My diabetic cat, Billy

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Maretheadley

Member Since 2013
After 3 months of 2 units insulin twice daily, Billy had a seizure the other night. He didn't eat well for several days but then we started on the insulin (reduced to 1 unit) again yesterday but 7 hours after his last shot, he threw up and then sat listlessly for most of the day. He is eating again but I'm afraid to resume the insulin since I think it may be causing hypoglycemia. I have to wait until Monday to take him to the vet and am having a great deal of anxiety about whether I am doing the right thing. I am new to this and only recently discovered I could do home testing, which I need to start doing ASAP. I worried that withholding the insulin may be wrong, but I also know that too much insulin can be fatal. Has anyone had a such an experience?
Maret
 
Ok first, can you smell nail polish remover from his breath? If so, this is an emergency and he needs to go to the vet now.

What are you feeding? Wet? Dry?

What kind of insulin is it?


Wendy
 
Welcome Maret amd Billy,

You are right to be concerned. It sounds like he may be getting too much insulin. Can you get to a drug store and buy a glucometer? We can teach you how to test. Then you will know exactly how low the dose is taking him. Too often, the numbers at the vet are higher than your numbers at home because the cat is stressed there and stress raises bg levels. Then the dose from the vet is too high once the kitty gets home and relaxes.

You want a meter that takes a tiny sample. Lots of people her like the ReliOn from Walmart. It is inexpensive as are the strips. (the strips are what are expensive with brand name meters.). You need 25-27 gauge lancets (30-31 gauge that human diabetics use are too small at first).

Can we teach you how to test?
 
Billy is behaving more normally as time goes on since his spell this morning and no insulin since. His breath is good. He is eating. His diet since diagnosis has been the DM wet food, steamed chicken, sardines in water with no salt. I have picked up some Fancy Feast canned which he likes. I think this low carb diet may have lowered his BG, but he was 350 at the vet on Wednesday (stress seems to be a culprit there).
Billy has been taking Lantus. Tomorrow I will purchase the home testing equipment you recommended and perhaps I can use your help.
This forum is a god send. I've learned a lot just reading the posts.
Maret
 
Thanks for the tips. I'll start learning to test tomorrow. Meanwhile, Billy is back on my lap purring. I think you are right -
the low carb diet lowered his BG and even one unit of Lantus might be too much.
Maret
 
Maybe.. But he might still not be quite ready for none. Let's see what the blood tests reveal. There are a few relion meters, the prime is the cheapest but the confirm and micro don't need as much blood.

Here is a shopping list

Getting started shopping list
1. Meter ie Walmart Relion
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie Ketostix or ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

Wendy
 
Thank you so much for the advice. I took my new Relion Glucometer to my vet yesterday and was given use instruction.
Billy's BG was 176 last night and 138 tonight, so his last insulin was 1 unit yesterday morning. He is eating well and acting like his old self. I'm very grateful to have the Glucometer as it relieves so much anxiety. (Over the weekend when I called my vet's office, they told me to give insulin if he eats, but not to give insulin if he doesn't eat)!!
But now I'm concerned that his BG might be too low and what I should do about it if it gets any lower. This is such a baffling disease...I am so new to this and don't yet know what I don't know....
 
Those are encouraging numbers! We generally tell new diabetics not to shoot under 200 until they have more data.

Just for reference, a regulated cat is in the low 200s at preshot and under 100 at midcycle but not under 40. 40 is getting too low and needs some extra carbs or sugar to bring up the numbers.
 
If you are not giving insulin, he isn't going to hypo on you, unless something else serious is going on.

Reference numbers:
Normal non-diabetic is between 40-120
Below 40 with insulin is hypo
240 is the renal threshold where glucose spills into the urine
 
Maretheadley said:
Over the weekend when I called my vet's office, they told me to give insulin if he eats, but not to give insulin if he doesn't eat
Click to expand...

This is a carry-over from other insulins. With Lantus, as long as there are no appetite issues, the cat does not need to eat at shot time. In fact, a better time for food is right around the nadir/lowest point of the cycle, which is generally around 5 to 7 hours after a shot, because that is when they're most likely to go hypo (if the dose is too high).

How are his numbers today?
 
Thank you ever so much for the info.

Billy was at 224 a few minutes ago, so I gave him 1 unit of Lantus. Is this ok? The nurse at my vet's office told me my vet would like to see numbers in the upper 200's when I took him in on Thursday. I am beginning to feel very confused about what the vet is telling me. Perhaps I don't know enough to ask the right questions.

I am so grateful to have found this online support group.

Billy also has a heart condition for which I give him 1ml atenolol/enaloril (sp?) and 0.5 ml furosemide daily.

Maret
 
Numbers above 240-250 mean the excess glucose will be passed in the urine. This is known as the renal threshold. Numbers that high mean the diabetes is unregulated and P/U and P/D will likely be present.

