Miss Rugs and the wild ride

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Ruthe and Smokey (GA)

Ruthe and Smokey (GA)

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Ok...different cat absolutely means different dosing! WAY different. Whereas Smokey was a very high dose cat, Miss Rugs is different.

Friday
AM preshot was 336 ( but didn't pick up insulin till pm so no shot)
PM preshot - 405 I unit
+4 76
+6 38 - non symphomatic - feed small amount of "crunchies"
+8 211

Saturday
AM preshot 228 - no shot
Met with vet and he suggested giving her the day to "reset" and reduce to 1/2 unit
10 PM 415 1/2 unit
+5 235

Sunday
9:15 AM (+11) 98 - no shot
1:10 PM (+15) 147 - no shot - was going to be out for 6 hours
7:30 PM (+21.5) 411 - 1/2 unit

Going to stay up to get a +4 shot before I turn in. I know that with Smokey, I would think nothing of giving a full dose at that 98, but this is a different cat with way different reactions. I don't want her to be going up into the 400s, but I am out of the house for 10 hours and am at least 45 minutes away so can't do the spot checks like I used to at lunchtime. I need to feel that she will be safe while i am gone. Am going to get some 1/2 unit marked syringes so I can give her smaller doses. Never dreamed I would be saying those words!

She isn't liking testing so I got some Liv a Littles that she gets only when I test her. She and the rest of the crew REALLY like them!

My cats all free feed canned food and I am not going to change that. They eat a little bit of everything from 9 Lives & Friskies to Fancy Feast to Wellness and Merrick and Tiki Cat. They are all 14 & 15 and do best when they can graze freely. Change is very stressful and after moving in August, the last thing I want is to stress them out with another change. It will take a little tweaking but I know we can get it to work.

Will keep y'all updated when I can.

xoxo
Ruthe and Miss Rugs
 
FWIW, I don't think there is anything wrong with free feeding as long as it IS low carb canned...

I am certain that is the preferred method actually- easier on the pancreas and such.

Just have to take into account the cat may have just eatned and working a food spike when you test.

( I meal feed BID w/shot cuz so many kittehs and they eat everything in front of them and leave nothing for later!)

Anyhoo- I also agree with you on cutting back the dose. For those of us not hime to test all day, it IS scary to leave them in unknown BG territory.

Keep up the great work! :thumbup
 
I'd say her reaction is pretty good!

However, with Lev you really don't want to be skipping shots, that's why she went up to 400, probably with a little rebound thrown in from the 38. Editing to add: however, if the cat shows a possibility of being an OTJ cat, yes, you may need to skip shots, but lowering the dose is the first line of defense rather than skipping shots altogether.

I suggest reducing even further to .25U, start low, go slow works very well for Levemir, but you sometimes have to start really low depending on the cat's reaction.

Sheila will probably drop in and offer her sage advice on low doses.

Miss Rugs is doing very well though!
 
She dropped again last night into the low 100s from low 400s again in + 4.5. She ate some food and we both stared at each other for the rest of the night - well we both slept with one eye open is probably a better description! I think her morning test was in the 140s - but don't quote me. Turning 50 and being sleep deprived is not a good combination! I will get her numbers on a spreadsheet soon so that it is easier to che

I was thinking yesterday that I am going to have to pick up some syringes with 1/2 unit marks as there is no way my old eyes could figure out a 1/4 on the full unit syringes at this point! Since she needs such a small amount, I will more than likely keep her at once a day for now until I can mess around safely with it next weekend. With the drop she gets at 400 with 1/2 unit, I wouldn't feel comfortable shooting 1/4 on a lower number unless I would be hanging out with her for most of the day. She is spending too much time hiding under furniture and I don't want her to live in fear of the big old One Touch or worse yet fear of her Mom! It took her till about age 10 to let me pet her so I don't want to go backwards. Maybe in time she won't mind the testing as much, but for now, I want her to chill.
 
Hey, Ruthe. Can you get some half unit syringes in the next few days - they sell them at Walmart, maybe you can get one pack to tide you over.

I do think that the sooner you can get her on bid dosing - with a lower dose - the better she will feel. My guys are both micro-dose cats. Go figure. Beau is OTJ, and Jeddie was, but is needing some insulin these days. He gets .15u bid. With that his PS's are in the mid/upper 100s and nadirs are about 80. If I skip a shot because he is in the lower 100s at PS then he is in the mid/high 200s at the next PS which I don't like to see.

