Martha with DM, HCM, IBD and CRF

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Hosanna

Hosanna

Member Since 2012
Will try to give you a bit more information about Martha.
1. She was officially diagnosed July 3, 2012. So we are really new! Her BG at diagnosis was 384. Fructosamine was 455 (142-450 range)
2. She is on Lantus. She started at 1 unit on July 5.
3. July 9 BG was 355
4. July 17 --BG was 315 on my home monitor, 297 at the vet's. Increased Lantus to 2 units bid
5. July 22 - BG was 297 on my home monitor-- Increased Lantus to 3 units bid
6. August 5 BG was 278 on home monitor. Increased Lantus to 4 units bid
She is eating primarily both wet and dry Hills M/D, especially formulated for Diabetes. I give her some other foods, such as Fancy Feast, to get her medicines in her. She will NOT be pilled. I am working to get her off Dry altogether but it's slow coming. She is "addicted" to dry kibble. Getting her diet straightened out my goal right now. I believe this can be controlled with diet to get her off the insulin.
It's getting increasingly difficult to give her injections because there are so few places to stick a needle in. Plus she is fighting me more and more on injections. She seems, however, to have settled down and understand the Lantus injections.
MEDICINES: Additionally, she gets budesonide for IBD; benazapril, lasix, baby aspirin (5 mg every 3 days) for HCM; amlodipine for BP; 5 mg Prozac for behavior issues;
SUPPLEMENTS: COQ10 for heart, Potassium, 1500-2000 mcg B12 daily for Neuropathy--She had a BAD case of neuropathy, which is why I took her in and when she was diagnosed with DM, but it is getting a little better now)
I hope this information helps you to help me help Martha. THANK YOU!!!!!
 
Re: Introducing Martha

Welcome! I hope we can help. Can we have some more info? What kind of insulin? What are you feeding her now? What was the timeframe moving from one unit to 4 units? Do you hometest? If not, can we teach you how?

You might also go back to your original post and edit the subject line to include the IBD, CRF and HCM to attract the eyes of people who deal with those issue.
 
Re: Introducing Martha

welcome to FDMB! I'm glad you found us.

Juggling multiple issues is tough, but there are plenty of people here with experience doing that. Hopefully we can help you start putting the pieces together.
 
Re: Introducing Martha

Welcome to FDMB!!

Having a bit more info on Martha and all that you're juggling would be helpful. If we have some additional info, maybe we can help sorting things out. When you have a chance, could you answer the following questions
  • What insulin is Martha on?
  • What medications are you giving Martha?
  • Are you home testing for her diabetes and if so, can you give us several days of test results?
 
Hi,
I hope this is the lady who posted last night on the Feline Heart message board about Martha. Glad to see you made it back on here. Not sure if I have the right person or not as my understanding was that Martha was first diagnosed as diabetic in January. Forgive me if I am mistaken.

All that aside, your vet is increasing the Lantus incorrectly. It should never be increased 1U at a time and certainly not to 4U within a month. Since you have a home monitor to test BGs, the proper way to test is before every shot and then at least once in the middle of the cycle if you can manage that. From the report of your numbers it does not sound like that is being accomplished. Even very fractious cats can be taught to tolerate the BG testing. We have members here who have advice for such cats if it is too difficult to test her more than once a day. You must test before every shot, that's the only way to know if it's safe to give the insulin.

The list of meds you gave was helpful. The budesonide for IBD may be part of the reason you are struggling with insulin doses, but mainly that's because the dose has been managed incorrectly by the vet. Here is some information on how to properly increase Lantus for cats. http://www.tillydiabetes.net/en_6_protocol2.htm Also: http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf Please share them with your vet.
Either method has proven results of getting cats in to remission from diabetes, but first you have to get Martha regulated.

I'm glad to hear you understand how important diet is to managing feline diabetes. It is even more important for cats with IBD. Has anyone discussed trying a raw food diet for Martha? There are lots of cases where a raw diet literally cured cats and dogs of digestive problems. You can find recipes to make your own or you can buy it pre-made from a couple sources online and even some pet stores carry the Nature's Variety raw medallions or order them for you. The online source I can vouch for is http://www.felinespride.com You can get a sample pack from them to try it for her, just call or email them.

