Introducing myself and Clide - Advice Please?

[RenaRF]

Hello! I'm new to this board but not to feline health message boards generally.

I'm a rescuer located in Northern Virginia, and one of my personal cats, Clide, was diagnosed with diabetes back in May. A little bit about Clide first. Clide was dropped at a high kill shelter a little over a year ago with a mouthful of rotten teeth. We rescued him (he was 14 when surrendered and is the sweetest fat tuxedo kitty you've ever seen), and the *plan* was that he was going to a senior sanctuary in rural Virginia. Long story shorter, he wound up coming back to me to get over an infection in May and he's stayed ever since.

He had bloodwork done back when we were trying to get our arms around the infection and that's when they mentioned high blood glucose. It wasn't terribly horrible, and the vet recommended we try diet regulation (Purina DM, Hill's MD [wet] and Royal Canin DS kibble [he LOVES his kibble]) and monitor his BG over the following weeks. And... sure enough, his BG came down from the low 300's to just a touch under 200 on the diet. He eats it exclusively.

Clide's 15 now and was dealing with some coughing etc., so I took him to the vet yesterday to get that checked out and to have another run at his bloodwork. Oh - forgot to mention - Clide also has stomatitis, and the mild breathing issues he's having are, we *think*, related to a flare-up in his sweet mouth (swelling way in the back). He is eating and drinking normally.

They called me today with the results. Total Protein and HCT indicate he's pretty dehydrated, and his BG was 325. Everything else - particularly kidney values - looked great. So, he goes back tomorrow for a glucose curve to get on the path to regulating him with insulin.

So that's what I know. I had a CRF (kidney) cat until he passed away in 2009 just past his 19th birthday. I'm a TERRIBLE needle phobe. I had to hire a vet tech to come out every other day for Grady's sub-Q fluids - so I'm really seriously worried about my own ability to do what Clide needs. Any advice? My understanding is that the needles are smaller - do the syringes come pre-loaded? Is there a more cost-effective way to get syringes and insulin online? That's the kind of information I'm looking for.

Any help is appreciated!!

Rena & Clide (and Rufus, Feats, Meatball & Bella)

 

[Larry and Kitties]

Welcome. I am in norther VA too, by Reagan National Airport.
Some users get Lantus for Canadian pharmacies
viewtopic.php?f=28&t=49608
For syrings see:
viewtopic.php?f=28&t=58093&p=631089&hilit=syringes#p631089

 

[terri1962]

Rena

Welcome to the board. I have never given Sub Q fluids but was a needle phobe as well and thought I would pass out when I had to give my Lilly her shots and test her. I used to break out in cold sweats everytime but you get used to it after awhile. Its what you need to do to keep kitty alive.
The syringes do not come pre loaded you have to draw the insulin from a vial or insulin pen. There are videos online for help, there is also a help section here on the board.
The others will come along shortly who have far more knowledge than I do. I just wanted to say welcome.

Terri

 

[RenaRF]

Hi - thanks for your reply. I am out by Dulles Airport, so between the two of us, we have it covered. I see a bunch of notices about Lantus and this or that. Can someone explain the differences to me? Anything I should be aware of when Clide goes for his curve tomorrow?

Welcome. I am in norther VA too, by Reagan National Airport.
Some users get Lantus for Canadian pharmacies
viewtopic.php?f=28&t=49608
For syrings see:
viewtopic.php?f=28&t=58093&p=631089&hilit=syringes#p631089

 

[BJM]

He had bloodwork done back when we were trying to get our arms around the infection and that's when they mentioned high blood glucose. It wasn't terribly horrible, and the vet recommended we try diet regulation (Purina DM, Hill's MD [wet] and Royal Canin DS kibble [he LOVES his kibble]) and monitor his BG over the following weeks. And... sure enough, his BG came down from the low 300's to just a touch under 200 on the diet. He eats it exclusively.

We strongly recommend a diet of low carbohydrate canned food because dry food is a water depleted diet and cats don't drink enough to compensate for that. This puts a workload on the kidneys.

So, he goes back tomorrow for a glucose curve to get on the path to regulating him with insulin.

Learning how to home test is less expensive than taking the cat into the vet and gives much more accurate values for your cat. Glucose levels at the vet can be 100 points higher due to stress. (some cats do go lower).

...I'm a TERRIBLE needle phobe. I had to hire a vet tech to come out every other day for Grady's sub-Q fluids - so I'm really seriously worried about my own ability to do what Clide needs. Any advice? My understanding is that the needles are smaller - do the syringes come pre-loaded?

Luckily, I can explain 'systematic desensitization' to you. It goes like this.
1) learn relaxation breathing first:
(abstracted from "The Relaxation Response" by Herbert Benson)

Begin by sitting in a comfortable chair with good back support, or lying down. The key thing is to have your body pretty much straight between hips and shoulders so your lungs have room.

