insulin. It'd also be good to get some post-shot tests in, to make sure he's not going too low, but you'll have to balance that with the ability to test. (The clothespin trick really does work.)

(When testing, it's important to give praise and cuddles before and during, and always give a treat afterward, even if the test wasn't successful. Also, after you get the blood on the test strip, put pressure on the prick spot to reduce the chances of bruising.)


Because of the high-dose, please take a minute to read Melissa and Popcorn's post on recognising and treating hypoglycemia. Read it, print it out, and tape it to the side of your fridge. When you suspect a hypo is *not* the time to find that your internet connection has gone down. You'll also want to check out Jojo and Bunny's post on stocking your hypo toolkit.

One other thing you'll want to do is to check Titus daily for ketones. Ketones are a not-common but still possible side effect of unregulated / under-regulated diabetes. Small amounts of ketones may be treatable at home; large amounts may require hospitalisation at a 24-hour care facility.

To test for ketones, pick up some ketostix in the diabetes section of your local pharmacy (I've always found them in the aisle, but some folks report their pharmacists keep them behind the counter). Stick a ketostix in fresh urine; if ketones are present, the stick will change color, kinda like a pregnancy test.


> is NPH 4 units 2x a day safe?

4u of NPH twice a day *can* be safe FOR _SOME_ CATS. BUT -- those cats will be few and far between and, in their cases, it's important to work up to that dose slowly, over a period of time, with lots of testing. That taking-it-slow, lots-of-testing history is *not* something I see in what you've said about Titus' history. Instead, it looks to me as if your vet is treating Titus as a small dog and starting him at way too high a dose of insulin.


> I want to switch over to Lantus because of all the good things I've read about it....but
> I don't even know how to bring that up to my vet, I feel like it's not my job to tell them
> what medicine my cat needs but I really truly feel deep down inside Lantus will be the
> most ideal for him....but maybe I am wrong?

You're not wrong. Lantus is a good insulin for many cats, though it does work best on moderately strict 12/12 dosing. If your schedule is more erratic, then Levemir or ProZinc might be a better choice. If you go with Lantus or Levemir, ask for a prescription for the pens or cartridges, not the vials; it'll be more initial outlay, but will save you money in the long run. (Info on pens and cartridges is available in this sticky here.)

Regarding talking things over with your vet: your vet knows more about more diseases in more animals than the folks here on the boards -- among other things, he's been trained to differentiate between different types of scaling disease in fish, do surgery on malformed parakeet beaks, and treat malnutrition in cows and horses. And there're *hundreds* of new developments every year -- new ways to diagnose a disease, new understandings of how diseases and medication and diet interact, new ways of treating disease. It's physically impossible for any vet to keep completely up-to-date on everything.

For most our pet's lives, vets provide a 'services' function: something is wrong or they need shots, we bring our pet in, they fix him -- it's all routine and there's no need for a deeper interaction. But now your vet isn't up-to-date on the latest developments in a disease that Titus has. At this point in time, as Titus' mother *and* as his advocate, it's up to you to make a partnership with your vet. You need to push him, either for him to do research on his own, or to listen to you and what you've found in your research and to work with you to help preserve Titus' health. If he won't cooperate with you, then it's time to find a new vet -- while I love my vet desperately much and have been with her for 15+ years, there is no relationship with any vet that's worth my pet's life.

For a soft approach to the changeover, I'd suggest calling your vet and saying that you don't think that Titus is doing well on NPH, and saying that you'd heard that some cats are doing really well on glargine (which is what Lantus is called in all the medical journals). Then ask him whether it'd be possible for him to check his medical journals or online sources and see whether it's true that glargine *does* work better. That gives your vet the chance to do some research on his own and respond to your concerns.


> I refuse to give him any insulin unless I know his numbers prior and then I'd love to check his
> numbers afterwards as well, but how long after do we check and then when again?

In the Humulin N primer, Sweetgrass says,
When curving on N for the *first time*, in my opinion, it is good to check bg's at +2, +3, +4, +5 and again at +6. This will tell you exactly where your peak is. After the numbers start to rise, you can go back to every two hour checks.
Click to expand...
So, if you follow her advice, you'd get a pre-shot test, then tests two hours after you give the shot, three hours after the shot, etc. Then, once the numbers rise, test every other hour until it's time for the next pre-shot test.


If you've any other questions (and you will!), feel free to ask; that's what we're here for.

-- Jean and her Gwyn
 
First off, Thank You so so so much to everyone for the warm welcome and advice!

I did ask the vet tech (the day we went in to learn how to inject insulin) why they picked that dose for him; I asked "is that a normal dose to start off with?" and her reply was "The vet chose this dose for him based on his weight and bg level." and that was that.

