Introducing Q and Robin

Status
Not open for further replies.
Q

Qlove

Member
Hello,
My name is Robin and my sugarcat is Q. We are not new to feline diabetes, but we are new members of the FDMB.

Some history:
Q is a female blended calico (mostly black) and is about 14 years old as of this month. She was diagnosed 4 years ago. Initially we were going to try diet change to control her high numbers, but it was too late, and Q was hospitalized due to lack of appetite, dehydration and vomiting and diarrhea.

At the hospital she was re-hydrated and they started her on PZI insulin. She was able to come home fairly quickly. We were instructed to dose her 2xdaily with 2u PZI. We continued this (without obvious problems) until Idexx discontinued the PZI. During that time, I was able to switch her from a total diet of dry food, (and gobs of it, it would seem) to a main diet of Evo canned and Evo Cat & Kitten dry food. (Q was a dry-food addict.) Eventually, Q started turning her nose up at the Evo canned, so we switched to Wellness grain-free canned.

The PZI was switched to Lantus (glargine) a little over a year ago. My vet failed to tell me that I would need to change syringes from the U-40 I was using with the PZI to U-100, but told me to continue giving 2 units BID. After almost 3 months, I realized the difference between the syringes. I bought U-100 syringes, but began using them to measure 5u BID-since she did not have seem to problems with the dose in the U-40 syringes.

As a side note: in retrospect I am disconcerted by the knowledge my learned vets failed to pass on to unlearned me. I feel somewhat guilty, except for the fact that I trusted my vets to give me the information I needed to properly care for my cat. I now know that I need to be more proactive, ask questions, doubt that I am getting all the information, and if necessary, get second opinions. (I will add here that I live in Anchorage, Alaska, USA and while a booming city of nearly 300,000 people, our vet pool-at least of what I would call quality vets-is limited.)

Recent events:
Q was dosed blind 2xdaily with 5u of glargine up until July 1, 2011 when she went into insulin shock just as I was waking to go to work. Thankfully, we have a bond, and I was able to recognize that something was wrong, and acted quickly with corn syrup. This had very quick results! I was then able to get her to eat and took the day off from work to observe her the rest of the day. It also happened to be a holiday weekend, so I was able to be home with her for 4 days starting that Friday morning. I monitored and began doing research online. Furiously researching-until my brain hurt. I searched through some of FDMB posts, your diabetic cat website and a few others and I stumbled on the information about Tight regulation.

Since Sunday, July 3, 2011 I have been home testing Q using a ReliOn Micro. I have yet to start using strips to test her urine, but I will. Sunday was a learning day. July 4th was a first attempt (failed) at getting a BG curve at home. I say failed, because Q and I were still adjusting to the home testing process...plus I was still withholding any insulin until I was sure we were not going to overdose again.

The rest of this last week, I tested before shooting. If her levels showed 150mg/dL or below I didn't dose any insulin.

After more research and as of Thursday July 8th, I have started the following:
0.25u/kg of her ideal weight 2xdaily. Testing before shooting. Yesterday was the first day I was able to be at home and try another BG curve. I tested her every hour. I watched what eating did, what the insulin did, how long it lasted, but most importantly was focusing on testing before shooting and watching her clinical signs.

I feel pretty good about the numbers we are getting. (Since testing began: lowest reading was 79mg/dL and highest was 211mg/dL) As of today's post we have yet to complete an entire week of the new dose (1u BID), and today, except for prior to shooting, I'm giving poor Q's ears a rest before I try another BG curve tomorrow.

So far, I do not even have my vet's "permission" to change the dose, but I'm doing it anyway. I am interested in trying TR with Q. I am NOT interested in repeating another insulin shock episode, but I feel ready to handle it. We have not officially started any TR, but I think it may be possible. I have read and reread the:

"RoompK, RAND JS Evaluation of intensive blood glucose control using glargine in diabetic cats. Vet Intern Med 2008; 22 (3):770; RoompK, RAND JS Factors predictive of non-insulin dependence in diabetic cats initially treated with insulin. Vet Intern Med 2008; 22 (3):791; and Roomp and Rand, unpublished data"

a pdf document that I found somewhere in my recent researching, and I really want to try TR with glargine. I understand that a so-called remission may not be possible for Q since she was diagnosed so long ago, but I am keen to give her the best health I can, the best quality of life I can, in the hopes that she can give me the best companionship that she can. I love my special kitty!

