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Lynx

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Hi, my name's Rob and my 14 yr. old aby, Zeek, started showing symptoms of diabetes the end of march, 2011. We've been struggling with IBD for about a year now. the last depo medral caused a bad reaction and seemed after that the drinking and peeing started. Vet tested for diabetes 5/11/11, started with Lantis, 3 units, first once then twice a day. still lots of drinking and finally vet said 5 units twice a day. first night he had 3 in the morning and 5 that night and when I got up he was in a semi-coma. came out ok. so we tried 4 units twice a day. same problem only not as bad. vet said to make sure he eats. made sure he ate and again was in bad shape after 4 units. so I tried 3.5 units and he was doing great till the other night when he didn't eat any dinner and started having trouble not long thereafter. spent the night at the AEC. I know I gotta get a meter, not sure which one and from where? Part of the problem is that the IBD is sensitive to canned cat food and he doesn't like the science diet ID or WD though will eat some at times. Been feeding baby food; chicken, turkey, and beef. He has been cleaning his plate up till the other night. He's been eating the science diet WD dry mostly. Haven’t given any more insulin since the bad reaction the other night. Drank half a cup of water last night but otherwise seems good.
Thanks.
 
first, and know that i say this because i care, you gotta get a meter asap. go to a walmart, and get their Relion Confirm or Relion Micro meter and a pack of test strips. What this has felt like to your kitty I cannot imagine. up down up down on death's door how many times now? so scary.

the testing will tell you sooooooooo much. your vet started you on a bad dose and a bad dosing schedule and it sounds like it has nearly killed your cat, several times.

i'd worry about getting going on the testing first and giving no more than 1 unit of insulin twice a day for now, if the numbers warrant it. food changing can come next. your cat is already hypo'ing, badly, on the combination he's getting, so don't touch the food just yet i think.

once you get the testing going, then worry about a more diabetic friendly food. for instance, raw is both good for diabetes AND IBD. my late Kitty had IBD and it was managed simply by feeding raw rabbit to her. BUT DON'T DO THIS WITHOUT DROPPING THE INSULIN DOSE. if you change the food but keep the insulin dose so high, you can easily kill your cat.
 
no. it doesn't have to be walmart. theirs is just very affordable and a good one as far as reliability, etc....

as far as name brand meters go, if you can swing one of them, the Freestyle Lite or Freestyle Freedom Lite are pretty much the same as Walmart's Relion as far as ease of use and amount of blood required.

the Accu-chek Aviva is liked by many, as is the One Touch Mini's.

there are other store brand meters (walgreen's, cvs, target, etc....) but i want to say that a good share of them have been found to be unreliable. for instance, i think many members found that any of them with True in their name have been questionable as far as results.

if you go with any of the brand name meters, get a small pack of test strips at the store, then order more online as that's the cheaper way to go (ebay.com, americandiabeteswholesale.com, store4diabetics.com just to name a few)
 
Any human monitor will work, be sure to look for one that takes a very small sample - Relion calls their micro. I'm sure any place with a pharmacy will have meters. What you may be most interested is the cost of the strips as they can go from darn cheap (pennies) to down right expensive (a buck). Many of us use the Relion micro because it's cheap, readily available in many places and cheap strips.
Remember to do some deep breathing to relax you, which will relax Zeek (Great name).
We also use a cotton sock with some whole grain rice. Put about 1/2 cup rice in sock, tie knot, cut off excess. Warm in Mircowave for about 20 seconds test on your inner arm or neck to be sure it's not too warm. Hold on zeek's ear until warm (not necessary if he's been sunbathing) some times 5-10 seconds, (sometimes more- my kitty took a whole minute) but she has always had the world's coldest ears.
 
I got my Contour from Walgreens and love it. When I was trying to decide between models, someone warned me not to get True Track because of its reliability.

Glad to see you're getting a meter. Knowing how your numbers are trending will help drive dosing decisions.
 