Not saying you need to be dosing less that .25u right now, but you may if she sarts to head OTJ. I found with Beau, who was on .3u for a while, that when he was going OTG it worked best to keep bid dosing as long as possible BUT I could not give him any insulin below about 140, even when he was getting .05u (I kid you not!) because he would drop into the 30s. If I skipped he tended to creep upwards. Eventually he was getting sid and skipping a few days, etc.

There's a technique for getting the .1u dose changes if you are interested. I think you will need to be prepared to do this with her soon enough. Those drops to really low are an indication of too much insulin for sure. And, yeah, it involves taking oiff glasses and/or using readers, lol!

Take a look and Jeddie's (and/or Beau's) spreadsheets to see how they react to the small doses.
 
Just posted this above for Mindy:

WalMArt Brand ReliOn Syringe comes in BLUE ( not gray) box with purple stripe.

Should read:

U100, 3/10 mL/cc capacity, 31 gauge, 8mm length SHORT Needle

About $13 for 100 count

;-)
 
She ate some food and we both stared at each other for the rest of the night - well we both slept with one eye open is probably a better description!

Oh man how i hate those nights!! It's a good thing Molly can't talk cause if she could she'd clearly tell me to back the hell off.

Everyone else already offerred great advice so i get to add the good and fluffy comments :-D Like the Halo Liv-a-Littles..all my cats love em!! The only thing is that i find so many of pieces are so incredibly hard that i can't even give them thus wasting so much of the container. Someone on this site, ages ago, told me about the brand called BeefEaters. They have a large variety of freeze dried treats for cats and dogs. They are far superior to the Liv-a-littles in quality and price. Do you have PetSmarts near you? Around here i can get a margerine size tub for $6.50 and holy cow how the cats love them!!! One of the civies has learned that they get a treat after i do something with the bead of blood on Molly's ear and has actually started licking the blood bead before i can get to it (damn cute cat, not to bright!). See if you can find that brand - better quality for less money.

Keep us updated on Little Ms. Riggs!!
 
Ugh...427 at about +24. Do I need a prescription at Walmart for the syringes? Not sure when I can get there.Might be easier to order them online from Hocks. I think that I eyeballed somewhere between 1/4 and 1/2 unit tonight...couldn't find my magnifying glass. I am hoping to get more readings this weekend. No way to do BID during the week with the drops she is getting from the 400s. My boss isn't impressed with my being distracted the way it is - strictly menopause related - add in the worried about the cat part and he will have an ad on craigslist for my job in a blink! So we will do what we can Mon thru Friday and then push it when we can on weekends to start.

Thanks for all the info and suggestions..all is most welcome!

Ruthe and Miss Rugs
 
Ruthe and Smokey (GA) said:
This morning at +11...115. I wish I could be home during the day to see what the rest of the day brings...Saturday is coming though....
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So did you shoot anything? That is rough not being able to check her during the day. I remember when you would take Smokey to work with you....different job! Doesn't sound like this boss is as accommodating.

What did you think of the hyper-t possibility?
 
Hi Pam,

I did not shoot this morning. With her dropping so much from 1/4 - 1/2 unit when she is in the 400s, at this point, I don't feel comfortable shooting and leaving for 10 hours. *sigh*. I am picking up some syringes tonight with 1/2 unit markings so that I can better gauge the 1/2, 1/4 and everything in between and less! Found my magnifying glass and will be all set!

I forgot all about asking my vet about the Hyper -T! Duh! I had to go down to pick up her Zeniquin last Saturday and he had stopped in the office so I was able to talk to him a little bit. After that drop she had from 1 unit of Levemir, I was thinking that maybe she wasn't d But the glucose was in her urine and that sealed the deal for him. Would that happen if it was something other than Diabetes?? He is open to anything and I am guessing that I would have to bring her back down to his office for new blood to be drawn for Hyper T? I doubt they hang on to the blood or they could use that. Their office is 45 minutes away in good traffic. I will be talking to him about her numbers and throw it by him for his opinion.

xoxo
Ruthe and Rugs
 
Well, I guess I was thinking they could be happening concurrently with one aggravating the other so to speak because of her age and the fact that she has been on canned food for years, why would she become diabetic? Also because her numbers are so erratic and her needing so little insulin.