I am now only feeding Wellness grain-free, some FF original, (and Evo cat & kitten dry as treat-only), but I am thinking about trying other brands, and maybe even raw foods. I haven't yet, but I plan to buy "Dr. Pitcairn's New Complete Guide to Natural Health for Dogs and Cats" for some raw food recipes.

I hope to join the ISG for glarine, and learn more about TR for Q.

So far my questions are:
The ReliOn Micro reads in plasma values. Do I "convert" them to whole blood? and if so how? (in order to compare my results with the TR protocol)
How much does eating grass (Q loves grass!!!-doesn't vomit, just loves to eat some every day) affect the whole "avoid grains" issue.
Q does not display signs of neuropathy, but she's fat (approx. 14lbs., when she should be about 9lbs.) and I think it strains her walking, playing and even breathing. I'd like her to get closer to her ideal weight. How should I go about this?

Q seems happy. She's a real trooper. She doesn't like the testing, but she's not holding any grudges. She still wants to get in my lap, still purrs when I give her attention, and still cuddles up with me at night. She's tough as nails, sweeter than glucose ;-) and just about the best friend I have ever had. Please help me give her what she deserves.

Since this is my intro post, I am sure I have left things out--not used all the jargon that many members are comfortable using. I am sorry for that. Personally, I feel that this message board can overwhelm newbies. I do not need to post daily. I do not feel that I need to learn how to give shots. I just have a few questions here and there, since I have no real Vet advice yet. I will be searching for a new vet, but in the meantime, I need to make sure Q's glucose stays under control, doesn't put her into Hypo, and doesn't damage her precious organs.

Thanks in advance,
Ms. Robin.
 
I posted a link over on the Lantus forum to see if some people can be of assistance for you. Cedric was on Lantus for a month, but he is now in diet control remission. He eats mostly wellness and evo, though I am trying to find some othjer grain free brands to try to give him some variety.

I have a relion micro and am totaly confused about your comments regarding plasma. As far as I know, it's a human meter that reads blood glucose levels. It might do other stuff too, but I never figured that out. I have been using it since April, and just used it on cedric this afternoon without issues.

I tempt Cedric with some Evo grain free treats and Drs Foster & Smith dried chicken treats when I test him. I set the packages out in our spot and he lets me poke at him (purring the whole time but not liking it) until he gets one of each when I finally get the blood. :smile:

good luck to you.
 
In the front of my user manual for the ReliOn Micro it states:
"This system measures blood glucose in fresh capillary whole blood. The results are shown as plasma values. This makes it easy to compare the ReliOn micro Blood Glucose Meter and lab results."

When I read about tight regulation, I read that the protocol is based on whole blood values and not plasma values. So I feel that I might be comparing apples to oranges, so to speak.

It makes me worry that Q's 79mg/dL might be a figure that is 10% higher than her actual value. Not so alarming on the high end, but somewhat alarming on the low end, if you get my meaning.

The pdf article I read (Roomp, Rand University of Queensland) states:
"NB. The blood glucose values were based on using portable glucose meters (Ascensia Contour, Bayer,
Leverkusen, Germany; Accu-Chek Aviva, Roche Diagnostics, Basel, Switzerland) which use ≤0.6 μL of
blood per test. These meters measure blood glucose concentration in whole blood and are calibrated for
use with human blood. Measurements from meters calibrated for human blood which provide plasma equivalent
values are approximately 10% higher."

So do I need to do some conversions? Do I need to get one of the meters mentioned in the article? I went with the ReliOn because it (the test strips) was more affordable for me.
 
Welcome Robin!

I usually spend most of my time over on the Lantus board but, as Jesse (Doombuggy) noted, she cross-posted asking for folks to stop by.

If you've looked at the Roomp & Rand (2008) article, they give 2 tables with the TR protocol. The Relion, and all other human meters for that matter, rely on the first table. You don't need to do any data conversion. The vast majority of people here use a human meter. The alternatives, either an AlphaTrack or serum chemistry analyzer, do rely on plasma rather than whole blood. There is a small difference in the results -- those meters read higher than human glucometers.

While you're in the process of getting comfortable with home testing -- and congrats for getting started -- you may want to visit the Lantus ISG and read over the starred, sticky notes at the top of the Board. We do follow the TR protocol and we have a great deal of information available. Below is an overview of the content with links.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published 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/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
With regard to food and weight issues, one of my favorite sites is a wonderful site on feline nutrition that's authored by a vet, Lisa Pierson, DVM. In addition, if you've not already come across it, Janet & Binky's food charts has information on basic nutrition and carb counts for most of the available cat foods.

