New Bewildered Member (Merlin) continued

Continued from https://felinediabetes.com/FDMB/threads/new-bewildered-member-continued.262958/page-2#post-2949869
Hi! I’ve started this third thread because I still have lots of questions, and Merlin’s not even on insulin yet! I’m searching for skin adhesive and adhesive remover in Ireland. It’s hard to find it, even on Amazon. The vet used a wipe of some kind of skin tack under the Libre, but then she also gushed on super glue, which is tormenting Merlin now that the sensor has proven to be faulty. I removed the sensor, but bits of the sticker are still stuck on and stabbing him at the corners. Metholated spirits, which the vet used, didn’t do a thing. I keep applying coconut oil, but sticker remains. I made a vest for him out of the top of a pair of tights to at least protect his skin when he scratches at it. I’m trying to beat the clock for when we apply the new sensor, so I can provide better glue. Did adhesive tape over the sensor work for anyone?

 

If he is not on insulin yet, are you testing for ketones every days.

 

Yes. I am testing his urine every day, sometimes a couple of times a day. All clear so far. Thanks!

 

Hi Jill
I have found this adhesive remover that delivers to you, quite expensive though. It says next day delivery if ordered before 1pm, maybe call them and ask if they can get it out today.
https://www.inishpharmacy.com/p/clinimed-3500-appeel-medical-adhesive-remover-50ml/appeel3500

 

Thank you! I went in a search of all the pharmacies in Cork city. I managed to find a remover like thisbut no adhesive skin glue. Best I can do is put some medical tape over the sides of it, I guess. Does anyone use skin adhesive for their Libres?

 

My vet used something like superglue to put Benny's Libre on too. After 2 weeks there was still some left when I went to remove it this morning. I used some Uni-Solve Adhesive Remover by Smith & Nephew to remove what was left. It is a medical adhesive remover for tape and dressing removal. This was recommended by a Facebook group for Freestyle Libre for pets. I don't know if it is available in Ireland, however. I got mine from Amazon.

My vet put a bandage over the sensor. Benny ate most of it. The same with a stockinette. I used a baby shirt and he was not able to eat it. There are adhesive patches made to go over the Libre sensor: https://www.amazon.com/gp/product/B07QB7V6MF/ref=ppx_yo_dt_b_asin_title_o01_s01?ie=UTF8&psc=1 I'll be trying those next time. Again, I'm so sorry not to know if they are available in Ireland!

I hope you will keep us posted on how it goes. I'm a new Libre user too!

 

Unfortunately, the stuff I got not only didn’t work, but it has really strong peppermint oil in it that makes Merlin squint. I ordered some equivalent adhesive dissolving wipes from Amazon.

 

I got another BG reading on Merlin, which, strangely, was exactly the same as the first number, two days ago, three hours after a snack. 15.9. If I were to fill out my spreadsheet it would have only three numbers in three days. Maybe I should wait til he’s on insulin…

 

I use citrus peel oil to remove sticker glue from other things, have found it works better than olive oil. Keep oo on the skin though to prevent the glue from migrating

 

in my humble opinion, as a fellow newbie NOT an expert -- no don't wait, keep testing. The more data the better, the more Merlin gets accustomed to ear pricks and treats and the whole thing becomes routine the better. I wish I had been able to get a headstart on all that like you are!

yes sometimes we get the exact same number, it happens and it always makes me question the BG test haha.

 

I will keep practicing, for sure. I just didn’t know if entering it on the spreadsheet before insulin was ok, especially with just one test a day… And another thing, I can’t figure out how to poke without completely piercing. I’m worried Merlin will have lace ears soon!

 

On another subject, ever since I switched my three kitties to lc wet food, they have had very few and very small poops. Should I be worried???

 

Yes, please enter all the data you have even if you are not giving insulin!
If you are using a device to prick the ear, you may need to reduce the depth of the prick. There should be a dail on the side to do this.

