Need Advice - Behavioral problems

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Patricia&Bernie

Member Since 2023
Hello,

I recently joined the forum and need some advice related to behavioral issues. I just adopted Bernie, a 13 yo diabetic cat. He is on 3.5 units Prozinc. (I gave his full history in my initial post last week). I've had him about 3 weeks now (adopted 7/24/23). In the first 2 weeks I was testing and changed his diet, and his glucose went from the high 300s- low 400s to low-mid 200s and once in the 190 range which was great. It looked like I was going to be able to get him regulated. He never liked getting his glucose tested, but I was able to do it with just a bit of fuss from him but at least I could keep him still enough for a test. It took him a few days to get used to me and the new environment, but he warmed up to me and things were looking good.

Last Thursday 8/10 I brought Bernie to his first appointment with my vet and he had a full exam -- urine, blood, fecal, etc. He wasn't happy and was super stressed and anxious at the vet. Hissing, biting, screaming. My vet said it was really hard for her and the vet techs to handle him. Almost immediately since we got home his behavior changed and now I can barely get any blood from him no matter what I try. His glucose has gone to the mid 400s practically overnight. He fights me immediately when I try to ease into pricking his ear and in just the couple of times I've gotten a reading it was after 5 minutes of him hissing, struggling and biting. I've been through this forum and have tried all the tricks -- rubbing ears, treats, the heated rice ball to warm the ears -- everything. He is not a lap cat and has only ever let me pet his head/neck area, which was fine. He's not what I'd call cuddly, but in the first 2 weeks of having him I was able to get blood with some fuss but nothing like it is now. I'm not sure what to do. My vet told me to increase insulin to 4 units BID and also suggested he get a Freestyle Libre implanted. I'm going to do the Freestyle Libre for 2 weeks so that there's no stress of getting ears pricked for blood. But I can't do it continuously since it's super expensive. I'll have to do home testing once the Freestyle comes out.

Any advice/suggestions related to his behavioral issues? I thought he'd calm down within a day of being home but it seems to be getting worse and any readings I get are really high (high 300s at nadir, morning readings in high 400s) and this is trending opposite of where I was before I took him to the vet. Seems like we're spiraling right now.

I'm keeping my distance right now to give him some space, but I'm not sure how to manage him long term. He seems to hate me now. I really need some help to get back to where we were so I don't have to just pump more and more insulin into him.

Thanks,
Patricia (& Bernie)
 
This is the link to your previous post for continuity.

Geez.... I'm so sorry that Bernie is struggling. It really sounds like he was traumatized during the vet visit. By any chance, did the vet take him out of the exam room to get the labs drawn? If so, I'd really wonder what happened when he was out of your sight. It's also possible that given his history, he took a few backward steps regarding trust. I think giving him space is important.

I'm not a big fan of urine glucose testing but it may be an option until you can get a Libre placed. Just be aware that there have been discussions about the accuracy of the Libre and some cats are pros at pulling them off. You can get strips that will test for glucose in a cat's urine. The strips are not accurate at either low or high numbers which is why blood glucose is a more reliable measure. It may be a temporary fix until you and Bernie can reestablish trust.

There may be some options but it's going to be more of an experiment to see if they work vs a guarantee.
  • Feliway diffusers placed around the house may help. They may take the edge off of the stress. If you've not used them, they are a pheromone than can help to reduce stress. They have helped when I introduced a new cat at home and when I moved. They are available on Amazon or Chewy's. Just make sure you get enough to cover the square footage in your home.
  • Thundershirts are a possibility. They are meant to be a way to help during thunderstorms but members have used them for other situations. If Bernie doesn't like to be held, I don't know if they would help or not. I've not used them so I don't know.
  • There is a clip that is kind of like a clothespin that was designed to act like a mom-cat grabbing a kitten by the scruff. It's called, Clipnosis. It used to be available on Amazon. The only place I'm seeing it is through MedVet. It was designed by a vet.
  • I'd also talk to your vet. It may be that some sedation may help but it also would involve pilling Bernie. I'm not sure that would be a good alternative at the moment.
  • I did a search on Chewy's. There are calming cat collars and a number of supplements that are supposed to be helpful for calming cats. If you try a supplement, just be sure it's not high in carbohydrates or in a sugar syrup.
  • Rescue Remedy is liquid that's been around for a long time.
 
Thanks Sienne for all the suggestions and linking my previous post with Bernie's history.

I'll look into the diffusers specifically and the other options, but his behavior change is primarily when I'm trying to test, not other times. He's not a naturally anxious cat and is in fact quite confident. I have the glucose/ketones strips but they don't give numbers, just confirms glucose and ketones.

I think it was trauma at the vet that is putting him in a continued frenzy. He doesn't want to be touched or poked, but luckily he doesn't mind the insulin shot. What also doesn't help the situation is that because he's so fixated on food at meal times, getting pre meal, pre insulin readings are competing with that and he has no patience/tolerace for getting the reading when all he wants to do is eat. He's unrelenting in trying to get to his food. It's easier (although still difficult) to get readings at non meal times. As for the ear pricks, I use a 28 gauge lancet and even before when he allowed me to do it, he always let out a big cry right when the lancet went in. I've read that cats don't have a lot of nerve receptors in their ears and that it "shouldn't" hurt, but Bernie seems to feel the pain. I've ordered some thinner lancets (33 gauge) to see if it makes a difference. Either way, I'll at least get a break for 2 weeks when the Freestyle goes in. I hope he doesn't rip it out!