Libby is right that there are a lot of pieces to put together here. One thing since I didn't see anyone mention this yet, is that if you take away the dry food, please please lower the insulin dose. I recommend 1U, as long as she is not experiencing any infections and is eating well.

One other thing, what did you mean here?
It's getting increasingly difficult to give her injections because there are so few places to stick a needle in. Plus she is fighting me more and more on injections.
Click to expand...
You can give insulin any place along either side of the body, as well as the scruff. There is some thought that insulin absorbs slower when it's injected in the scruff but I doubt that has been proven. She is not experiencing any sores, is she? I just want to make sure we may not be dealing with a case of Cushing's disease, where they have skin tears. Perhaps you just meant that she is sensitive to the injections? Some cats can be sensitive to Lantus and since the dose is fairly high there may some discomfort for her. Lowering the dose would also help with that.

Hope that covers everything for now. The other best thing to do is keep asking questions. More members will pop in every so often. Between all of us, we'll get this figured out for Martha. If there's something you don't think you'll be able to do, please explain why and we can probably help. Sometimes all it takes is someone who's been there to give a fresh perspective.
 
What I meant about being increasing hard to inject Martha..... She is almost nothing but bones from her neck on down. She is overweight, but most of that is in the belly area. Vet says she is losing muscle mass.
 
Hi Hosanna,

I think I recognize you from the IBD Yahoo Group. I just want to say that I am extremely happy to see you here!! I am no expert on feline diabetes as my kitty, Max, needed insulin for only four weeks, but it was thanks to the amazing people here that Max was OTJ so quickly. I received valuable information and support here which gave me the strength to home test (against the wishes of my vet AND the specialist) and make decisions for my cat that quickly saved him from going hypo back in March and helped him be insulin free. I continue to check in here daily, just to keep myself educated. I am always impressed by the amount of help here and the wealth of information (not just on diabetes, BTW). You've come to the right place!! Good luck!

Heidi
 
I messed up royally last night. Martha was hypoglycemic (--BG, 47 but no real symptoms) and I, not knowing any more than I do about this new threat in our lives, gave her insulin! I realized right away that something didn't "feel right." Then I gave her food, and she was ravenous and devoured two bowls of it. I've been in touch with ER and her vet also, who is going to call again this morning. He said no more insulin for at least two days. I watched her through the night, taking her food several times. She slept a lot but seems okay. This disease is so terrifying.
Heidi, stay educated! Oh I wish I knew more about this horrid disease.
 
Martha's BG this morning is 207. Will we never get this straight! She was very hard this morning to stick her, kept fighting, and I could barely get any blood at all so had to stick her three times to get a reading. She was so docile last night while hypo.
Vet says to check her BG tomorrow morning and give him the reading so he'll know where to go from there. No insulin today, but maybe start up tomorrow at 2-3 units. Does this sound about right?
 
I know food changes can result in sugar changes. I am trying very hard to get her off all dry food. To do this, I am feeding her only Fancy Feast Classic wet food right now. It's very low in carbs. If she should insist on dry, I will feed her the M/D.
Of course she loves FF, and yesterday she did not have any dry food at all. Could this have contributed to the hypo episode last night? We possibly need to consider that also when deciding on dosage?
 
Fundamentally, you didn't do anything wrong. Most of us who have been using Lantus for some time will shoot low. Maybe not quite in the 40s but I do shoot in the 50s. We also don't stop insulin for a couple of days if our cats drop into the 40s. Take a look at Gabby's SS. She dangles her toes in low numbers fairly often. The Tight Regulation protocol, which has been published in a leading vet journal, specifies that one way a cat's dose is reduced if if the cat's numbers drop below 50. We differentiate between low numbers and symptomatic hypoglycemia. All of that said, we generally don't advise someone who is new to using Lantus to shoot low. If you get a number that's below 150 (here on Health people tend to use 200) at shot time, please post for help or skip the shot.

If you ever have a question about what to do and you don't get a response on Health, there is usually someone around on the Lantus TR board pretty much 24/7.