I do not know why your vet would want to see numbers this high in your cat. It makes no sense.

The BG (blood glucose) levels in a normal non-diabetic cat range from 40-120 on a human glucometer. These are the numbers we strive for to achieve remission.
 
P/U means polyuria - peeing a lot
P/D means polydipsia - drinking a lot

Do you normally give shots at noon and midnight? Then your shot might be OK. Lantus needs to be dosed every 12 hours, regularly. If you have to skip shots because he's low, that's fine, but you want to try to keep to the same schedule. If you find yourself skipping more than a shot or two here or there, you may need to decrease the dosage.
If you have any concerns, you can continue to test his BG to make sure he doesn't go too low. Do you have a hypo kit, just in case?
 
Ok...now I have a problem... Billy's BG is suddenly 401 and he was walking in an uncoordinated way and then lay down and yowled about 5 times. I had given him 1 unit of Lantus an hour ago after test showed BG of 254. Last night his BG was 168 and this morning it was 142 so he got no insulin both times. But now this is totally freaking me out with this development.
Any clue about this is?

Maret
 
I'm not sure. I'm really new to Lantus so I can't help. But try changing the topic icon on your first post as well so people can see the 911 icon and jump in to help. Good luck! I hope Billy feels better soon.
 
What is he testing at right now? How is he acting? I've noticed similar pacing and yowling in Michelangelo about when the insulin is starting to hit. I've learned to tell from those signs to test him in the next half hour to an hour and see a significant drop in numbers.

Have you also been testing for ketones?
 
Well, he had an episode shortly after my last post...yowling, throwing up and peeing while lying down and then hyperventilating for a short while...this may have been a seizure? He was just flattened by this, lying down and not moving.
Finally he got up and asked to be fed. I gave him a can of Fancy Feast and he perked up after that. Now he is behaving rather normally, cleaning himself a bit. I tried to test his BG and the Glucometer did not give me a number but just said
"High", so something is wrong with the Glucometer now. But Billy is improving. Tomorrow I'll retest him after dealing with the Glucomter. Maybe it is broken and his counts were really lower and I should not have given the insulin. This is the third time this has happened after giving him insulin, the other two were before I had the Glucomter.

Maret
 
Maretheadley said:
Well, he had an episode shortly after my last post...yowling, throwing up and peeing while lying down and then hyperventilating for a short while...this may have been a seizure? He was just flattened by this, lying down and not moving.
Finally he got up and asked to be fed. I gave him a can of Fancy Feast and he perked up after that. Now he is behaving rather normally, cleaning himself a bit. I tried to test his BG and the Glucometer did not give me a number but just said
"High", so something is wrong with the Glucometer now. But Billy is improving. Tomorrow I'll retest him after dealing with the Glucomter. Maybe it is broken and his counts were really lower and I should not have given the insulin. This is the third time this has happened after giving him insulin, the other two were before I had the Glucomter.

Maret
Click to expand...

1) Maybe he is epileptic; a vet would have to diagnose that.

2) When a glucometer reads "HI", it means the glucose is over the upper limit of what it can read; it is not broken.

3) Always test before you shoot! If he was low when you gave insulin, you may have sent him into a hypo and then compensatory hormones kicked in to release stored glucose.
 
Lets get you set up with our color-coded spreadsheet, so you will have a visual display of the test results by day, color-coded to highlight his status.

The instructions are here.

Also, while you are working on home-testing, please see my signature link Secondary Monitoring Tools. With glucose levels this high, you need to be testing for ketones, a by-product of fat breakdown. Too many ketones may indicate diabeteic ketoacidosis, a potentially fatal, expensive to treat, complication of diabetes.
 
Thank you so much. I really appreciate your help.

I gave Billy his shot of insulin last night after he tested 254. Then he had the seizure and i tested agan and he was 401. An hour after that he was at "hi". Then i posted my SOS. During the night he wanted to eat and then threw up. This morning he ate but is listless. i just tested him and it was 203. i'm afraid to give insulin now because this is the 3rd time he has had these episodes after getting the insulin.
I realize now that my Glucometer is not broken because I tested myself and it was 84 (no idea what I should be since this diabetes disease is so new to me).
I will start the spreadsheet as soon as possible. Thanks for sending it to me.
I'm taking him to the vet tomorrow.

Will test again later tonight

Maret
 
Did you end up giving him any insulin this morning?

If you could set up the spreadsheet BJ linked, that would really help us see what might be going on.
 
I just downloaded the spreadsheet.. I have figured out most everything but have a really stupid question... What does 'PS' mean (as in AMPS)? I've figured out AM is morning and PM is evening..