 

hmmmm good question are you using a lancing device or doing it freehand?

if freehand, make sure you coming in a 45 degree angle and the pointy side down, press gently into the ear or a little jab -- for me it took a lot of practice to learn just how hard to jab and how deep i needed to go for blood, and it varies depending on where on the ear I'm poking so...even now sometimes after months of this, both the wife and I will accidentally poke too hard at a thinner spot and maybe end up with blood droplets forming on both sides. But it is much much more rare these days. You'll get it!

and if you're using a lancing device then yes maybe dial it back a little in the depth setting

 

In my experience with raw, the poo is small, pretty hard & very little smell. Also, generally not every day

 

Here’s a thing I don’t understand. If you have a grazing cat who comes back to the same bowl of food until he gets a new bowl, how do you write that in the spreadsheet? Do I need to weigh the amount every time I dole it out? And here’s the hitch…the two other cats eat out those bowls too. Is it important that Merlin is fed separately and I watch him eat it and record the amount taken out of the bowl? I will make sure he eats before insulin, but how much does he need?

 

That is my experience as well

 

I think you need to work out how much he should eat for the whole day and then divide that up into 2 main meals which he will have before both doses of insulin, and then the rest should be divided up into 4 snacks (2 am cycle and 2 pm cycle). Once you know how much he needs to eat, you may be able to let him eat with the others for the snacks. But it is important that a diabetic cat eats about the same number of carbs and calories each day.

 

How would I figure out how much he should eat?

 

Hi Jill
It's not as complicated as you think, honestly.
We have two cats and they are both fed at the same time but in separate rooms, George in the kitchen and Duke in the dining room so we can be certain he's eaten all his meal.
We give Duke a packet of Sheba in jelly which is 85 grams plus another 25 grams totalling 110 grams in food plus we add 25mls of water to that food, this is done for his breakfast and supper. We also give him little mini meals at say +3 +4 +5 hours after his insulin shot AM and PM, sometime he eats it sometime he doesn't but we make sure he always eats his breakfast and supper or at least 90% of it. Sometimes he's just not that hungry which is a problem with diabetic cats as they must eat before their insulin but if he struggles we get the roast chicken out and place it strategically in his food the while he's finding the chicken he's also eating the Sheba. Other times on rare occasions he just flatly refuses to eat everything so we hold back on the insulin wait a while to see if he eat's or give him a reduced dose, this is of course with Prozinc insulin and i can't honestly tell you if it's the same method with Lantus, maybe @Bron and Sheba (GA) can advise more, thanks Bron.
Also Jill please still add the data to Merlin's spreadsheet regardless of insulin or not.

 

Since he is not given shots yet, how do I enter my BG readings on the spreadsheat? Where do I put the times of the readings?

 

When i did mine before Duke started insulin i used the time from when he finished his breakfast/supper, that would be his AMPS/PMPS so +1 would be 1 hour after his food +2 2 hours etc on the spreadsheet.

 

Hi again Jill
The figures you entered need to be entered into the World mmol/L page.
If you delete the ones in the US mg/dl and reenter them in the World mmol/L page then the spreadsheet will automatically convert and add them to the US mg/dl page , if that makes sense lol.

 

I thought I set it up with the instructions for a world mmol/L page? At the bottom it says “=‘World mmol/L’ !A9” I’m confused now…

 

there are 3 tabs at the bottom, US mg/dl is selected and is where you're entering data, I think.

if you click on the tab to the right of that, where it says World mmol/L and enter the data there, it will automatically appear on the US tab in US numbers from what I understand. Never done it myself.

 

Brilliant Kyle.

 

Is that the right way now?

 

It seems that it keeps the numbers as mmol/L in the cells, but it color codes them to the US groups at the top

 

So, since he’s not on insulin yet, do his BG numbers (all four of them) mean that his blood sugar is quite low all the time, and he needs to eat even more often than every two hours til he gets insulin? Should I be giving him the foods on the UK list that are closer to 10 percent carbs rather than 5, like I am now?