"Considerations for Diabetics (and hyperthyroidism)
Since both hyperthyroidism and diabetes are common in older cats it is often necessary to deal with both conditions. Usually, the cat has one disease, which is being treated, then the second disease begins and must be dealt with.

If your cat is hyperthyroid first, you will probably have started therapy and gotten the thyroid hormone levels near normal. Then if the cat then becomes diabetic, the hyperthyroidism (which is controlled) probably won't play a major role in the diabetes management.

The situation is a bit more complicated if the cat is diabetic, then becomes hyperthyroid too. Since hyperthyroidism has similar signs as diabetes (increased appetite, drinking, urination, and weight loss), a cat that is diabetic who continues to show these signs may be thought of as just needing additional diabetes management care. But the possibility of hyperthyroidism should not be overlooked. Since hyperthyroidism causes a general increase in the body's metabolic rate, it will have an effect on the diabetes and diabetes management. Often, a cat that is hyperthyroid requires higher doses of insulin in order to maintain the blood glucose levels near normal. As the hyperthyroidism is brought under control, the metabolism slows to a more normal rate, and the insulin dose needs to be adjusted. Pre-existing diabetes will probably have an effect on which hyperthyroid treatment option is used."

But if this were the case then it seems like she would need more insulin than it seems she needs. So I guess I would just ask your vet if he thinks it is a possibility. He may have tested her and ruled this out so didn't even mention it to you. Did you get copies of the blood work?

I was meaning to ask, just curious, you said in an earlier post that she had pyometra a while ago...is that because she wasn't spayed?

I forget, why is she on the Zeniquin? She has an infection somewhere? Maybe that is the reason her numbers are so erratic then.

If so that is worrisome for ketones if she is not getting enough insulin.
 
Yikes...I had a nice long replay and I have no idea where it went! Ugh!

I do have copies of her test results. There is a T4 listed and her results are 1.1 (ref range is 0.8 - 4.0). I believe this is for HyperT correct?

She is on Zeniquin for a UTI. She has had them in the past and Zen worked great. I couldn't do go for the culture so I went with what has worked in the past and my vet was ok with that. On her Urinalysis it says that her pH is high at 8.0 (ref range is 5.5 - 7.0); Ketones negative; Glucose strip 2+ High - RBC/HPF 4-10 high (ref range is 0-3).Occult Blood 1+ high

Blood work shows Glucose high at 365 - Magnesium low, Na/K ratio low, chloride low - cholesteraol crazy high at 428 and triglyceride high at 179. HGB is low at 8.3 (ref range is (9.3 - 15.9) and HCT is 25 low (ref range is 29-48).

She had pymetra because she had not been spayed. I believe that all happened in 2001 or 2002.

I came home and the cats had hardly eaten any food. So I am taking them off the FF/Friskies/etc and they are on Wellness and Merrick and pepcid. No one is puking but something has changed with them since the new style FF cans came out. They just aren't interested. Not sure if I gave Rugs 1/4 or 1/8. I went to Walmart and got the syringes with the 1/2 unit markings. She got something between none and 1/4 - Her preshot was 206 which I attibute to her not eating much. She is eating right now and I am very glad!

Any thoughts?
 
You're not the only one whose cats haven't taken to the new FF formulas. They're going to lose customers, that's for sure and it sucks because it's been the go-to food for FDMB for a long time. I remember when I first read that FD kitties could have certain FF foods - I was so relieved because I used to get FF as "treats" for them and knew Gandalf loved it! I just always thought it was "snack" food and that Science Diet was the end all/be all of cat foods. Ugh.

If you can duplicate the dose you did again, you might have success getting her better controlled with such small doses. Yes, a lower preshot can mean they didn't eat much. Was that a +12 preshot?

I'll let someone else handle the Hyper-T questions. Gandalf did not have hyper-T, but had a parathyroid tumor removed over a year ago, so we watched his T's. I had the vet do free-T4 values too, but they always came back within normal, even though he had the tumor.
 
Ruthe and Smokey (GA) said:
Yikes...I had a nice long replay and I have no idea where it went! Ugh!
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Hate when that happens!