Now, breathe out completely. That way there will be room for a full breath in. If you start with half filled lungs, taking a deep breath in won't feel very large.

Pause.

Slowly, take a deep breath.

Pause.

Slowly, exhale.

Repeat, and establish a pattern of slow, deep breathing. Give yourself a good 20 minutes (turn off the phone, close the door) to get into this process. If done at bedtime, you may drift into sleep.

By slowing and deepening your breathing, you often cause the heart rate to slow and relax, muscle tightness to ease away, and blood pressure to decrease.

2) Privately, not on the board, in concrete measureable terms, write down a description of where you currently are in dealing with needles.

3) Privately, not on the board, in concrete measureable terms, write down a description of where you would like to be are in dealing with needles.

4) Figure out what would be little tiny steps in between those 2 descriptions such as:
Covert rehearsal (mentally picture yourself going throught the steps - 'virtual' practice)
- imagine yourself going to a pharmacy to purchase an insulin syringe
- imagine yourself picking up a syringe and holding it
- imagine yourself inserting the syringe into a vial or pen of insulin and moving the plunger to draw some out
- imagine yourself gently pulling up a fold of skin on your cat
- imagine gently sliding the syringe into the tent made by the fold of skin, pressing the plunger in to deliver the insulin, and withdrawing the syringe.
Then
take each of the above steps, and work through them one at a time for a day or a week or two, while doing the relaxation breathing until you can feel comfortable (or even just tolerate) the activity.

Now, shift into real practice:
take each of the above steps, and work through them one at a time for a day or a week or two, while doing the relaxation breathing until you can feel comfortable (or even just tolerate) the activity.

...Is there a more cost-effective way to get syringes and insulin online? That's the kind of information I'm looking for.

Lantus should be purchased in the 3 mL Solostar pens, without the pen needles. A 10 mL vial loses efficacy before it is completely used up. A pack of 5 pens is how they are usually sold; some hospital pharmacies may sell them individually. You may hunt around to see if anyone would want to split a 5 pack with you. With a prescription, Lantus may be ordered from Canada less expensively than the US in some cases. You use a regular syringe to withdraw the amount of insulin you need from the pen.

 

[RenaRF]

Ok thank so much. Every answer I get generates more questions. I've poked around the FDMB website and other resources and I can't seem to concisely get answers to the following:

1. At what BG level does a cat require insulin (as opposed to diet)? Clide is 15.9lbs (down from his 16+lbs. last vet check, but we've been trying to get some weight off of him as he is overweight).
2. What are the long-term effects of untreated diabetes? Is there a BG level at which treatment would be considered "cusp", meaning it could go either way with diet v. insulin as treatment?
3. Per your message - should I have faith in the glucose curve? Clide's pretty calm at the vet's provided you aren't sticking a thermometer in his bum (he hates that). I don't want him to have invalid results. I assume that the day-long, repeated bloodwork is designed to accommodate stress at whatever level?
4. Is there a particular type of insulin I should favor? Avoid? Are the pens easier than a syringe?

That's what I have for now. Thanks for your assistance.

Rena

He had bloodwork done back when we were trying to get our arms around the infection and that's when they mentioned high blood glucose. It wasn't terribly horrible, and the vet recommended we try diet regulation (Purina DM, Hill's MD [wet] and Royal Canin DS kibble [he LOVES his kibble]) and monitor his BG over the following weeks. And... sure enough, his BG came down from the low 300's to just a touch under 200 on the diet. He eats it exclusively.

We strongly recommend a diet of low carbohydrate canned food because dry food is a water depleted diet and cats don't drink enough to compensate for that. This puts a workload on the kidneys.

So, he goes back tomorrow for a glucose curve to get on the path to regulating him with insulin.

Learning how to home test is less expensive than taking the cat into the vet and gives much more accurate values for your cat. Glucose levels at the vet can be 100 points higher due to stress. (some cats do go lower).

...I'm a TERRIBLE needle phobe. I had to hire a vet tech to come out every other day for Grady's sub-Q fluids - so I'm really seriously worried about my own ability to do what Clide needs. Any advice? My understanding is that the needles are smaller - do the syringes come pre-loaded?

Luckily, I can explain 'systematic desensitization' to you. It goes like this.
1) learn relaxation breathing first:
(abstracted from "The Relaxation Response" by Herbert Benson)

Begin by sitting in a comfortable chair with good back support, or lying down. The key thing is to have your body pretty much straight between hips and shoulders so your lungs have room.

Now, breathe out completely. That way there will be room for a full breath in. If you start with half filled lungs, taking a deep breath in won't feel very large.

Pause.

Slowly, take a deep breath.

Pause.

Slowly, exhale.

