Introduction -- diabetes and asthma -- and a question

[kareydk]

Hi, my name is Karen and my sugar kitty's name is Simon. He was simultaneously diagnosed with diabetes and asthma. The asthma was what landed him in the emergency clinic and the diabetes was diagnosed as part of the battery of tests they do.

He has been on lantus for three weeks now. He started at 1 unit for a week, then to 1.5 for a week and now 2.0.

I am not testing heavily right now because his BGC has been high and we know that the severity of his asthma is requiring high doses of prednisolone (he's also on terbutaline for that) -- and that spikes the BG, but the asthma is more critical right now. (I'm hoping and praying that we can get a 24 hour period with no coughing spells -- unfortunately that wasn't today). At any rate, I'm testing just before dinner now since the evening routine of meds and inhalers seems to be less stressful on him than the morning routine, and he's less likely to end up in a coughing spell in the evening than in the morning.

This is my first attempt at using this board -- everyone on the Facebook support group highly recommends it. I'm hoping that I'll find answers to questions here.

One question -- if I get too much blood in an ear poke -- up until just now I've always gotten a small drop, but today I really got him apparently and the drop of blood was the size of an M&M -- can getting too much blood on the test strip skew results? I tried to just touch the strip to the edge of the blood, but he was wiggly. Typically his BGC has been in the mid to upper 300s to low 400s, but just now it was 167. I'm hoping that's not too low to get two units of lantus. He hadn't eaten anything in four hours, other than a couple of treats to tempt him to take his albuterol.

 

[Elizabeth and Bertie]

Hello and welcome Karen and sugarkitty Simon!

I'm so sorry to hear about Simon's health problems, Karen.

Typically his BGC has been in the mid to upper 300s to low 400s, but just now it was 167. I'm hoping that's not too low to get two units of lantus. He hadn't eaten anything in four hours.....

As a general rule we recommend that those new to treating diabetes don't give a shot if the BG is less than 200.
This is just until the care-giver has some data about how their kitty responds to the insulin.
When you say your kitty hasn't eaten in 4 hours, is this because he is off his food? Is he likely to eat when you give him insulin?

One option to not giving the shot is 'stalling': That is, waiting and testing again in half an hour (without feeding) to see if the numbers are coming up to 200 on their own.
Another option could be to give a reduced shot.

I'll post a link to this thread in the Lantus forum to try to get some more eyes here for you.

Eliz

 

[BJM]

Asthma in cats: Fritz The Brave
Once he is somewhat stablized, check out using inhaled steroids for part of his treatment. These will have less impact on his glucose.

Lantus is a depot insulin and its effects build up over 3 to 5 days. If you diligently check before giving insulin, and about 5 to 7 hours after the shot, you will see how low he goes and if it may be safe to slowly shoot at lower numbers and if the dose needs to be adjusted. We track our diabetics glucose and insulin doses on a Google Drive spreadsheet so that it may be shared with others for feedback. Instructions are here

What are you feeding him? We recommend low carb, over the counter canned food with under 10 % calories from carbohydrates. Dr Pierson of Cat Info explains why this is important and discusses what complications may occur with the penchant for feeding dry foods.

If you decide to change his food, you will need to test the glucose as it can drop around 100 mg/dL when you do that.

 

[kareydk]

Simon is on Wellness canned food -- we have weaned him off the dry. He eats the grain free chicken or turkey. The vet had told me no more than 2.5 of the 3 oz. cans per day, but he has been ravenous. Leaping onto counters any time there is a suggestion of food -- whether it's his food or raw carrots or strawberries -- he's there. I checked the can, and based on what I think his weight should be (not the thin version of himself), I think he should be getting three cans per day. So for his late afternoon snack, which I gave immediately after his blood draw, I gave him a half a can instead of the usual 1/4 can. We actually ate dinner without him constantly grabbing at our food. (I lost a half a burger bun that way last weekend).

He does get some treats here and there -- whenever we have to administer his inhaler for either his albuterol or flovent. He doesn't like the inhaler, so we are trying to get him to associate it with a tasty morsel so he fights it less. He still fights it some, but not like in the beginning. I also give him a treat when I poke him for a blood draw. The albuterol treats are the bad for him treats, but until we can get him to accept the inhaler, they seem to work better than the Pure Bites chicken treats, which I give him otherwise.

Of course this reading has to come when both internal medicine vets are out of the office and only the emergency vets are open. His vet does not want me making adjustments to his insulin dose -- she actually doesn't want me testing at all, but I know that their BG levels can come down quickly when they switch to a low carb canned diet, although with the levels of steroids he's getting, it seems like that would counteract the switch to canned.

It's just about dinner time now.

 

[Sue and Oliver (GA)]

Too much (or too little) blood can skew the results. Maybe take another test? Next time, you can get a drop on your fingernail and test from there.

Generally, we think unregulated diabetics should get more food. Their bodies are not able to use the food while their numbers are high. If he were mine, I would increase his food a little. Another thing that sometimes helps is to add some warm water to the wet food and make a gravy. Lots of kitties like this, it helps keep them hydrated and makes them think they are getting more to eat!

 

[julie & punkin (ga)]

sorry i didn't see Elizabeth's post asking for dosing help before you needed to shoot. We do have several kitties with asthma that also use Lantus. I'm going to flag Melissa to come and see if she can give you any suggestions.

We have a template for an essential tool that we use to record blood glucose numbers on - a spreadsheet. It lets us see the blood sugar in context - numbers standing alone don't mean as much as numbers in context. Can you follow the directions there to get a spreadsheet going so we can help you with dosing for your sweet Simon?

Sounds like you're on the right track already - switched to canned low carb food, found FDMB, hometesting, holding the dose for at least a few days at a time. We would normally increase in 0.25u increments so that we can be certain we don't overshoot a good dose. How much does Simon weigh?

We'll be glad to teach you what you need to know to keep him safe and get his blood sugar under control as well as possible. Most of us who use Lantus/Lev post on the Tight Regulation insulin support group. The premise of Tight Reg is that if a cat's BGs are held between 50-120 (ie, tightly regulated) their pancreas can heal and they can go off of insulin and become diet-controlled. The protocol that we follow is here - look about 5 paragraphs down for the PDF called "Management of Diabetic Cats Using Long-Lasting Insulins." Some people print off a copy of it for their vets. It's the only protocol for treating diabetic cats that's been published in a professional veterinary journal.

There's a ton of good information - no one can remember it all from the beginning, so we understand when you just keep asking questions. Here is a great spot for you to start: New to the Group?

When you've got a spreadsheet going (and holler if you need help), i'd invite you to go over to the Lantus Tight Reg support group and post there. Then your posts will get seen quickly by people who can help you with dosing and teach you how Lantus works.

You're on the right track! Kudos to you for searching out help for Simon!! And welcome to FDMB!