Kathyh said:
We also use a cotton sock with some whole grain rice. Put about 1/2 cup rice in sock, tie knot, cut off excess. Warm in Mircowave for about 20 seconds test on your inner arm or neck to be sure it's not too warm. Hold on zeek's ear until warm (not necessary if he's been sunbathing) some times 5-10 seconds, (sometimes more- my kitty took a whole minute) but she has always had the world's coldest ears.
Click to expand...

Just to clarify here, use plain un-cooked WHITE rice, not brown rice. Brown rice will go rancid.
Put 1/4 cup to 1/2 cup into the toe of a thin-ish sock and either knot if off or sew it shut just above the rice.


My Smokey had IBD and therefore steroid-induced diabetes. He was on oral predisolone.
Steroid-induced diabetes is common in IBD cats.


Your cat was suffering from an overdose of insulin, an understandable 'reaction' given the way too
high starting dose. We advocate the start low, go slow, approach here. (Start at 1 unit 2x/day and
work up from there in increments of not more than .5unit)

Obviously, it's safer to up the dose if needed. Once an over-dose is in the cat, you can't take it back out.

Did your vet give you any information on treating hypoglycemia ? ( low blood sugar from too much insulin).

Here is our reference on that:

http://www.felinediabetes.com/hypogly.htm

Getting this diagnosis is scary, and the learning curve is steep at first. Like getting a drink
of water from a fire-hose.

But we are here to help you every step of the way.
 
I'm so glad you found FDMB...there is much support and information here! You've gotten some good starting points so far, and yes - getting a meter and testing at home will be the best thing you can do for now!

I use a One Touch Ultra Mini and am very happy with it - and you should be able to buy one at your local pharmacy. The strips are very expensive to buy locally, though, so I only do that when I'm in a pinch. There are online sources, likehttp://diabeticcare.com/ - the strips are much cheaper, and shipping is free.

If you need any assistance in getting Zeek's ears to bleed for you, post away...everyone here has lots of tips and ideas to help you along. Eventually, his ears will "learn" to bleed, and the pokies get much easier.

Since you are using Lantus, you could check out the stickies at the top of the Lantus support group:
http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Again, lots of good information, with the emphasis on "lots". There is a lot to learn about FD, and you don't need to do it all in one fell swoop. First things first, I would work on the testing to make sure Zeek doesn't hypo again, and go from there.

Welcome aboard!

Amy & Trixie
 
Thank you all so much. I seem to have found the right place. I don't know what to say about my vet. He's young. But he never mentioned home testing even after the bad hypos. I told him I wanted to see how he tested and he was very accommodating.
Got the one touch mini for $114, strips were the most expensive element of the lot, I'll get the next bunch from your source. Zeek did great! I had to stick him twice before I got enough to test but he just hung with me. Fortunately abys have big ears and so should be able to collect blood without warming, but thanks for the suggestions. Read over 500 so I gave him dinner and then 3 units, never had a bad reaction from that dosage. So I’ll test him in the morning and if it’s up there again I guess I’ll give him 3 again. Where do I go from there?

I like the idea of controlling symptoms with food but like I said, he's only really loving the baby food as far as wet goes. Have tried chicken thighs, gizzards, and livers tho mostly cooked, but I don't think he'll eat it raw anyway and what about salmonella? He'll eat steak but I'm hoping on finding something less extravagant. Raw rabbit sounds interesting. I tried some canned rabbit and pork liver but it aggravated his IBD. My other aby has CRF but can eat most canned food and since I started feeding him all the canned he wants his symptoms have disappeared.

Thanks again! Rob
 
Hopefully now that you are testing, he won't drop that low again. 3 units is still quite a lot, but if you test every 3 hour you will hopefully catch him if his bg is dropping. The dose needs to be held at the same for usually 3 full days (6 doses). It seems that it would be a good idea to call on some of the experienced people from the Lantus group to take a look, especilly tomorrow when you have more data. You can put the data in your message for now, like this:

AMPS xxx (This is your morning preshot number)
+3 xxx (This is your number when you test at 3 hours after his shot)
+6 xxx (6hours after)
+9 xxx (9 hours after)
PMPS xxx

Those hypos are frightening. I hope that you have put your hypo it together - hopefully you won't need it soon, but better safe than sorry.
 
