Nana's VERY complicated case

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kimouette

kimouette

Member Since 2012
Hi everyone,

I am currently TRYING to help a very old woman (87 years old!) who's cat has been diagnosed with diabetes about 2 weeks ago. She lives very far from where I live and that is killing me! The poor woman she is so old but so willing to do whatever it takes to cure her cat Nana... Nana is all she has left from her dead husband, so putting Nana to sleep is completely inconcevable. After seeing her old hands shaking and how bad her vision is, I felt really bad for even trying to teach her how to test Nana... This is very hard for me, cuz on one hand I feel like I must do whatever I can to help her cure the cat that she loves so much, but on the other hand I'm afraid she could hurt herself or her cat while testing, or maybe she could misinterpret the BG results or even the insulin dosage... :cry:

Her vet is the usual European stupid vet : he diagnosed diabetes, sent her back home with Caninsulin, told her to inject 2 units every 12 hours, does a fructosamine test every week, is against testing and adjusting dosage, he wouldn't even let her use her glucometer from the puncture he did for is own test (she wanted to see if the glucometer and his results would be the same using the same blood sample).

It takes me 3 hours by train to get to her house and I do work 30 hours a week, so I cant test and adjust everyday like I should.
I might go to her house again next week, but I'm not even sure I'll be able to do it...
She can't find a new vet first of all because at her age she wont drive anywhere outside her village, and also because she lives in a very secluded location (between 2 mountains, only one road gets there, it's the end of nowhere!) so of course there's only 1 vet nearby!

Whatever advises you guys are bout to give me, please keep in mind that I am stuck in that context and that there's no way we can test the cat before each injection.

Here's everything I know about her cat:
Name : Nana
Age : 11 or 12 years old
Weight: about 5 kilos (yes she is a overweight)
Food : She is already eating low carb canned food, but she will change brand next week (same carb content but higher meat quality)
The cat stays inside the house, she has overall good health (no other medicine), her last bloodwork was done last week and showed nothing unusual (except high BG of course), I dont know if the vet checked for ketones but since her BG is fluctuating, I guess it's not necessary.

Here are the only values we have : (in Mmol)
8:00am : 28.5
Received 2 units of Caninsulin
+2 : 14.6
+7 : 9.9
+10 : 11.2
+12 : we couldn't do any test . she gave only 1 unit of Caninsulin cuz we both thought 2.0U wouldn't have been safe
Next morning at 8:00, at the vet's clinic (she had her weekly appointment set for the next morning), on an empty stomach (and probably stressed), her BG was 22

I'm not sure what I am asking you guys, I dont even know if there's anything to say since the cat will not be closely monitored.
I'm lost, I'm sad and I'm confused...
Kim
 
Oh, bless you, Kim, for trying to help this lady and her cat. And of course as you say, Nana is so much more than 'just' a cat; she is a precious living part of the life this lady once shared with her (now deceased) husband.

Clearly, the lady wants to try treat her cat. She does not want the cat put to sleep. Whatever you can do to help her, IF indeed you can help her will be a bonus. But with you or without you it sounds as though she's going to give it a shot (no pun intended! :-) )

My thoughts are that you do need to be honest and direct with her (but in a kindly way) about the 'possible' effects of the treatment not going well just so she is clear about that. I say 'possible' because there is no certainty that the treatment will go badly (she might surprise you!). My guess is that she will still want to try treating Nana. As to "hurting herself", how do you see that happening? (Sorry if I've missed or misunderstood something in your post about that.)

Do you know yet how she is managing with doing the shots? Re measuring the dose, would it help to have a syringe filled with coloured liquid that shows the amount she needs to measure, just for comparison. I know the insulin is colourless but it might help to focus her vision. (How do visually impaired diabetics measure their own insulin, I wonder???) For my craft work I have a large magnifying glass with a little light on it that stands on my table. Maybe something like that would help with regard to insulin measuring?

Regarding testing, well, she may not be able to do that. Although it's certainly worth trying! If she can't do it, then Nana is going to be in the 'same boat' as most diabetic cats around the world!

I do agree about reducing dose initially...

I know this sounds like a situation that is far from ideal, but treating Nana may give the lady a real sense of purpose. And that is one of the things that makes our lives worthwhile...

- - -
Edited to add: Kim, I think you're a very special person...
 
Kim

Check my signature link for supplementary monitoring techniques, including home testing using urine using human urine test strips. They aren't perfect methods, as they aren't as accurate as blood glucose and ketone testing. If done consistently and tracked in table on paper (assuming she isn't a good computer user), it will help her monitor what is happening.
 