One other question, there was a reply that for Lantus you do not shoot while giving food... my vet told me opposite and said to feed while giving the shot... now I'm confused. :oops:
 
essoh said:
I just downloaded the spreadsheet.. I have figured out most everything but have a really stupid question... What does 'PS' mean (as in AMPS)? I've figured out AM is morning and PM is evening..

One other question, there was a reply that for Lantus you do not shoot while giving food... my vet told me opposite and said to feed while giving the shot... now I'm confused. :oops:
Click to expand...

"PS" means "Pre-Shot." It's assumed that you've given a shot within around 15 minutes of taking this test.

Other insulins require the kitty to eat at shot time because they can hit the system fast and hard and the cat needs food on board to help cushion the blow. A lot of vets either assume this is the same with Lantus (and Levemir) or haven't received information telling them otherwise. With Lantus, however, as long as the kitty isn't having any appetite problems, you can feed them when giving a shot but you do not have to feed them when giving a shot. Make sense? ;-)
 
The last two posts by ESP and KPassa somehow came to me at "My diabetic cat, Billy". These posts were between the two of you...(Just FYI)

Maret
 
Maretheadley said:
The last two posts by ESP and KPassa somehow came to me at "My diabetic cat, Billy". These posts were between the two of you...(Just FYI)

Maret
Click to expand...

Essoh was posting in your thread, that's why. ;-)

How is the spreadsheet coming along? If you need help, there are a few people on here who can get it started for you. Let me know and I can track one of them down for you. :-D
 
Thanks! I will start on the spreadsheet soon.
After talking with my vet today, I gave Billy 1/2 unit of Lantus (his BG was 272 before the shot). She had suggested 1 unit, but twice now after getting the full 1 unit, Billy has had a seizure episode and I don't want to risk that again, so she relented 1/2 unit once a day. She wants me to test him every four hours.
Now the ugly truth of ketones is entering my consciousness and I must find a way to use those strips....while he is peeing!

All best,
Maret
 
Maret, if he won't pee with an audience, you can get some aquarium gravel and put it in a clean box. Leave him alone with it and if he is like most cats, he won't be able to stand a clean box. The gravel won't absorb the urine and you'll get a good reading.
 
Greetings...
I don't know what to make of this. Billy's numbers are fluctuating so much. My vet told me to hold the insulin until tomorrow morning but here's what's been going on:

Fri. 4/19, 1:15pm BG 224 I unit insulin given
Sat 4/20 12:15pm BG 168 - no shot
Sat 4/20. 12:15am BG 142 - no shot
Sat 4/20 11:15pm BG 254 - 1 unit insulin given (Billy had seizure after shot)
Sun 4/21 12:30am BG 401
Sun 4/21 1:00am BG HI
Sun 4/21 1:30 am BG HI
Sun 4/21 11:30pm BG 203
Mon 4/22 12:15pm BG 272 - 1/2 unit insulin given
Mon 4/22 9:30pm BG 227
Tue 4/23 8:15am BG HI - 1 unit insulin given (Billy had seizure before shot)
Tue 4/23 9:20am BG HI
12:00pm BG HI
3:00pm BG 241
9:00pm BG 164 - 1 unit insulin given
Wed 4/24 8:15am BG LO
Thu 4/25 1:00am BG 296
Thu 4/25 6:25am BG 517
Thu 4/25 2:30pm BG 327
Thu 4/25 7:45pm BG 53

My vet told me to start over giving insulin again tomorrow morning (Friday).... But I am not going to. I should probably test Billy every hour maybe?

I just don't get this up and down.
Billy has been eating. He's also been sleeping all day and has not come downstairs once. He does not seem to feel bad.
I'm not sure what I should do now!

Maret
 
I am not an expert but it looks to me that he is bouncing up and down. I also think one unit is too high and maybe you should have stuck to the half unit for longer however as I said, I am not an expert so i am going to ask some more experienced eyes to come take a look

Wendy
 
Wow, you and Billy are having a rough time. I am sorry it's been extra hard. FD is hard anyways. Good for you for being such a dedicated bean.

How is the spreadsheet coming? We need that format to be able to help you because that's the way we think about the data.

One thing that strikes me is that Lantus needs to be dosed every 12 hours, very consistently. I am wondering that if you jump around in time, you are going to get wonky numbers.
Liz
 
It definitely looks like 1 unit is too high to me. It takes him too low, then his body compensates when it can by bouncing him up high. Also, he may have a partially functioning pancreas, providing some of his insulin, further complicating dosing.

You want a dose you can give every 12 hours, that doesn't take him below 50 on a human glucometer, doesn't result in skipping because he is too low to shoot safely, and keeps him below the renal threshold of about 240 much of the time.

You may need to switch to an insulin you can give as needed, such as ProZinc. Plus, since it is a U-40 insulin, you can use a conversion chart to shoot low doses such as 0.2 units, 0.4 units, etc.