Now that you've got meter in hand, it's a good idea to not only test before shots, but also in between shots, so you can see how Zeek is responding to the insulin. Most kitties will "nadir" (peak, or hit the lowest point in the 12 hour cycle) at around +6 (6 hours after the shot), but not always. My Trixie usually hits her nadir around 4 hours after her shot. Those pre-shot numbers are important, because they tell you whether or not it's safe to give insulin, but the in-between numbers give you very imporant data, as well. You'd be surprised how quickly some kitties BG numbers will drop once they've had their shot.
 
I think y'all are right about the heating of the ear prior to pricking. had much better luck after doing so this morning. But he tested only 111. So I didn't inject. What now? test every 3 hours?
Question, is this how I handle a hypo? "I hope that you have put your hypo it together" If so, I probably don't. All I know is to put honey on his gums.
 
Glad to hear the ear pokes are doing better! 111 is a nice number, but you're right...at this point you don't have the data to shoot such a low number.

What insulin are you using? If you're using Lantus, here are a couple great links from the Lantus support group...these do a much better job of explaining things than I ever could!

Handling Low Numbers (Includes a link to what you need in your Hypo Kit):
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46003

Handling Low Pre-Shots:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46005

I hope these help you out!

Amy
 
Lynx said:
I think y'all are right about the heating of the ear prior to pricking. had much better luck after doing so this morning. But he tested only 111. So I didn't inject. What now? test every 3 hours?
Question, is this how I handle a hypo? "I hope that you have put your hypo it together" If so, I probably don't. All I know is to put honey on his gums.
Click to expand...


Once again, here is the link about handling a hypo:

http://www.felinediabetes.com/hypogly.htm
 
Recapping the short histroy of this cat - taken from first and last post:
Diagnosed May 11. Started Lantus 3 u once daily. Changed to twice daily (time on 1x not given)
Still drinking a lot of water. Vet raised to 5 u twice daily. After 1st 5u evening shot, went hypo.
Tried 4 u 2x daily. Same problem. Vet solution was "make sure he eats".
Again, hypo on 4 u.
Tried 3.5 u "doing great until the other night when he didn't eat". Spent the night in emergency.
Owner gets glucometre - first test last night - over 500. Gave 3 u.
Today AMPS 111 - no shot.

Rob - you have done a great job by testing Zeek. Hypos are extremely hard on the cat's body, and I'm guessing that the 500 that you got last night was a result of another near hypo. When the blood glucose goes too low from injected insulin the liver dumps glucose to provide nourishment and tries to protect the brain from dying. The reason the cat staggers and looks glazed is that the brain is short of nutrients. (I don't know all the physiological terms and processes, but I'd be interested if someone does and wants to put it in another post or pm to me.) The high number you see is the glycogen that the liver has dumped. And it seems that after a hypo some cats become very sensitive to insulin, and the cat can start on a rollercoaster of very high and then very low. When the bg is high, the temptation is to give more insulin, and this compounds the problem. It looks to me as though this might be what is happening with Zeek at the moment.

If this were my cat, I would be tempted to not give insulin for a day or perhaps two and monitor bg - perhaps every 4 hours. He needs to eat (your vet was right about this part) and so I would try and figure out foods that he will eat on a regular basis. Several small meals a day is better than one or two big ones. Monitor his urine for ketones, just in case. And then start over with Lantus at perhaps .5 or 1 u twice a day.
 
Just-As-Appy said:
If this were my cat, I would be tempted to not give insulin for a day or perhaps two and monitor bg - perhaps every 4 hours. He needs to eat (your vet was right about this part) and so I would try and figure out foods that he will eat on a regular basis. Several small meals a day is better than one or two big ones. Monitor his urine for ketones, just in case. And then start over with Lantus at perhaps .5 or 1 u twice a day.
Click to expand...