They did take him out of the room for the tests and my vet said Bernie was especially mad during the fecal test, I don't blame him. I needed to get a thorough exam and establish baselines for him at the vet since his history is kind of spotty and we want to understand everything going on. The good news is that everything else came back normal except the fact that he's highly diabetic. My vet has treated all my previous pets, she's an animal lover and I trust her completely. She also treats several diabetic cats and has a few cats on Freestyle right now. The vet techs I don't know but I'll ask her for more specifics when I see her Monday for Bernie's Freestyle implant.

FYI, for anyone considering Freestyle, my vet told me that Freestyle Libre 1 and 2 have worked well for her cat patients and are accurate, but she has a cat patient on Freestyle Libre 3 right now and they don't think the readings are accurate. I'm putting Freestyle Libre 2 on Bernie tomorrow.

Thanks again for the advice
 
A fecal test? So they restrained him, poked and prodded, likely drew blood from his jugular, squeezed his bladder and then shoved something up his anus to retrieve poop. Nice, and just how NOT to establish trust with a new patient. Sounds like poor Bernie was abused and I don't blame him for being pissed and distrustful. He doesn't really even know you that well yet. I'm so sorry for both of you.

I've adopted/ fostered a bunch of diabetics who had no reason to trust me at first and they all learned to come and jump on the washing machine for their tests, none ever had to be restrained. Cats really hate being restrained. If Bernie is focused on food, use it. I always give my cats about a tablespoon of food when testing, and they don't even notice they're being poked anymore. That little bit of food can make all the difference between a cooperative cat and one that wants to shred you.

Food can help regain his trust. Encourage him to come to you by sitting and offering him little bites of chicken or pieces of low-carb dry kibble. I use Instinct Original Chicken (about 8% carb calories). It will get better but you'll have to be patient and let everything be on his terms for little while.
 
Yes, the vet appointment wasn't great, but he needed the tests so they had to be done.

How long does it take for food to affect blood glucose? I thought I had to do the test before any food was consumed. Is it ok to get the blood test within a couple of minutes of him starting his breakfast? If so, I think he may be ok with the ear prick while he's eating. I usually give his insulin once he's about halfway through his food and he doesn't even notice.
 
He didn't need all those tests done at one time unless he was sick, having symptoms and needed an immediate diagnosis. Unfortunately, Bernie is going to remember so your vet is going to have to work a little harder next time to make friends. With new animals, I like to do a simple meet & greet for the first appointment so it will be a positive experience but if that's not possible I expect my vet to spend a few minutes reassuring the animal and she's happy to oblige because it makes the whole appointment go better. All the kids love her. Check out fear-free veterinary concepts, here's one: https://www.mspca.org/angell_services/fear-free-concept/

I never thought about how long it takes for food to affect glucose but a few minutes isn't going to make any difference. My morning (and evening) routine is prepare a little food, get the testing supplies out, test strip partially inserted in meter, lancet in one hand, tissue for backing in the other, at which point cat is already on washer pawing at me to hurry. I push strip in, set the food in front of cat and poke while he's eating. If the syringe is loaded, I'll give the shot. Then he gets the rest of his breakfast or dinner undisturbed in the kitchen. Don't want to make mealtimes something to be suspicious about.
 
I just tried to do the ear prick as he started eating and it was as bad as ever. I'm at my end with him. Just going to continue the insulin without testing. I can't get near him to do the tests it's an all out fight and he is getting violent.
 
There are a lot of cats out there getting insulin without being tested so please don't feel bad because it's not working for you right now. Bernie has been traumatized and it's going to take some time for him to get over that. He's stressed and he's picking up on your frustration as well. I think you both deserve a break so why not just work on gaining his trust for now because that's more important and without it you won't get anywhere. You already have the skill to test if something seems amiss. Give him his food, insulin and a quick little pat on the head until he's calmer. And he probably shouldn't go back to the vet for awhile unless it's an emergency. Be kind to yourself.
 
A few minutes between giving Bernie some food and a test, like Deb said, isn't going to make a difference. If you use a zero carb treat like freeze dried chicken or a piece of cooked chicken, it definitely won't have much of abnormal impact on the test numbers.
 
Update: I had Bernie fitted with a Freestyle Libre 2 this past Monday morning (8/14/23) and it was great!...until he ripped it off on Friday night It was expensive for just 5 days but we got a lot of info.