First BLESS YOU for trying to help!!! I don't know if they are available in the UK but here in the states we have meters for humans that talk for the vision impaired...maybe if she could find one of those that would help with the testing to make sure she reads the meter correctly.

What color are Nana's ears? If they are a dark color perhaps instead of testing on the furry side, she could test on the inside of the ear...I do that with Autumn because her ears are so dark it is hard to see the blood on her fur. It doesn't matter which side you use, wherever it is easier to see the blood drop. It also might be worthwhile to experiment with different lancet devices one might work better for her than others.

I know you can't do this with Lantus or Levemir but I don't know about the insulin she is using so it might be worth looking into....can you prefill the syringes for her for several days? My mom is diabetic and has very poor eyesight as well as Parkinson so she shakes as well but manages her testing and shots just fine, now of course she uses Levemir and the pens which you can't do for Nana but it does seem that if the lady is willing to give it a go in treating Nana then she will find a way to do it. As well as giving her a reason and purpose in life to get out of bed every morning.

Mel, Maxwell, Autumn & The Fur Gang.
 
Just a thought... does she have any home help? A carer or neighbor or relative that looks in on her daily? If so, your best bet might be to educate one of them and see if you can work out a deal where they help with Nana as well as caring for your friend. She might be eligible through the government for a carer if she doesn't have one now.

Also, as Nana is getting regulated, she'll need more frequent testing, but long term, with low carb diet, she can probably get away with a low dose of insulin and infrequent testing. I know, less than ideal, but with a low dose there's very little chance of hypo, and with low carb diet the numbers should stay in a predictable range.

Bless you for helping Nana and her bean.

Lori
 
I was going to suggest something like Lori mentioned. Ask if she has any local family, friends or even a supportive church network. She won't be able to check BG regularly, but having someone else who can stop by and fill syringes and occasionally test would be very helpful.
 
Thanks everyone for the support and the lovely compliments!
Xenia (that's the lady's name) is aware of the potential dangers of a bad treatment, that is not an issue, only her age and her memory is. Yesterday she wanted to try testing by herself for the first time, so she called about 10 times! And in the end she told me she couldn't do it and gave up. She said she'll try again tomorrow (this morning) and I hope she manages to complete the test.
Elizabeth thanks for pointing out the syringe measurement eventual problem.. That just reminded me that there are also u40 syringes 0.5ml instead of 1ml. I know they are more expensive but I'll talk to her about it. It would be easier to get the exact amount of insulin cuz there is much more space between the markers.

Bjm, I read the links in your signature. Correct me if I'm wrong, but urine glucose testing is not reliable enough to make daily insulin dosage adjustments right? And I think Xenia would not be able to tell which urine is more recent than the other and how "old" it is. If that's the case, then it could make her just more confused about what she should do.

Mommaofmuse, a talking meter is not necessary in her case. She does misread sometimes, but its only the decimal that she doesn't see clearly. So everytime she reads the results she says for exemple 287, and I ask her 287 or 28.7? And the. She sees the decimal. Of course it's frightening but since she is going to call me every time she does a successfully test, I am not too worried about that. Oh and Nana's ears are the perfect color for a test: white hair but almost nothing on the ears, the drop of blood is a complete contrast on this type of ear! And I'll talk to Xenia about your mom: it might give her a little more confidence!

Lorrie and Maggie, the idea of finding someone who could test and inject the cat for her is ALL I've been thinking about for the past 48 hours!! She is going to ask 2 of her neighbors, and in the meantime I checked all the adds. The problem with someone from the exterior helping her is that these people need money, I asked her about her eventual budget for that kind of help, but she has none. There is someone coming twice a week to help her clean the house, but I dont think she works early or late enough to be there for the test and injection. And even if she would come earlier it would only be twice a week.
I keep my fingers crossed for the 2 neighbors she spoke about. In the end she might have someone only for the evening test/injection, and maybe not for the weekends... I don't think anyone is gonna be generous and available enough to be there everyday of the year, every 12 hours, but we'll see. I guess one test a day is better than nothing! Even though it's gonna be hard to evaluate what the dosage of the "non tested injection' should be,
 
kimouette said:
...Bjm, I read the links in your signature. Correct me if I'm wrong, but urine glucose testing is not reliable enough to make daily insulin dosage adjustments right?...
Click to expand...