My boyfriend and I tried doing a pre-shot on him after I posted the original thread, and no luck :( I mean we got blood but once we prick him he growls, hisses, moves all over the place and runs away by the time we can scoop it up....it's very hard on us...because he hate seeing him like this but we know we need to do this....and we will try again in the morning...he's had enough today...the poor guy won't even eat anything unless I bring it to him he's so worn out and over it...he was purring earlier though so that made us smile...and now he is laying by me while I type this....we tried the burrito method today...no success tomorrow we will try the hey lets hang out on my lap while i pet you while my boyfriend pokes your paw out of nowhere approach :)

I have printed out Humulin N 101 and also the signs of HYPO and what to do if it occurs. Thank you so much for suggesting it.

I will continue to only do 1unit since he is also on a diet change (do I tell my vet this a well....I suggest being honest is best but again they suggested this high dose...do I just simply tell them with the research i've come up with this has worked best on other cats and I feel safest doing it this way...etc?)

Also do you suggest even though I can not get a bg number from him as of right now, I still administer 1unit to him BID or wait until i get results from the monitor?

I will try and see how Titus does on NPH but last night wasn't successful as he threw up a lot for him....after i'm guessing 4-5 hours after giving it to him (we gave him 2units) maybe he peaked then and it wasn't good? I have no idea.

I will call my vet soon and let them know where I'm at in my research and also where Titus is at with clinical signs (he isn't over-eating or begging for food and he is drinking normal amounts of water and urinating just fine...but he has no energy really) and tell them I am trying to home test but its been unsuccessful and I dont know if I am suppose to give him insulin if I dont know his BG levels because I dont want him to go into HYPO.

again Thanks so much for everything. I am so happy I found this board and I cant wait for the day to help newbs out ;)



I
 
I'm not sure where you're located, but here in Ontario, Canada, we don't need prescriptions for insulins. I could get Lantus from my pharmacy without prescription. Not sure if the laws are the same where you are though. So basically you could maybe switch on your own, without having to convince your vet about its benefits!
 
From an animal trainer standpoint - you can train him to let you prick his ears. Start at step one - touching his ear=treat. Do that a few times a day for a few days. Next applying a cloth=treat. Work your way up. You can train even the most temperamental to do anything with the right reward and slow steps. I tried the paw prick at first too and could never get good results.

Also are you changing the food over slowly? You can't just switch him cold turkey. You have to mix old with new for quite a while. There are other posts about this. Switching cold turkey is bad news - even for the tigers I train!
 
> My boyfriend and I tried doing a pre-shot on him after I posted the original thread, and no luck :(
> I mean we got blood but once we prick him he growls, hisses, moves all over the place and runs
> away by the time we can scoop it up....it's very hard on us...because he hate seeing him like
> this but we know we need to do this....and we will try again in the morning...he's had enough today...

Always give praise and cuddles when testing, and always give treats afterwards. If the problem is that he moves before you can get the blood on the test strip, try scraping it onto your fingernail and testing from there. You might also consider the clothespin trick.

And you might try ear pricking again; the trick there is getting the blood flowing, either through warmth or massage, and having something on the other side of the ear to give something to prick into (like holding a piece of paper in the air and trying to write on it with a pencil -- it'll just mostly just flop of the way out of the pencil; put the pencil against the wall and you can write). If the problem is that the blood is absorbed into the fur, try putting a tiny dab of Vaseline on the spot, to help the blood bead up. Some folks will make two pricks right next to each other, to get enough blood. You can trying 'milking' the ear, by putting your thumb on the rear side and putting a finger on either side of the prick-hole and sliding your fingers inward.


> I will continue to only do 1unit since he is also on a diet change (do I tell my vet this a well....I
> suggest being honest is best but again they suggested this high dose...do I just simply tell them
> with the research i've come up with this has worked best on other cats and I feel safest doing it
> this way...etc?)

That depends on your relationship with your vet. Some folks have vets who are willing to listen and research and go along with new things. Other folks have vets where the best approach has been to do things on their own (with board guidance on dosing, etc), and then go into their vet's office for a check-up armed with their spreadsheets and test results. "I know you had me start at 5 units twice a day but then I started testing his blood sugar at home and see, here, --
* this is the weekend he hypo'd, so I reduced his dose
* I did this blood curve one weekend and look at this rebound! so I reduced his dose
* etc.

In those cases, the key is to bring in all of your test results, including curves, so you can impress the vet with all of the info you have on how your cat is doing on the insulin. Most vets end up pretty impressed. You may also want to bring your glucometer in with you, so that the two of you can do side-by-side tests and compare results.


