New diagnosis, 14 yr old female - cant get urine sample

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LindaMS

Member Since 2013
Hello, I took my 14 and a half year old female, Samantha (sammy) in yesterday due to sudden weight loss. The vet called last night, the blood work shows high BG. i am to get a urine sample from her today and take it in, then go see the vet tomorrow for an education/planning session. I have had Sammy locked in my bathroom for 3+ hours and it appears she has no intention of peeing any time soon. Should I be fearing renal shutdown, or do they just sometimes go that long without peeing? (never needed to keep track before!). Sammy's brother is not impressed with things today either. He hissed and growled at us for over an hour last night, which is highly unusual. I think next time I take Sammy in to the vet I wont let him see the carrier or see us go out the door. (they are inside cats).

Linda
 
See my signature link Secondary Monitoring Tools for some ways to get a urine for testing, including non-absorbent aquarium rocks in a clean litterbox.

And welcome to FDMB!
 
I've done that. It just takes patience. I would wait a while longer. I'm guessing you have a litter box with some special non absorbant gravel in it, in there?
 
Dyana said:
I've done that. It just takes patience. I would wait a while longer. I'm guessing you have a litter box with some special non absorbant gravel in it, in there?

She went! yes, I had a clean box in with the plastic granules she is used to from her Cat Genie litterbox. Off to take sample to the vet!

Thanks.

Linda
 
Wendy&Tiggy said:
How did the visit go?

Wendy

The vet visit went well, I got my instructions on giving shots, and did some test injections with saline. Turns out I am really good at this! Sammy didnt bat an eye, she just didnt care. Was prescribed Purina DM wet food, 1.25 cans per day (I cant imagine my tiny little 8.3 pound kitty eating that much right now). I was told to give 0.9 units insulin 2 times a day., unless she doesnt eat well, in which case I am to give half that dose.

Took the Rx to the drug store. They said measuring 0.9 units is virtually impossible in a syringe, They called the vet, who changed the dose to 1 unit, and not to half it anymore. Geeze, really didnt make me feel good about our start, not being able to get good instructions that i can actually follow!.

Sammy is taking the new food well, so we are going to start insulin tonight. I admit, I am scared, not of giving the shot, but of giving her too much and causing her harm. But I know I have to do it, as her readings are very high 33.2 mmol/l
 
LindaMS said:
Wendy&Tiggy said:
How did the visit go?

Wendy

The vet visit went well, I got my instructions on giving shots, and did some test injections with saline. Turns out I am really good at this! Sammy didnt bat an eye, she just didnt care. Was prescribed Purina DM wet food, 1.25 cans per day (I cant imagine my tiny little 8.3 pound kitty eating that much right now). I was told to give 0.9 units insulin 2 times a day., unless she doesnt eat well, in which case I am to give half that dose.

Took the Rx to the drug store. They said measuring 0.9 units is virtually impossible in a syringe, They called the vet, who changed the dose to 1 unit, and not to half it anymore. Geeze, really didnt make me feel good about our start, not being able to get good instructions that i can actually follow!.

Sammy is taking the new food well, so we are going to start insulin tonight. I admit, I am scared, not of giving the shot, but of giving her too much and causing her harm. But I know I have to do it, as her readings are very high 33.2 mmol/l

I'm wary of saying too much because I'm still very much learning myself, but please don't do anything you're not comfortable with, and wait for someone more knowledgeable than me to give you advice. I've learnt this the hard way (after 3 hypos), but if something doesn't sit right with you you're well within your rights to question it, even if it did come from a vet.
I really don't mean to worry you, it's just that introducing insulin at the same time as a diet change really needs to be watched closely.

Good luck with Sammy :smile:
 
There are over the counter, low carb, canned foods which may be fed to diabetic cats that are effective in significantly dropping the glucose level as much as 100 mg/dL (5.5 mmol/L) ... and significantly less expensive than the Rx foods.

Also, stress from being at the vet may increase the glucose level 100 - 180 mg/dL (5.5 - 10/mmol). Which means that as much as 15.5 mmol/L could be due to diet and stress.

Zanne is correct - changing food and diet at the same time can be risky if you don't home test the glucose. You might want to consider changing 1 thing at a time - either start the insulin OR change the diet so you can see how that works, while you work on learning how to test. Of those 2 options, the least risky is waiting on the insulin until getting the diet changed and learning how to home test.

Since you went to a pharmacy for the insulin, I hope your vet prescribed Lantus and not Humulin/Novolin. Lantus is an excellent insulin for cats and has carryover, or depot effects in the cat, giving it a gentle onset and gradual wear off. Humulin/Novolin lasts only 6-8 hours in the cat and may require dosing every 8 hours for optimal glucose control.
 
Home blood glucose testing is for the safety of your cat. It requires a human glucometer such as the Arkray USA Glucocard 01 or 01 Mini from our shopping partner ADW or the branded version, the WalMart Relion Confirm or Confirm Micro. Pick up at least 2 boxes of test strips for the meter so you always have a spare box and 26-27 gauge lancets. You'll use the lancet to prick the outer edge of the ear just outside the vein along the edge, about 1/3 of the way up from the head.

You should test before giving insulin to make sure your cat isn't too low to give it. When you can, you test between the shots around the expected low point, or nadir to see how effective the insulin is. Many folks do the mid-cycle testing on weekends or days off. Some folks set the clock for the middle of the night to get mid-cycle tests.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.
(May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
I agree with everything BJ said

- dont need to feed the wet DM food - many cats get sick of the liver flavour fast and stop eating it. Store bought foods are just as good and cheap. SeMany of us feed Fancy feast classic pates, friskies pates or wellness grain free canned. You want canned foods that are under 10% calories from carbs as fed - unfortunately the manufacturers dont post this on the cans but this highly experienced diabetic cat vet called them and did the math to create this sheet. Look at column C : http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

- what insulin is it?