I'd also encourage you to put together a spreadsheet. Now that you're home testing, keeping track of Q's blood glucose tests will help you to see patterns and watch her progress. We use a spreadsheet template that's available through Google documents. Google has been a little glitchy lately so if you have trouble with the link, post in the Tech Center for help. If you are planning on joining us on the Lantus Board, having a spreadsheet will be very helpful since we are very numbers driven there.
 
We use Lantus but I'm not in the Lantus board.

The spread sheat is very crucial and something really good that you should set up.


Our experience with tight regulation:

Simba was and is very hard to regulate, and when in 2008 he constantly was at the 400-600's in bg numbers, I decided to try and get a firm grip over his bg, and started splitting the entire day dosage, into 4 different shots over a day with 6 hours apart.

But before I did this, I had done a lot of testing, a lot, really a lot, so I knew a lot.

It worked fine for a while, but every now and then Simba throws a very long lasting on one insulin shot, and I was keeping him so tight in the bgs, that he ended up in a very severe hypo and got brain damages from that.

So I went back to giving insulin shots twice a day, but 3 U BID didn't do it, 4 U BID didn't do it, finally 5 U BID did it .... however he again ended up in a very severe hypo in January this year, after a years perfect regulation on 5 U.

Simba is just that kind of guy.

After this last time in January this year, I have let him swing and started over at 1 ½ U BID, but that didn't do it. At the moment I am keeping him at 2 U BID but fear he will end up in a hypo from that too.


For all my testing I've used a normal human meter, the Bayer Ascensia Contour. I don't go by the plasma bg at all. Instead I use the Fructosamine test to "check-off" the dosage besides the ordinary bg testing at home.
 
I _am_ keeping a spreadsheet, but it was one I made up--just to have something and I haven't switch it over to the template I was able to get off google docs last night.

And NOW Q has decided to use her Lantus reserves I think, because at+24 her level is still lower than it was yesterday(113mg/dl). Last night, when at PMPS (or +12) she was at 82, +13=72, +14=86, I decided not to dose her and continue checking to see when it began to rise. At +15=73, +16=73, and +17=73. I wasn't able to stay up all night last night to test her every hour, but I've about decided that I needed to do a full 24 hour curve for 1 dose! Today AMPS she was at 95 and that's after some food, too! I know I'm knew to testing, but I don't know what the heck is going on, and I REALLY don't want to put her into hypo again. I'm scared to dose her (the 1u I was going to try BID), if her AMPS is 95.

Is it possible to regulate a cat on a single dose per 24hrs?
Is it possible her pancreas is trying to kick in?

Perhaps I should be starting a new thread, but I'm really struggling. I'm only just over 1 week doing ANY testing, and I can only do these full curves on the weekends, unless I take time off from work, which I cannot afford if I'm going to need to buy test strips. I read last night about overlap, but at this point I'm not seeing a real rise yet, so how do I know when to start the overlap?

Watching her clinically today, she seems happy and healthy. I was even able to watch her pee (and kicking myself for not having the urine strips, yet) this morning, and it's not a gross amount. She hasn't been consuming tons of water, and her food intake, while less than it used to be, is not really showing signs of a loss of appetite. Her hair is silky and shiny. She still wanted to go outside and walk around the yard. She still wanted to get in my lap and purr this morning, despite some difficulty finding the sweet spot with the lancet.

I know that 70-95 is still technically high for a non-diabetic cat, but I'm scared to dose her knowing that 1u can make her drop potentially to too-low numbers. I just don't know what to do. Keep withholding insulin until I see reading around 150? Keep withholding insulin until I see a reading back up over 100? Give her reduced dose of insulin and watch her closely for Hypo? And now, the day is burning, and I need to consider what time I will "have to" dose her before work tomorrow! I just don't know. I'm tired now too, since I stayed up so late testing her.

I'm only sure of one thing, and that is that I need to keep testing her. I need more data! I just hope I'm not damaging her organs while I'm collecting the data I need. I will work on completing the SS and figuring out how to post it for anyone who wants to see. My data is only a week worth, and only a single 12hr curve, and then this odd continued single dose insulin action situation---there just isn't enough information yet.
~Robin
 
70-95 is still technically high for a non-diabetic cat
Click to expand...
No, it is not.

mmol/L mg/dL(US)
<2.2 <40 Readings below this level are usually considered hypoglycemic when giving insulin, even if you see no symptoms of it. Treat immediately[26]

2.2-7.5 40-130 Non-diabetic range (usually unsafe to aim for when on insulin, unless your control is very good). These numbers, when not giving insulin, are very good news.