Can you eyeball 0.25 units? Magnifiers may help. They come as syringe clip-ons, eye glasses clip-ons, visors, or free-standing. Check our shopping partner, Amazon.
 
Thanks for the advice. I'll talk to my vet about this. Meanwhile, last night at 11:45pm Billy's BG was 316 and this morning at 8:30am it was 342. So I gave him 1/2 unit of Lantus after he ate. I'll check him again in 6 hours.
Did I do the right thing?
I am so appreciative of this Forum. The yo-yo emotions I'm experiencing are so draining. I feel like I'm playing with fire all the time. And seeing my baby suffer is just the worst.

Maret
 
Maretheadley said:
Thanks for the advice. I'll talk to my vet about this. Meanwhile, last night at 11:45pm Billy's BG was 316 and this morning at 8:30am it was 342. So I gave him 1/2 unit of Lantus after he ate. I'll check him again in 6 hours.
Did I do the right thing?
I am so appreciative of this Forum. The yo-yo emotions I'm experiencing are so draining. I feel like I'm playing with fire all the time. And seeing my baby suffer is just the worst.

Maret
Click to expand...

Half a unit is reasonable, just watch for hypo symptoms. Here is a link on How to Treat Hypos

Syringe magnifier

Magnifier visor

Clip -on magnifiers
 
After I gave Billy 1/2 unit Lantus at 8:30am yesterday (342 BG), his BG was 204 at noon, 179 at 3pm, 279 at 6:30pm, 230 at 8:30pm and 215 at 12:30am.
He has had no insulin since 8:30am yesterday.
This morning at 8:45 his BG was 171. I gave no insulin.
Am I doing the right thing?
This forum is such a comfort.
Maret
 
Maret - I would take up Sues offer to do a Spreadsheet for you - it will help you see trends better and help us better assist you!

Here are your readings in our format

4/26 AMPS 342 1/2IU (AMPS = AM Pre Shot)
+3.5 204
+6.5 179
+10 279
PMBG 230 - skipped (PMBG = PM Blood Glucose)
+ 4 215

4/27 AMBG 171 - skipped (AMBG = AM Blood Glucose)

First from what I can see the insulin is working nicely - you can see his drop from 342 to 179 which was his "nadir" or low point. It happens generally 5-7 hours after the shot. Skipping under 200 is a good idea to until you know how he behaves. I know you skipped this morning but it would still be good data to get a +3 or +4 (3-4 hours after 8.45am) to see what happens next without the insulin.

Reason is that you need this data for future because you will need to learn how to shoot at low numbers until he is low enough to not need insulin. Here is a primer on shooting low numbers:http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Let us know what his next test shows!
Wendy
 
Hi Wendy and Sue,

At 12:45pm Billy was at 167. I gave no insulin. So I'll do a another test at 4:45. Thank you for the "low numbers" Information.

I would like to take up Sue's offer on the spreadsheet. Sue, I tried to send you a private message about that yesterday, but I don't think it went through. I chose PM and sent the post to your user name but I must have done something wrong. I've been keeping a word document chart with Billy's numbers since the 17th.

I must say you guys are angels.

Maret
 
Thanks to Sue for helping me with a spreadsheet for Billy, which I have not filled out yet, because I learned yesterday that Billy has congestive heart failure. My vet does not want me to give Billy any insulin unless his BG is over 300 (he has been under 250 for days and some of the low numbers indicate he would be hypo if I'd given any insulin these last few days). I believe this is where the fine art of "shooting low numbers" comes into play?
So now we have doubled Billy's Lasix dose. The vet told me there is nothing further we can do and will eventually have to put him to sleep.
So my question is: do I pursue insulin testing and dosing despite the heart condition?
Does anyone else have this situation?
Billy has had the heart condition for years now but was diagnosed with diabetes in December. Everything was working until he went hypo 3 weeks ago and since then has been hypo twice more and has not been his normal self - lethargic, sleeping a lot and lacking curiosity.

I am so thankful for this board. I read it all the time, have learned so much, and still there is so much to learn.

Maret
 
Untreated diabetes = starving to death - is that really what your vet wants you to do?

It is possible to give very low doses of insulin; folks here have done it successfully. If he has hypoed previoulsy, the dose was too high, or he wasn't eating enough. Additionally, Prozinc is U-40 insulin, so less concentrated than Lantus. This makes it even easier to give small doses using a conversion chart and U-100 syringes; doses as small as 0.2 units may measured fairly accurately.
 
What stage is the CHF?

Have you had an ultrasound done?
Have you had an echocardiogram done?

What medications are you giving Billy for the CHF? furosemide? enalapril? baby aspirin weekly? pimobenden?

Fluid buildup around heart, lungs?

Is his breathing compromised by the CHF?

How is his appetite?
 
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