- Home testing - this is key to preventing hypos especially if you changed the food since many cats go into remission when the food is changed to wet. Shooting and not testing is like driving with a bag over your head. we can recommend meters and how to test

Wendy
 
Thanks all. I will be testing at home, and have no problem doing so. I had a glucose monitor here, but the strips are expired. i will get new ones today. I gave her her lantus this morning. The more i thought of her having 2 high readings at the vet.. (33.2 and 31.4 two days later), the more i realised i have to deal with this or risk losing her.

First shot of many done, and it really was no big deal for either of us. She barely noticed!

I did read that there are companies here in Canada that produce syringes that have half unit markings... I am going to look for those today too. The ones I got yesterday do not have that.

Thanks for the support.

Linda
 
I am in Canada too

- meter - which meter is it? Some are better than others for cats. I use the bayer contour cos i got it free online with strips , and because i can get 100 strips for $40 on ebay. Saves $. Let me know and I can give you the url and code for a free meter. (although if you buy your BD syringes at walmart they have a flyer in them for free meter usually)

- food - fancy feast pates and friskies pates are good and low carb. As it wellness grain free. I get fancy feast because I can get cans as low as 50c. Currently they are 57c in walmart Canada. (even online with free shipping)

- the BD ultrafine 2 3/10cc short syringes have 1/2 unit markings. You can get them pretty much anywhere ie shoppers, walmart, costco...

Also I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

What dose of lantus is it? How much?
Wendy
 
Wendy&Tiggy said:
I am in Canada too

- meter - which meter is it? S

Got a free OneTouch ultra mini
- food - fancy feast pates and friskies pates are good and low carb. As it wellness grain free. I get fancy feast because I can get cans as low as 50c. Currently they are 57c in walmart Canada. (even online with free shipping)

Thanks for this! I think that both my cats are sick of this Purina DM already, and quite frankly, the smell makes me gag.

- the BD ultrafine 2 3/10cc short syringes have 1/2 unit markings. You can get them pretty much anywhere ie shoppers, walmart, costco...

Also I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

What dose of lantus is it? How much?

She is on Lantus 100 u/ml - one unit, twice a day
Wendy

so far her numbers have come down about 10 points. She was at 33 or so at the vet, I am getting readings of 23 before shot. I am going to test every three hours today, see what happens.
 
LindaMS said:
Wendy, the templates for US and World are the same??? I need the one for Canada .

There's a second page with mmol, if you look at the bottom left of the spreadsheet you should see the button for it. My apologies if that wasn't what you meant.
 
I use the US one and just multiply my Canadian ones by 18. It helps because most of the advisors on here are American and they can understand it quicker. but anyway since you are already set up you are good!

Do you think you can get those tests I suggested? I know you are having testing issues so maybe see if there is anything in here that will help. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub. Also since she is so high, do you have urine ketone test strips? You will want to test daily while she is this high.

Its very important to always get a pre shot test as you don't want to shoot under 200 yet. Also we can't tell how well the dose is working without knowing how low the Lantus is taking her. Remember dose changes are based on lowest number of the cycle - you don't want to increase the insulin and push the lowest number of the cycle into hypo. Heres an example of a lantus curve:

Example of an active Lantus cycle:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle). This number is what you base dose changes on
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Wendy
 
The insulin is not working. Her number at +5 hours is just as bad as her pre shot numbers. I am so worried, the vet say I should just hang in there, and doesnt want to talk about anything until I do a curve, which is not to be until she has been on her new food for at least a week. I think that the insulin should be having some effect, shouldnt it? How fast does it work, am I being unrealistic?
 
With Lantus, it takes roughly 5 days to stabilize on the initial dose and 3 full days on any subsequent dose.

Then, you check around the expected nadir and adjust the dose based on the protocol you're following.
 
Deep breaths. You need to wait 5 days as BJ says for the lantus depot to build up. Then we can change the dose if necessary.

Meanwhile, Go here and read the stickys, they will give you more info on how lantus works and is dosed. http://www.felinediabetes.com/FDMB/viewforum.php?f=9

She is now only on wet food right?

Wendy

Ps since she is high are you checking her urine for ketones daily?
 
100% wet food. I cant get her to eat only 2 meals a day, she just wont eat enough that way, being a cat used to free feeding on dry. So I am trying to make sure that she is hungry for her pre shot meal, and then give small servings of food between "meals". Same for my non diabetic overweight big boy. i emailed the vet, they said it is high numbers for sure, not an emergency, and they will call me tomorrow.

Thanks for the support!

Linda
 
Thats good - many mini meals will help support her pancreas. (A large meal will stress it). The only thing is you don't want to feed for 2 hours before the shot because you don't want the pre shot test (once you are getting one) influenced by food. However Hills MD is too high in carbs at 13% - you want a wet under 10% - like fancy feast classic pates, friskies pates, wellness grain free - or even the wet Purina MD.

I don't like these high numbers - please tell me you are testing her pee for ketones. You can get a pack of strips in Walmart for less than $10. You don't want her developing diabetic ketoacidosis - its life threatening and expensive to treat - Diabetic cats are prone to it when their blood is over 340 and so we test twice a week no matter what.. and daily if the cat is over 340.

What did the vet say? I am reluctant to recommend a dose increase because we just don't know if she is dropping low at any point- you don't have enough tests to know - but at the same time, she is very high and I don't like that either. Maybe sneak her up to 1.5 and try and get a few more tests - like one at night.

Wendy
 
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