I do have copies of her test results. There is a T4 listed and her results are 1.1 (ref range is 0.8 - 4.0). I believe this is for HyperT correct?
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Yes, it is. Sometimes at the mid to high normal, people then request to have a Free T-4 by ED run to confirm. So I am sure with that number your vet didn't feel hyper-t was a problem but you might ask him anyway since older cats should have lower T-4 numbers, not higher. Maybe he will want it redone to compare at a later date and then maybe run a Free T4 at that time?

She is on Zeniquin for a UTI. She has had them in the past and Zen worked great. I couldn't do go for the culture so I went with what has worked in the past and my vet was ok with that. On her Urinalysis it says that her pH is high at 8.0 (ref range is 5.5 - 7.0); Ketones negative; Glucose strip 2+ High - RBC/HPF 4-10 high (ref range is 0-3).Occult Blood 1+ high
Click to expand...

Just curious, what was the urine specific gravity (USG)?

I don't know about the rest of the blood work. If you have any questions that your vet didn't answer you might post them on Health so possibly one of the vet techs can comment.

Regarding the pymetra, by your comment it just sounded like it was more recent and I was just curious since she is 15(?) so that was why I asked.

I came home and the cats had hardly eaten any food. So I am taking them off the FF/Friskies/etc and they are on Wellness and Merrick and pepcid. No one is puking but something has changed with them since the new style FF cans came out. They just aren't interested. Not sure if I gave Rugs 1/4 or 1/8. I went to Walmart and got the syringes with the 1/2 unit markings. She got something between none and 1/4 - Her preshot was 206 which I attibute to her not eating much. She is eating right now and I am very glad!

Any thoughts?
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I don't know about the food except for what Vicky said about others making negative comments. We are feeding Tigger exclusively raw now and he is doing so much better. I order it online and it is shipped to your door.

I am glad you got her to eat. I wonder though as that infection clears if her numbers will come down all around and you can get her off insulin altogether. We can only hope! Please don't forget to check for ketones if you can Ruthe.

How is Marie doing these days?
 
Pamela,

I will mention the Hyper T to my vet when I speak to him for sure. Her urine specific gravity was 1.027. I think a friend of mine might have some Keto diastix that he uses to check his poodle - couldn't convert him to be a vampire. I'll have him bring them over this weekend. Since she had the UTI before I took her in to get checked, wouldn't the ketones have showed up on the urinalysis?

Other than the crazy high cholestrol, the rest of her blood work looked good to me.
 
Ruthe and Smokey (GA) said:
Pamela,

I will mention the Hyper T to my vet when I speak to him for sure. Her urine specific gravity was 1.027.
Click to expand...

Here is from one of Dr. Lisa's posts:

Cystitis vs UTI - Check Urine Specific Gravity
Posted by: Lisa dvm (IP Logged)
Date: December 3, 2009 01:27AM

Sharyn & Fiona Wrote:
-------------------------------------------------------
>Is
> there any real way to know w/out doing a C&S?

The first thing that I do with ANY cat that is showing UT symptoms is to check the urine specific gravity.

If it is high (over ~1.035) the chances of having an infection are extremely slim.....ie....1% if the cat does not have sugar in its urine. (Sugar in the urine raises the chance that a bug *could* grow in concentrated cat urine.)

If less than 1.030, the chances of a cat showing FLUTD signs go up to ~25%...depending on what study you read.

When Bennie (my Obesity project) had FLUTD signs (bloody urine...urinating frequently/small amounts...looking like he felt lousy..) he was too fat to do a cysto on so I just banked on the fact that his chances of having an infection with a USG of 1.45 were slim to none. He got buprinex and love....to decrease his stress level...and time. He was fine with in 2-3 days.

I encourage my clients to take a urine sample to the vet and have them do a quick USG check. You only need a few drops of urine.

Lisa, dvm

So it 'sounds like' there is possibly an infection going on here. I hope the AB works and maybe she will go off insulin once it is cleared up.

I think a friend of mine might have some Keto diastix that he uses to check his poodle - couldn't convert him to be a vampire. I'll have him bring them over this weekend. Since she had the UTI before I took her in to get checked, wouldn't the ketones have showed up on the urinalysis?
Click to expand...

Make sure the strips are not out of date.

Ketones can build up from not having enough insulin, high bg levels, infection, inappetance, or a combination of any of these, so no it would not have neccessarily shown up on the UA right at that time.