Per feline diabetes expert Dr Janice Rand, it is possible to use some of these less exact measures to adjust insulin dose. Please review this file and see if you think it might be workable: link3.pdf
 
Is there anyway you can locate someone to help out for a while? Not sure of this woman's finances, but it might be worth it to see if the treatment, properly administered, is going to be effective. Otherwise, I hate to say it, the cat may be better off without the insulin etc. How in the world did the vet think she was going to manage this? Sorry?, not much help. Maybe there are vet techs in the area who can assist for a fee? Worth looking into.
 
2 suggestions for someone to help her without costing her.

1) Contact one of the local pastors/priests, explain the situation and ask if they know of any one in their parish that would be willing to help her with the testing. That might give even ANOTHER person a 'worth' in their own life too...

2) Contact an older group like the Girl Scouts here in US that has older members that might be interested in learning how to do it...maybe even earn a 'badge' for it?? Don't know if you have that type of groups there...

BIG HUGE HUG!!! THANK YOU for doing everything you're doing...
 
Ruth you are right! It is very frustrating to see how the stupid vet is dealing with such a delicate situation. I've built a little document to gather every single person that could help her. Tomorrows I'm going to her house again and I'll speak to her neighbors. If they don't want to help I have an ad that I'll put everywhere in her village!!

I'm bringing her 0.5ml syringes and I'll let her do as many tests as she can. The goal is to do a complete curve. When I have that I might encourage her to switch insulin for Lantus (cuz from the last readings it looked like the numbers are way too high before each injection. We'll probably need a longer acting insulin.

If the vet tries to interfere when she asks for another insulin I swear I'm going there! I'll take an appointment and use this time to teach the vet couple of things and have him admit that he thinks cat's bg adjust to the insulin instead of the insulin that should be adjusted to the cat! That is is biggest mistake right now.

I'll probably have question for you guys when I have Naba's curve, especially if switching to Lantus cuz I have never used that insulin.
;-)
 
Nothing happened the way I planned! In a good way though. I went to xenia's house thinking I would do a curve showing how nana metabolizes 2u of Caninsulin, but here's what happened ( I might have saved her from hypoglycemia) :

here are the final results:

Yesterday at 8pm she didn't test and gave 2u of insulin
Today :
7:41am : 7.1
8:06am : 7.3
Skip insulin cuz she is under 8.3! First time she skips an injection!
9:22am : 7.3
10:14am : 5.8
11:57am : 5.1
1:12pm : 5.3
4:10pm : 7.1
5:45pm : 7.8

Tonight at 8pm her neighbor is gonna be there to help!!! I showed him how to do the test, the only problem is that Nana HATES this man!! He couldn't heaven get close to her while I was showing him how to test. I guess the next test is gonna be very challenging for everyone!

Since her bg started to rise in the afternoon I wouldn't be surprised that she is arround 9 or 10 at the next test. And if that's the case, I'll advise her to give 0.25u to 0.5u depending of the results.

I know that Caninsulin is normally known for leaving the body quickly, but what happened here? Could she metabolize the insulin differently and still have some left in her body as late as 20-24 hours after an injection? Could these results mean that she had hypoglycemia during the night? Or is it only her pancreas starting to heal by itself?

She wasn't very hungry today (does this explain anything?)
Otherwise I thought she looked great! Much more playfully than last time I saw her!

Oh and as for the neighbor he might not be able to help her whenever she needs him but she'll ask that man's wife or the neighbor upstairs next time she can't test. That makes 4 people! I hope one of them is always gonna be there to help!!
 
If diet change is starting to help, or pancreas starting to work again, or didn't eat enough, glucose can stay low.

Caution when shooting is always a safe way to go.

If she can measure the amount of water drunk each day, that data helps provide context for the insulin numbers. High water consumption will occur when the diabetes is still uncontrolled OR if another medical condition is present. Checking the wet litter present in the litterbox does the same thing - lakes of wet litter indicate a problem; small balls of clumping suggest normal urine output.
 
Ummm.... Those look like really good numbers.... Actually, remarkably good numbers.... Nana was diagnosed as diabetic, right..? (I mean, I didn't dream that..? ) This is a puzzle. Scratching my head here..... :?
 
Elizabeth, I am!! I truly am! Nana hasn't need insulin for almost an entire week!
Her bgs are starting to rise a little but we will try our best to control her bg with food (Xenia will receive 0% carb today or tomorrow and we hope the bgs get stabilized at non-dosable values for a while (or forever!)
party_cat
I was wondering... How long with no insulin means OTJ?
 
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