It would be really helpful if you could compile your data on a spreadsheet. It will be much easier for us to provide input regarding your dosing strategy if we can see the full picture. We typically increase doses in 0.25u increments and it seems like your cat's doses were increased in larger amounts. Reducing the dose may be fine, especially if the increases were in large amounts.
 
Hi Hosanna,

You will definitely learn more about diabetes the more you are here. I wish I could give more diabetes advice, but at least I can offer moral support. I spent a lot of time reading and re-reading the articles and old posts on this site. Concerning Martha's food switch.....there is info about food and diet when you first pull up the feline diabetes site. Look on the right side under Education and click on 'diet'. I also typed in various subjects in the search field and was able to read the MANY previous posts. Also, post all your questions! Even if it's the middle of the night, as Sienne said. The people here are very helpful and knowledgeable. Before you restart giving insulin you may want to check here first for some recommendations. Lots of things can affect dosing, including diet change.

Hang in there!
Heidi
 
Of course she loves FF, and yesterday she did not have any dry food at all. Could this have contributed to the hypo episode last night? We possibly need to consider that also when deciding on dosage?
Click to expand...

Yes, that more than likely contributed to the hypo. That is why Vicky advised you to drop the insulin dosage if you wanted to eliminate dry food all together. The carbs in the dry food keeps the BG high, just like soda and candy would do to a diabetic human. 4u is a big dose, and to be honest, the dry food was probably the only thing saving Martha from a hypo all this time.
 
Sienne and Gabby said:
Fundamentally, you didn't do anything wrong. Most of us who have been using Lantus for some time will shoot low.
Click to expand...

Would you say that if Martha was in a diabetic coma this morning???

Sienne, I am sorry to be blunt but telling a newbie who has been shooting 4U of Lantus they didn't do anything wrong by shooting insulin on a BG of 47 when they do not have any type of compiled BG data is horrendously poor support. Those who shoot low BGs do so because they have compiled the data that proves it is safe and is needed to maintain normal BGs, that is how Tight Regulation works. Anytime we are dealing with someone so new we should not tell them it's fundamentally OK to shoot low to stay low. They simply don't yet understand. And we don't have the data to know what is fundamentally OK for that cat either.

The good thing here is that Hosanna knows it was a mistake in judgment and she was able to save Martha and that Martha ate so good to keep her BG from bottoming out. Ry is right that the dry food is probably what has prevented Martha from a severe hypo all along.

Hosanna, there is a possibility that Martha might be more sensitive to the Lantus after the low last night, so please please don't let the vet convince you that 3U is still acceptable, especially if you're going to continue feeding Fancy Feast (make sure it is the "classic" varieties). That alone can cause her insulin needs to drop by more than half. 2U might be OK, but the proper way to dose Lantus is start with 1U, hometest on a regular basis, determine the lowest BG during several cycles and raise or lower dose in .25U increments accordingly.

You're going to continue running in circles with Martha's treatment unless you get a baseline, 1U is that baseline. As long as Martha is eating well and not suffering from any infections it should be safe to do that, but I have to be forthright and explain lowering the dose that much may come with the risk of ketones. We would like to see you test for ketones, if no one's explained that to you yet, please ask. It's important to test for ketones if you lower the dose to 1U at this point.
 
Wednesday afternoon: Martha had NO dry food at all yesterday, she hypo'd last night. I thought I might better give her a little dry today and measured out 1/8th cup. I gave her half of that, but she only ate a little, then was back wanting canned food. I have her on only Fancy Feast Classic. If this keeps us, she will soon be off dry!
But what to do about food and insulin? I'm afraid the vet is going to put her on a high dose of the Lantus, maybe 3 units. After reading what I've been reading, I am not comfortable with that. I mentioned to him about the food change but he "doubted that it had anything to do with last night's hypo." This is an excellent vet--an internist who has treated Martha for five years now for different illnesses.
Now I'm learning I need to measure ketones--how to do that?-- and increases of .25 and all kinds of things. My head is spinning! All of this is so overwhelming. Just thinking of poor little Martha having to depend on me almost makes me want to cry.
 