> I will try and see how Titus does on NPH but last night wasn't successful as he threw up a lot for
> him....after i'm guessing 4-5 hours after giving it to him (we gave him 2units) maybe he peaked
> then and it wasn't good? I have no idea. [....]
> but he has no energy really

NPH can peak around 4-5, and vomitting can be one of the symptoms of hypoglycemia, as well as lethargy. (Note that you can also have hypos without any symptoms at all.) But vomitting and lethargy can also be symptoms of ketones. If you can learn to blood-test, you'll always be able to check if Titus is having a hypo, and checking for ketones would rule those out as well.


> Also do you suggest even though I can not get a bg number from him as of right now, I
> still administer 1unit to him BID or wait until i get results from the monitor?

I am not a Humulin N user, but what I would do is to either skip this evening's shot, or just give 1 unit. Then tomorrow, try for a pre-shot test, give 1 unit, and see if you can't fit a curve in.

I'd also stop by the pharmacy and pick up some ketostix and test for those; it's about $15-20 for a bottle of 90 sticks and can potentially save you thousands of dollars in emergency hospitalisation costs. This is especially true as we don't know whether the lethargy and vomitting are caused by hypos or ketones, and the treatments vary drastically.


> I will call my vet soon and let them know where I'm at in my research and also where Titus is at
> with clinical signs (he isn't over-eating or begging for food and he is drinking normal amounts
> of water and urinating just fine...but he has no energy really) and tell them I am trying to home
> test but its been unsuccessful and I dont know if I am suppose to give him insulin if I dont know
> his BG levels because I dont want him to go into HYPO.

I'd really give testing some more tries; it's really the best thing you can do to take control over Titus' diabetes, especially since it doesn't appear that your vet is up-to-date on the latest stuff. Where do you live (nearest medium-to-large population center)? It's possible that we have someone who could come over and help you with this.
 
Try these as your after testing treat. Most of us use the chicken ones (you may see references to FDCC which is freeze dried chicken crack) I'm not sure if the cheese ones are ok but the meat ones are all acceptable FD treats. I have 6 kitties and every single one of them would crawl through water to get to that stuff... seriously. If you ONLY give him this treat for testing/shots... well, he'll learn pretty quickly that if he wants the good stuff he has to sit still and let you do your thing with the poking. When Tugger was getting tested a lot every day, all the other cats and the two dogs would come and wait (some patiently, some vocally) for their treats. Imagine a circle of 5 cats and one very large dog drooling over each shoulder... :lol:

You could try my methodof dealing with fractious kitties who need meds etc. It doesn't always work for every person/kitty but it sometimes does. The key is that I use my body to keep him in position, without putting pressure on him, I promise I am not really sitting on my kitty lol. The only time this doesn't work for me is with the kitten. He's so darn small he can wiggle through my knees, under my butt and out the back lol. He's almost big enough for it to work on him though ;)
 
I think Titus does best under no restraint, my new approach seems to be something he can get use to "it's a let him think he's in control" approach LOL.
Basically he is laying on the floor relaxed and I rub his paws with my hands and then sort of poke him with my fingers getting him ready and he purrs during it and then I get the lancet and poke (he didnt run away, but I wasn't able to get blood this time...but he didnt run or growl) and he let me try again but on the third try his tail was like "Oh no she didnt..." so we will see how it goes with this easy going method, I'm going to try again in a little bit and just get him use to the poking without running away and then eventually get the monitor out (he runs when he hears the monitor start a beep LOL, he's a quick learner...)

He isn't showing any clinical signs of diabetes since I changed his diet last week 90% wet food (soulistic brand/the petco brand only chicken flavors no fish) and 10% EVO dry food it's only 7% carb and has a lot of moisture actually for a dry food, He was already eating the soulistic canned food (for a day I tried wellness pouches but read it's best not to change his whole diet at once...so we only changed his dry food from halo to evo and are giving him much more wet food and a lot less dry food, it's in reverse and he is doing fine) his energy seems to be back a little even too, he was playing today with a toy, I was so happy!!! He isnt drinking a ton of water or begging for more food, he's just relaxing and enjoying the day...his tummy is a bit upset with all the wet food but he's handling it well overall.

I am hoping to speak to the vet tomorrow about switching over to an L insulin because I feel its safest for him to be on a slow acting/gentler insulin since the one time we did give him NPH he puked after 4 hours on only 2 units (when they prescribed 4) I plan on starting at .5 BID with him (if he wont let me check his BG) and seeing how he reacts to that but I really want to be able to test his BG at home before ever giving him any insulin and eventually letting him let me do a curve test on him so I can see where he peaks and how long he peaks on that dose etc. I have all the knowledge now thanks to everyone on this forum now it's time to use it and treat him with whatever is necessary...and best for him.

Diabetes is confusing because it's constantly changing in the body, but I know in time Titus and I and with the help of my boyfriend and all of you can regulate this and hopefully have him free of insulin and just on he right diet for him :)

I am located in Southern California, Burbank :)

Rach
 
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