Anyway, for anyone needing a low stress solution to getting a lot of glucose data, I definitely recommend the Freestyle Libre. He barely noticed it was there except for when he looked at me strangely every time I put my phone up to the sensor to get a reading. I was doing it 20 times a day it was so interesting to see what was going on. What I found was that his glucose definitely shot up fast after meals, and it took about 2 hours for the Prozinc to kick in, and he was at his lowest around 6-7 hours after a shot. It then went back up right before dinner. What was super interesting is that when Bernie was playing or moving around a lot, his glucose also tended to spike. I knew this because my phone would give a super loud and annoying alert telling me his glucose was "critically high". Since the sensor is for humans, Freestyle goes to a max of 400 and above that is considered critical. He only got those when he was playing, which was funny. My vet said that cats are very sensitive to things around them and it didn't surprise her that glucose rose when he was excited. Having the sensor implanted was low stress and his behavior got back to normal -- he wasn't stressed and didn't want to kill me. I think the only reason he ripped it off was because it may have gotten itchy as his fur was growing back under the sensor, or that he was just curious and started to realize it was there. He first started rubbing it on the doorways and then he just bit it off late at night. It was hanging off and I couldn't rip the rest off (they use very strong medical glue to put it on), so I had to go to the vet and have them use the glue remover. If I ever need to put another one on I'll ask for it to be a little higher on his back and not where he can bite at it.

For the 5 days he had it on, the vet bumped him to 4 units BID and since then we got his mid-day numbers to the low-mid 100s which is huge progress for him. Now that I'm back to manual testing, I do one ear prick test a day at mid day to make sure his glucose doesn't get too low. I'm still using the Alphatrak 3. He's still around 150 at his lowest but his highest is now closer to 230 as opposed to 380. I guess he needed the 4 units to get there. I wish I could test before meals as well but he is still so crazy about getting fed and won't calm down enough for a reading, so I'll just be happy with one test a day when he is much calmer and not expecting a meal. My only concern is that if his glucose is slowly getting better, that if I'm not getting a pre-meal reading I may be giving him too much insulin, I'm hoping at some point we can lower the dose over time.
 
With proper placement, application and protection a Libre can last the whole 14 days. My last two, one different cats, lasted 14 days. You should join this FB group, https://www.facebook.com/groups/libreforpets
A Libre is not that expensive. I got my last two for ~$76 for the two. You may be able to find someone near you who can help apply the Libre.
 
I agree, I do think it's possible to keep the Libre on for 14 days. My vet just placed it where Bernie could get at it with his teeth. If I do it again I'll make sure it's better placed. As for cost, I live in NYC and I can't find a Libre for less than $80 even with coupons from goodRx or other prescription coupon sites.
 
Patricia&Bernie said:
I agree, I do think it's possible to keep the Libre on for 14 days. My vet just placed it where Bernie could get at it with his teeth. If I do it again I'll make sure it's better placed. As for cost, I live in NYC and I can't find a Libre for less than $80 even with coupons from goodRx or other prescription coupon sites.
Click to expand...
Hi Patricia, just wanted to add to the Freestyle conversation. I use a Libre 3 on Ivy, I get 2 for under $63.00 at a time from Wegman’s. I see there are Brooklyn and Manhattan locations for the store in NY and some in NJ, too.
They find the lowest coupon and that’s what I pay.
Maybe you could check with them to see what your cost would be.

I apply the sensors myself and don’t use glue. (Check the Facebook group for all the tips and information or reach out to me, I can share more information I’ve learned. )

I do have a tee shirt or tank top on Ivy as she pulled one off 1x when it was uncovered. Lesson learned.

The Libre 3 uses an app on your phone and you get 24/7 monitoring. I don’t even have to scan the sensor. I like that a great deal.
If Ivy goes low on the sensor I double check the glucose with an ear prick and see what that number is on a handheld meter. The Libre usually reads lower than a handheld meter will, so you need to check to be safe.

My cat isn’t easy to poke many times a day, so I use the Libre to get an overall picture of what’s going on.
I hope this helps and wishing you best of luck with Bernie. :cat:
 
Thanks for the advice. I'm pretty far from the Wegmans but will try to find some better coupons that what I used. The problem with NYC (among many!) is that prices are much higher than everywhere else. Even chain stores like Target or McDonalds have higher prices than you'd see in other parts of the country -- it's because rent is so high that retailers, including pharmacies -- make up for it with higher prices. So a coupon that works for you in your area for the same store won't work in NYC. All those Rx coupons are based on the zip code. Right now I'm going to continue with the AlphaTrak as long as Bernie will let me test him, even with some moderate resistance. If my vet wants another set of continuous readings I'll try the Libre again. Thanks!
 
Patricia&Bernie said:
Thanks for the advice. I'm pretty far from the Wegmans but will try to find some better coupons that what I used. The problem with NYC (among many!) is that prices are much higher than everywhere else. Even chain stores like Target or McDonalds have higher prices than you'd see in other parts of the country -- it's because rent is so high that retailers, including pharmacies -- make up for it with higher prices. So a coupon that works for you in your area for the same store won't work in NYC. All those Rx coupons are based on the zip code. Right now I'm going to continue with the AlphaTrak as long as Bernie will let me test him, even with some moderate resistance. If my vet wants another set of continuous readings I'll try the Libre again. Thanks!
Click to expand...
I understand about nyc prices. I hope you can find one that will work, if you should need it.
Could you use a pharmacy in NJ just over the bridge?
Just a thought, if that was a work around.
 
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