While I'm fairly new to FD, too (about 5 months in), I would tend to agree with this. The approach to dose adjustments that your vet has taken has been dangerous. By holding off on shots for a day or so, Zeeks "shed" (explanation below) will deplete, thus giving you a clean slate to work with. Since you are now testing, you can see how Zeek responds to the insulin throughout the 12 hour cycle, and then make dose adjustments accordingly. Right now, since Zeek has been on such a high dose, his shed is probably massive, so you'll see some BG reactions from that until the shed drains.

I don't know if I saw it in this condo or not, but the motto here is "Start low and go slow"...that is, start with a low dose, and increase that dose slowly. There are a couple reasons for this, one of which you have already experienced: the risk of hypo. It is safer for a cat to run with higher BG numbers for days than it is for a cat to be too low for a few minutes. By starting with a low dose, monitoring, and increasing that dose slowly, you reduce the risk of future hypo events.

The other reason to "go slow" is so that you don't inadverantly bypass Zeek's ideal dose. We generally increase by .25units, when an increase is in order. Then, we try that dose out for at least 6 cycles (3 days, 2 shots per day) if not a bit longer, then re-evaluate. This allows us to tweak to the dose to what works best for our individual kitties.

Has anyone mentioned the wonder of spreadsheets to you? If you look in our signature lines, you'll see we all have links to the spreadsheet we use to track the progress of our kitties. Seeing everything painted out in color really helps us see what's going on, and it helps the folks who are experienced enough to help with dosing advice guide you down the right path.

Here's an explanation of the "shed":
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

Keep up the great work - Zeek is a lucky cat!

Amy
 
Went to the link for low pre shot readings and they said to go ahead and shoot unless it was lower than 50. So I gave him 3 units at 10:36am. I tried to get a reading at 2pm and it didn't go well at all. 3 or 4 sticks and no amount sufficient to get a reading. I don't know what I'm gonna do next. No more shots unless I can get a good reading. I'm not sure I'm up to this.

"My Smokey had IBD and therefore steroid-induced diabetes. He was on oral predisolone.
Steroid-induced diabetes is common in IBD cats."
Click to expand...
so my vet gave my cat diabetes?
 
Zeek is one tough cat - honestly (and I'm going to be very blunt) I do not know why he is still alive. Hypo after hypo, compromised brain function, and now 3 units again.

You can do it - you have learned to test and give insulin. Now, you need to back off the insulin and get data - lots of it. Those people who shoot a low number like 111 hav weeks, if not months of data, to know exactly how their cat react to insulin. The data you have shows that this high a dose results in a hypo.

I'm sorry if I sound harsh, but Zeek gets hit by a truck, just starts to feel better, and bam - another truck.

Maybe others have suggestions for you.
 
Hi Rob,

Until you've collected enough data with your home meter, do not shoot unless the number is over 200 at shot time. I'm very concerned that you shot 3u on a 111, because it seems likely he's been having hypo incidents on that high dose. Please make sure you're testing today, and if he's below 200 when it's time for his shot tonight, do not shoot.

I agree with the suggestion to not shoot for a couple of days and let the insulin shed clear. This will also give you the opportunity to change his diet. Dry w/d is incredibly high in carbs and you will not be able to regulate your cat while he is eating that food. Cat with IBD greatly benefit from a raw diet. Here's some info on diet: http://www.catnutrition.org/ibd.html

When you do restart insulin, start at 1u. That is the normal starting dose for Lantus. Your vet started with WAY too high a dose.
 
Given Zeek's history of hypos, I would go so far as to say if you're not able to get a pre-shot number this evening, I would skip tonight's shot.

Remember the shots need to be 12 hours apart, so since you shot at 10:30 this morning, his evening shot needs to be at 10:30, too. IMO, even if you are able to get a pre-shot number, if you're not able to stay up late and test tonight, again, I would skip the shot.