 

If you delete the numbers in the US mg/dl cells then refresh your spreadsheet it should change to US numbers automatically.

 

yes I believe when you manually enter data into the cells on the US tab, it overrides the automatic bit where it converts from the world sheet and fills it in on the US sheet for you

So right now the four BG tests are 3 yellows and 1 pink. That's not low. It's also not super high which is good!

no, it does not mean you aren't feeding enough or that you should feed higher carb like 10%. I think it means that you are doing exactly the right thing with the lower-carb food and it is helping a little, but he is still going to need some insulin. Just hopefully not that much.

 

I like the sound of that. Thanks!

 

I have an insulin question now. We are trying to decide what time schedule Merlin should be on. The vet is ready to give him his first dose of Lantus and install the new Libre. I would like this to happen on one visit and wait around for an hour afterwards to make sure all is well and the monitor is working. We would ideally like a later schedule (and the vets doesn’t open until 10) for his 12 hour doses. If we do the first shot at 11, is it ok if he has eaten twice before it? My husband gets up at 830 and could test and feed him. I can feed him again at, say, 10:45. Would this schedule be too unusual or confusing? We are artists/performers and our work is more at the end of the day. What do you all think?

 

So.....you need to withhold food for 2 hours before the pre-shot BG test and ideally you need to test, feed and shoot all within a short window 10-15 minutes, some people take a little longer like 20 minutes but that is pushing it.

So it goes like this, with the entire process taking place in a 10-15 minute window is best.

After withholding food for the last 2 hours you:

• Test the cat's BG to make sure it is safe to shoot
• Feed the cat to make sure they have some food on board for the shot
• Shoot the insulin.

Testing in the early morning, feeding then shooting hours later isn't going to work out very well as far as I know.

I am not sure what to suggest here tbh. Maybe someone else has a bright idea

@tiffmaxee
@Suzanne & Darcy
@Bandit's Mom

 

I'm not sure about that one Jill but personally i would hold back on the insulin at the vets and do it yourself at home, explain to your vet that Merlin needs to be fed just prior to his insulin being given and you don't want to risk a hypo, also that way you can determine yourself when the 12 hour dose times are.
Melissa any ideas @FrostD thanks.

 

If he eats breakfast at 8:30 and then does not eat again and you give him his first insulin injection at 11 a.m., that would be more than two hours without food so it should be okay to get a Libre reading and then the vet could administer the insulin. But that would also mean that you would need to give him his second insulin injection at 11 p.m. (and no food for him after 9 p.m.)

ETA -- of course after 9 p.m. -- two hours later... when you would test... you then feed him before his shot!) sorry if this was confusing. Always, test, feed and shoot, in that order.

 

If it has to be that way, then you will have to work the shot times back to whatever you want them to be. Are you suggesting shooting at 8:30 a.m. and 8:30 p.m?

Of course, as soon as you get a Libre reading, you give him food and he eats it either while you shoot the insulin or you shoot just after he finishes up. @Hendrick Cuddleclaw laid it out just right as far as how the routine is supposed to go.

 

Suzanne's suggestion is great as long as you have no problem staying up until the wee hours if you need to monitor him because he's in the lower numbers that night

 

So I am not sure if you already have been told this or not, but when you need to adjust insulin shot times, they can be adjusted by up to 30 minutes per day. That means you can shave (or extend) 15 minutes off of each shot time for a total of 30 minutes adjustment -- or you can do the whole thirty minutes at one shot time. Otherwise, shooting early can act like a dose increase.

 

I'm confused here Suzanne
Wouldn't Merlin need food straight away before his insulin is given.

 

Yes. Withhold food for two hours prior to when insulin will be given. Then the order is: Test, feed and shoot.

 

I am not suggesting that you do shots at 11 a.m. and 11 p.m. I am just saying if that's the earliest the vet can give the shot... then you are stuck with that... unless the vet will put on the Libre and just let you do the injection at home at whatever time you need to do it to accommodate your schedule.