There are two ways to measure ketones. The easiest and least expensive is to pick up Ketostix at any pharmacy. These are strips that have a swatch at the end. You dip the swatch into Martha's urine stream and after 15 sec. (or whatever the instructions are on the box) compare the color of the swatch to the colors on the box.

The expensive way to measure ketones is to get a blood ketone meter. The strips are very pricey. There are advantages to the meter -- blood ketones give you a level that tells you what the ketone level is at the moment. With urinary ketones, it tells you what the level was a couple of hours ago. The majority of people use Ketostix unless they have a cat that's prone to ketones.

Vicky, reading the entire paragraph rather than a single sentence is generally advised:
Fundamentally, you didn't do anything wrong. Most of us who have been using Lantus for some time will shoot low. Maybe not quite in the 40s but I do shoot in the 50s. We also don't stop insulin for a couple of days if our cats drop into the 40s. Take a look at Gabby's SS. She dangles her toes in low numbers fairly often. The Tight Regulation protocol, which has been published in a leading vet journal, specifies that one way a cat's dose is reduced if if the cat's numbers drop below 50. We differentiate between low numbers and symptomatic hypoglycemia. All of that said, we generally don't advise someone who is new to using Lantus to shoot low. If you get a number that's below 150 (here on Health people tend to use 200) at shot time, please post for help or skip the shot.
Click to expand...
I bolded the last sentence so you could more clearly understand what I said rather than getting yourself in a twist. Maybe you missed the last sentence in your effort to overreact.
 
Can someone help me decide whether or not to try keeping her on all canned food, as she has been today and yesterday---or mixing up the dry and wet as before? The change in food certainly had an effect on her sugar, I don't want that happening again.
Also, can someone simplify how I should respond to the vet tomorrow if he's wanting to put her on 3 units?
I cannot be checking her BG several times a day, or even continue at twice a day. Her little ear is already ragged from my sticks, and she is very tired of it--growling and hissing.
I hope I don't sound as though I'm not willing to do all I can for her because THAT IS NOT THE CASE. It's just that I can only do so much at once time.
I will appreciate your guidance.
 
Well, I keep posting but not getting the responses I need. I will add this one. Martha had to go to the vet today for the glucose testing since I could not get any blood, and then when I did, the meter broke. anyway, her BG was 297. Which means vet put her back on 2 units Lantus bid.
 
The dose should not ever be based on a single test at the vet. Please remember that stress can raise the blood glucose, 100+ points is normal - it even happens to nondiabetic cats. This can lead your vet to put your cat on too high of a dose, so that when you get home your cat drops and hypos. Vets dosing this way has killed cats.

Putting her on 100% canned is your best shot at regulation/remission. You should be adjusting her insulin dose to reflect the low blood glucose, not her diet. Martha already hypoed on 4 units and I would be hesitant to start her at 2. She has shown great response to the low carb diet. I, personally, would switch her to 100% low carb and start your insulin at 1u or even 0.5u and go up from there. Remember, you can always raise the insulin dose, but once the insulin is in your cat, you can't get it out. It is safer to start low and go up than start too high and have to deal with hypos and bouncing numbers.

I would NOT give Martha 2u if your meter is broken. Not testing is extremely dangerous and we cannot really give you advice if we don't know how the insulin is affecting Martha's numbers, as it might be putting her at risk. Growl and hiss she might, but making her ear a bit sore and having her hiss is a lot better than having her die from a hypo. You HAVE to test her. Even if you have to wrap her in a towel and sit on her, please at LEAST test her before you give her more insulin. I went through the same testing struggles with Scooter. Everyone does in the start. Remember to give her praise and treats after testing, even if you're unsuccessful. It's for her own safety.
 
Hosanna,

Try asking your questions in a new post. That will bring more sets of eyes and bump you higher on the posting list. Don't stop asking your questions. BTW...my vote would be to get Martha on wet food exclusively. And REALLY watch the insulin dosing if you do switch to wet food only, as other's have already posted above. There is some GREAT information in their responses. You'll want to watch Martha's BG numbers at various times during the day, not just before meals so a new meter is in order. I use the Relion Micro from WalMart. I still check Max's BG once a month even though he doesn't get insulin anymore. Just did all the civvie's yesterday, too, just to be sure.
 
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