And beyond that, I agree with the others that you should hold off on shooting for a day or so to let that shed drain, and start over with 1 unit. This will keep Zeek safer, and give you the opportunity to practice ear pokes and collect that ever-important data

Getting the tests is tricky at first. Be sure to give lots of attention and low-carb treats - even with unsuccessful pokes! Over time, Zeeks ears will learn to bleed...it really DOES get easier, but there will still be times when multiple pokes are needed. I had to poke Trixie's ear 4 times tonight before I got sufficient blood.

No doubt, FD has a steep learning curve and it is overwhelming at first. Remember, we've all been exactly where you're standing today, and we want to help you through these tough and confusing times.

Unfortunately and indirectly, yes...it's possible that your vet inadvertantly (and unintentionally) gave Zeek diabetes. Steroids are known to cause diabetes.
 
Lynx said:
Went to the link for low pre shot readings and they said to go ahead and shoot unless it was lower than 50. So I gave him 3 units at 10:36am. I tried to get a reading at 2pm and it didn't go well at all. 3 or 4 sticks and no amount sufficient to get a reading. I don't know what I'm gonna do next. No more shots unless I can get a good reading. I'm not sure I'm up to this.

"My Smokey had IBD and therefore steroid-induced diabetes. He was on oral predisolone.
Steroid-induced diabetes is common in IBD cats."
Click to expand...
so my vet gave my cat diabetes?
Click to expand...



You only shoot at Lantus at 50 if you have some experience in how your cat reacts to insulin,
and know that you are only filling the shed. And most certainly not 3 units.
Right now you know your cat hypos at that dose.

PLEASE lower your dose. I know how difficult it is to go against your vet, but frankly, the vet
scares me.

With IBD, you have to treat. We face it here all the time. We get a fair
number of steroid-induced diabetics.

Also Diabetic cats get IBD and sometimes they have to be treated with steroids.
You just go on managing things. It DOES get easier.

Your kitty has steroid-induced diabetes. An unfortunate by-product of the treatment for IBD.

Budesonide is supposed to better than some for IBD treatment; but every cat is different and
some will become diabetic, some will not.

Please don't get discouraged. You can do this. Have you posted your location yet (city,state),
so you can get some hand-holding if you want. Perhaps we have a nearby member.
 
I don't know ANYTHING about lantus, but I am seriously worried about Zeek.
Hypo after Hypo after Hypo, and 3 units on that low a BG.
PLEASE keep an eye on Zeek and keep testing him.
I don't want to freak you out, but seriously, I am crying as I type, I am that scared.
Not sure if I need to be this worried. Like I said, I don't know anything about Lantus or how it works.
 
Hi Rob, I am just tuning in and do not have Lantus experience, but I wondered if you are still around and how are things going? Have you been able to get in any spot tests? From a quick read it sounds like your vet has you on a dose that might be appropriate for the W/D, but not for the lower carb foods. If his eating is inconsistent or just depending on which food he eats, that could be why some days he does fine on a dose, and other days it is taking him too low. That's why you want to go back to just 1u, get some data, and maybe think about transitioning away from the W/D, etc.

Immediate issue is today though. Is he eating ok? Is he eating the higher carb food? I think that would be what will likely keep him from hypoing. If he is not eating, or only eating baby food, and you can't get him to eat more, I think you may want to consider taking him to the ER so they can monitor his blood sugar and raise it if needed. I don't know Lantus, but 3u is quite a bit of insulin.
 
I'm not sure what the timing is either. How long has it been since he got the last shot? If you post times like:

+4 100 (hours since shot, BG#)

that helps people follow along. Since people are in different time zones, posting the actual time can be confusing.

Hope he is doing fine today! Update us when you can - we tend to worry about other people's cats here :YMHUG:
 
Rats my post disappeared. It's this darn laptop....
I'd go the start-over route at 1 unit. Cedric used lantus for a month and never went higher than 2.5 twice a day. Better safe than sorry.
I give cedric 4 small meals a day now. I have bought an autofeeder to feed him 2 meals when I am at work. It's a cat amte c-20, and comes with an ice pack. It's great!
Welcome and good luck! Please keep us posted. The people here can be a great help - they really were to me!
 
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