Optimally, the vet would allow you to do this. If you follow the test, feed, shoot routine and you have the Libre on you can get that +1 check that you are looking for (you said you'd hang arount the vet for an hour to make sure it was all okay) it will be fine. Really, the Lantus probably won't have lowered BG in an hour anyway (it will take a little longer to onset.)

 

Thanks Suzanne
Jill is wanting the vet to administer the first dose but how can that be possible as Merlin will not have been fed prior to his first dose. It will be test, no food and shoot, that's how i read it.

 

Yes... I really don't like that 11 a.m. shot time... but I don't know their schedule, and I am not sure if the vet will be flexible enough to put the Libre on and let them take the insulin home and do it themselves on their own schedule. Maybe if the vet insists on doing the first dose they may have to skip the p.m. dose that day and start up again the next morning whenever they decide is the best time to shoot on a daily basis -- with their schedule? Again, not optimal (the skipping) but I can't think of anything else right now except either the really late (11 p.m.) shot time or doing a skip of the PM shot and starting fresh the next morning.

 

Well we all know he needs that food prior to getting the shot. Even the vet knows that, I'm sure, so I don't know why any vet would give insulin without food on Board first? Can't they feed him at the vet (although some cats will not eat at the vet.. mine usually won't). It's very confusing.

 

Okay. I've got to go out of the house for the afternoon. I am sure that the Brain Trust will help with a solution. You're really making progress, Jill, and I know you will do the very best job of helping Merlin and keeping him safe! I look forward to seeing his progress.

 

I agree Suzanne it's very confusing.
That would be the ideal situation if Merlin could be fed at the vets but if not the vet shouldn't give him his shot i don't think.

 

Yes. No food... no shot!

 

Ok. Just back from getting a new monitor. It was much less of a @#&^ show this time. I guess this is the second, as opposed to the first, time she has fitted these, the first being Merlin’s first. She wants us to schedule his first injection for tomorrow morning at 9:30, but she asked that I bring him in fasting?!! I said “my old vet,” (as in, you guys) said she always feeds them first and then injects. She said “different people have different methods” and she would feed him an hour after insulin. She also wanted me to leave Merlin there for two hours to make sure he doesn’t hypo and that I might not know the signs. He has a new monitor now that, supposedly, will be working in 15 minutes, and we live 5 minutes away from the vets. I will be testing him too. Should I go ahead and make the appointment for 930, but feed him right before we go? If for some reason we have to wait at all, will he be ok with the food he gets before we go? Is she right? Will I really know if he hypos? Help!!

 

ooof that's tough. Remind me how much insulin she is going to shoot? Lantus?

 

Way back when we first discussed insulin and it was Caninsulin, she said she would start with .5. I hope that’s the plan still for Lantus. If she wants to use more, should I insist on .5?

 

Also his first reading on the libre was 25.3! That’s the highest ever. He did eat a lot when we got home and he was super stressed…

 

sorry to say, I do not feel comfortable giving dosing advice. Let's leave that up to the experts like Suzanne, Bhooma or Elise


Suzanne said she would check back in later, had to go out. We'll see what she or one of the others has to say about your situation.

 

I started a new thread…
https://felinediabetes.com/FDMB/threads/new-bewildered-member-merlin-continued-more.263411/

 

If you are following the SLGS protocol, then the recommended starting dose for a cat on Lantus - if the cat is on a low-carb wet food diet - is .5 unit. every 12 hours.

I am not sure if you have decided on which protocol to follow. If it were my cat, I would not start with anything larger than that. In fact, and this is just a personal opinion, but I might even start with .25 units because I see a lot of yellow on Merlin’s spreadsheet- so out of an abundance of caution I would probably so that with my own cat. It’s not what is written in the SLGS guidelines, but this is what I probably would do with my own cat. I would also feed my cat before taking it to the vet.

 

Oops. I thought this was on the new thread. I ll copy it over there.