Repeat, and establish a pattern of slow, deep breathing. Give yourself a good 20 minutes (turn off the phone, close the door) to get into this process. If done at bedtime, you may drift into sleep.

By slowing and deepening your breathing, you often cause the heart rate to slow and relax, muscle tightness to ease away, and blood pressure to decrease.

2) Privately, not on the board, in concrete measureable terms, write down a description of where you currently are in dealing with needles.

3) Privately, not on the board, in concrete measureable terms, write down a description of where you would like to be are in dealing with needles.

4) Figure out what would be little tiny steps in between those 2 descriptions such as:
Covert rehearsal (mentally picture yourself going throught the steps - 'virtual' practice)
- imagine yourself going to a pharmacy to purchase an insulin syringe
- imagine yourself picking up a syringe and holding it
- imagine yourself inserting the syringe into a vial or pen of insulin and moving the plunger to draw some out
- imagine yourself gently pulling up a fold of skin on your cat
- imagine gently sliding the syringe into the tent made by the fold of skin, pressing the plunger in to deliver the insulin, and withdrawing the syringe.
Then
take each of the above steps, and work through them one at a time for a day or a week or two, while doing the relaxation breathing until you can feel comfortable (or even just tolerate) the activity.

Now, shift into real practice:
take each of the above steps, and work through them one at a time for a day or a week or two, while doing the relaxation breathing until you can feel comfortable (or even just tolerate) the activity.

...Is there a more cost-effective way to get syringes and insulin online? That's the kind of information I'm looking for.

Lantus should be purchased in the 3 mL Solostar pens, without the pen needles. A 10 mL vial loses efficacy before it is completely used up. A pack of 5 pens is how they are usually sold; some hospital pharmacies may sell them individually. You may hunt around to see if anyone would want to split a 5 pack with you. With a prescription, Lantus may be ordered from Canada less expensively than the US in some cases. You use a regular syringe to withdraw the amount of insulin you need from the pen.

 

[Squeaky and KT (GA)]

Welcome Rena and Extra Sweet Clide! ...from what was also an awful needle phobe! The needles I use are 5/16th" long, 30 gauge - seems to be the most common. It's small and thin. You really WILL get used to it very quickly - the IMAGINED horror is MUCH worse than the actual event!

Home testing will be a breeze for both you and Clide very quickly too. I use the Walmart Relion Contour which has inexpensive strips - tried others but this is our favorite. Meter, strips, ketone test strips and box lancets for about $35.

BIG hugs! Just being here and posting tells me you're gonna do just fine! You're already over the biggest hurdle.

 

[BJM]

Rena

1) Normal glucose values for a cat are similar to a human 70 - 120 mg/dL

2) Untreated diabetes = death, from starvation, as the body cannot use the calories consumed.

3) Day-long serial blood tests done at the vet are designed to show what the insulin is doing over the day, without regard to the cat's stress levels. Doing it at home is more accurate in reflecting how your cat uses insulin at home where he lives.

4. Lantus, Levemir, ProZinc, and PZI are good choices. Avoid NPH or Humulin N as these only last 6-8 hours in the cat.
You do not use the insulin pen to inject; you use it as the source of insulin to fill the syringe.

 

[Squeaky and KT (GA)]

Ok thank so much. Every answer I get generates more questions. I've poked around the FDMB website and other resources and I can't seem to concisely get answers to the following:

1. At what BG level does a cat require insulin (as opposed to diet)? Clide is 15.9lbs (down from his 16+lbs. last vet check, but we've been trying to get some weight off of him as he is overweight).

'Normal' BG for a cat is 70 - 120

2. What are the long-term effects of untreated diabetes?

Death by starving while they stuff themselves with food.

Is there a BG level at which treatment would be considered "cusp", meaning it could go either way with diet v. insulin as treatment?

Within the 'normal' range of 70 - 120

3. Per your message - should I have faith in the glucose curve? Clide's pretty calm at the vet's provided you aren't sticking a thermometer in his bum (he hates that). I don't want him to have invalid results. I assume that the day-long, repeated bloodwork is designed to accommodate stress at whatever level?

Why pay the vet to do it? You'll get a more true picture when it's taken in the setting where he spends most of his time - home.

4. Is there a particular type of insulin I should favor?

Can't answer that one, we started on Humulin N and have changed to Lantus.

Avoid?

Humulin N

Are the pens easier than a syringe?

Even if you purchase one of the insulins available in the pens, you'll still use a syringe. The pens only dose on even units, I THINK don't always deliver exact doses. Cats dose on even units, half units, quarter units, big drops, little drops...

That's what I have for now. Thanks for your assistance.

HUGS!

Rena

Lyresa and KT

 

[Larry and Kitties]

I tried using a pen for my Tonis. He was on about 8 units of Levemir. It is a pain compared to using a syringe to get the insulin from the pen and then inject it with the syringe.