3.38-6.88 61-124 This is an average non-diabetic cat's level, but leaves little margin of safety for a diabetic on insulin. Don't aim for this range, but don't panic if you see it, either. If the number is not falling, it's healthy. [/color]5 90 A commonly cited minimum safe value for the lowest blood sugar of the day

5.5-10 100-180 Commonly used target range for diabetics, for as much of the time as possible.

7.8 140 According to the American Association of Clinical Endocrinologists (AACE),[30] threshold above which organ and pancreatic damage may begin.[31]

<13.33-15 240[32]-270 Feline Renal threshold for glucose, when excess glucose from the kidneys spills into the urine and roughly when the cat begins to show diabetic symptoms. See Hyperglycemia for long-term effects of high blood glucose on cats.

16.7 300 Approximate maximum safe value for the highest blood sugar of the day, in cats, to avoid neuropathy and complications. Some cats can go on long-term at this level or higher, but there will be side effects eventually. Check for ketones.

>20 >360 Check for ketones frequently, be sure you are giving insulin. Cats are much more resilient than dogs or humans at these high levels; nevertheless, the blood sugar should be lowered. The cat can feel any of numerous ill effects both short and long-term, see hyperglycemia for details.
 
40-130 Non-diabetic range (usually unsafe to aim for when on insulin, unless your control is very good). These numbers, when not giving insulin, are very good news.
Click to expand...

Now I really don't know what to do. Should I continue to withhold the insulin until or unless I begin to see a higher range over 130? Is this her pancreas trying to kick start again?

For now I will keep testing. Thanks for helping me not kill my cat.
 
I dosed 1u 26 hours ago. I just took another reading and she's at 96mg/dL. This is up from 95mg/dL from 2 hours ago. She had eaten before the +24 reading and she has since eaten a little more.
 
I'd hold off for now. I believe you probably do have pancreatic action going on here. Going forward you might want to reduce the dose to 1/2U BID, if it were my cat, I'd want to be able to shoot every 12 hours because of the shed and keeping it full, so finding the right lower dose would be beneficial.

I'm not an expert, hopefully others can better explain things.

It's great that you're hometesting now and it looks like Q is doing a wonderful job too :)
 
There is no way on God's green earth I would give her insulin. Just test her, get some more numbers, and hold off on the insulin. We always say "better too high for one day than too low". Sometimes, it can happen, that a hypo will start/put a cat into remission.
 
Our vets don't want me to give any insulin if Simba is 180 or lower.


If he would be I would try a low dose.


So better to hold the insulin and keep testing.
 
I had also heard that a Hypo even could start/put a cat into remission, but that it may not last.

Her Hypo event was 07/01 (11 days ago) Since then, she's had some intermittent doses, not a regular BID schedule... By far though, 73mg/dL is the lowest number I have seen since I began testing 8 days ago. Her highest was 211mg/dL, but that was before I switched the EVO dry from a portion of her daily calories to treat-only servings. I heard that over 200, the glucose spills, and that I might see it if I tested her urine, which I have yet to do.

I will withhold insulin and continue testing, even if it's years before her BG shows a rising pattern, I will keep testing.

Thank you all for not judging me, and simply helping. It's so hard not to blame myself for all this....I was the one that fed her a sole diet of crunchy food, once upon a time. I was the one that watched her gain weight. I was the one that watched her urine get out of control, but didn't get it to the vets attention until it was too late and she ended up in the hospital. I was the one that thought it was OK to dose blindly. Now, I'm facing this learning curve and nearly putting her into another HYPO.

Thank you again and again and again!!!
 
Guilt trips are not allowed here. :mrgreen: We have never gathered statistics, but I would guess the vast majority of us gave our kitties dry food. We sure did. We fed Oliver Science Diet Light for years and kept waiting for him to lose weight. We never read that it wasn't a good idea. I am sure it, and his weight, tipped him into diabetes.

What matters now is what you do from now on. And for now, you are doing great!
 
Robin, you're the one who loves her unconditionally and would do anything for her. The only thing I see is someone who dearly loves Q. Tons of (((hugs)))
 
:smile: :cry: :smile:
How is it that perfect strangers can make you feel better and make you cry at the same time?

I do feel better than I have in a week, which I think is why the tears came out just now. I AM trying to do anything and everything for Q. I will try to just forgive myself and focus on what comes next.

Happytails to you!
 
Status
Not open for further replies.
Back
Top