Not trying to alarm you really Ruthe, just a reminder to check for them.
 
Hi Pamela,

I appreciate the reminders and I know that you are just trying to get me back in the groove. I have to admit that ketones didn't even cross my mind because Smokey never had any and he was a really high boy for many months as I am sure you remember. BUT I know this is a different cat and I need to be on the alert for all possibilities. I know the Keto diastix are current because I bought them for the poodle boy.

Thanks for the info on the Cystitis vs UTI. Rugs has had UTI's over the years, and my vet seemed certain - and I do trust him on this with her. But I will recheck her as is normal procedure. I know that she needs to finish the round of Zeniquin and then give some time in between before the recheck. Now just want to add that there is no blood in her urine and she pees like a racehorse...

Do you think that this UTI could really be the cause of her diabetes? I know he said that her teeth could use a good dental, but not so bad that we couldn't hold off. I seem to remember that infection could increase the insulin needs...seeems sooooooooooooooo long ago.. ;-)
 
From your other thread....

"I can be a testing fool over the weekend to see what's happening between 4 hours and 12 hours to see what's going on during those hours I never get to test. I am not being delusion thinking that she is going to be a once a day cat...would be nice...but I can see I need lots more data. She was laying on the couch tonight and didn't run when I tested both ears - was a bit shocked after the 400s to have 95...other ear was 99. I hope she doesn't have something going on that is eluding us....You know how you just have a feeling something isn't right...but maybe what isn't right is diabetes and my radar is off."

So this is after no shot this AM and a half unit last night (Wednesday)? Maybe the infection is clearing.

Sorry, this is hard to follow with two different threads going on. Maybe you can start a new one or just continue on this thread so it is easier to follow?

"Do you think that this UTI could really be the cause of her diabetes? I know he said that her teeth could use a good dental, but not so bad that we couldn't hold off. I seem to remember that infection could increase the insulin needs...seeems sooooooooooooooo long ago."

Well, your memory serves you well! Yes, it could be 'just' the UTI and then again the teeth thing on top of it, or just one or the other. She has been on a canned food diet for a number of years now, so it only makes sense that possibly something else is going on to bring on the diabetes, and you know, with cats it can be transient. Also something else to consider, is she overweight? That can also contribute to insulin resistance.

Ruthe, can you set up a spreadsheet? I think others would like to see how this is transpiring, even if it may just be (hopefully) temporary. You can find instructions in the Tech forum.

"Ah... a visitor at the Wellness B & C bowl...must be REALLY hungry..It's Plumpers (daughter of Miss Rugs). Ah...another visitor (Marie aka tube cat and mother to Miss Rugs) is at the Indoor Select bowl....now moved on to the Wellness B & C. There is hope! ANd Rugs is nibbling Wellness B&C and FF B&C and back to the Wellness...She likes the buffet setup so she can sample different course!"

Ahh, how nice to hear that the other kitties are doing so well and Miss Rugs is eating! So question, if Marie is the mother to Miss Rugs, how old is Marie? I will never forget our Marie. She is such a fighter to come through all that she did. I still have the pictures of her with her feeding tube.
 
Saturday great, Sunday, not so great. I will get the spreadsheet done today. I think some of the problem is food related (canned EVO cat and kitten), the other part is potentially not giving enough insulin...skinny half vs fat half unit, etc. I need to call my vet today and send him her numbers. I still have this feeling there is something else going on. Maybe that is because I don't remember Smokey in the early days of insulin.
 
Doesn't that Evo have low carbs? I thought it was under 7%....?

Yes, early days of insulin can be a bit bumpy. Another case of ECID, I think. Be sure to look at the nadir for making dose changes. Did you do a curve on the weekend?

Hang in there.
 
I did a little mini curve over the weekend. I think the free feeding is going to be the challenge with her numbers. This morning I woke up at 4 am and I have a direct view of the kitchen. There she was chowing down on food I had put down around 7 last night. I tested her at 5:30 am and she was at 206. I didn't shoot her last night till almost 7 so figured I would wait a little bit and see what happened. She ate a little more (fresh food) and was at 284 at 7 am and I gave her a skinny 1/2. It's mind boggling how 1/2 unit can bring her down from 500 to 186 in 12 hours or can keep her level some days. Still working on the spreadsheet, but hope to have it up and running tonight.
 
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