New Dx. Lots of Complicating Factors! Long Post.

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ShadowsMom

ShadowsMom

Member Since 2014
Hello FDMB’ers. I’m here on behalf of my 20 year old Shadow who was very recently given his diabetes Dx. Labwork performed on 06/04/2014 showed that he was spilling glucose into his urine and follow up BG testing at home the next day showed that he averaged around 250. Our doc ordered a fructosamine add-on to his labs and his level was at 287 (ref: 191-349). She believed him to be prediabetic at at point. Shadow also exhibited an elevated (69 ref: 12-59) ALP and fPL of 5.4 (>5.4 is consistent with pancreatitis). This lead to the possibility of Triadidtis. Tack on his stage 3 CRF (managed and stable for 3.5 years) and hyperthyroidism (stable) and we have ourselves a very complicated cat patient! Our vet suggested that we schedule some follow ups with specialists for an abdominal ultrasound and nutrition consult. We have appointments for both of these on 06/24. I shifted his diet slightly and began feeding Wellness Core Chicken, Turkey and Liver with a touch of pumpkin to help with antibiotic induced diarrhea (lost a tooth to neck lesions and because he isn’t a candidate for dental anesthesia, Clavamox was the best alternative). I break up his food into 4 smaller meals a day - usually at 9am, 2pm, 9pm and midnight and he’s syringe fed to ensure that he receives a full ration of food. He consistently threw BG 200- 250 in mornings for a week so I skipped 3 days of testing. It was last Saturday night, just after our vet office closed, that Shadow decided he wanted to fully commit to the wonderful world of diabetes.

A BG test at 9 pm that evening (previous meal was at 2pm that day) showed 465. Commenced with the freak out and hurried him off to the E-vet. Their meter read 486, so at 10:40 that evening, he received 1 unit of Lantus from their vet and we were sent home with a Lantus Rx and instructions to do spot checks every 2-4 hours over the weekend and to contact our own vet on Monday for further details. I was to continue feeding him on the usual schedule, but decided that since I was going to be awake with worry for the next several days anyway, I would give him food on the 8’s and 2’s. Their insulin protocol is to check AMPS and PMPS, and give .5 unit if BG 250-299 and 1 unit if it was >300. A reading under 250 means no insulin is given and to check levels at the next 12 hour injection interval.

Our regular vet is currently on vacation and the sub has us following the above mentioned protocol. Once she’s back I would, however, like to discuss the possibility of moving Shadow over to the Lantus TR protocol since I have both the time and ability to perform regular checks. I’m hoping that because we’ve caught his condition so early, that he’s a good candidate for remission. Granted, he may have some some other issues going on and we will be juggling things for a while, particularly if the nutritionist recommends a home made diet, but I’d welcome some suggestions on when to begin transitioning to TR. It will be after I consult my vet and provide her with the backing research, but should I wait until he’s on his new diet? If so, how long? Any help would be appreciated.
 
Thanks for the welcome. This is a lot of adjustment and although I'm used to a fairly complex regimen when it comes to his CRF, this is an entirely new game. I don't want to make any mistakes, but I realize that I'm also prone to worry... a lot. For his sake, I hope to get things right the first time. Wish me luck!
 
Welcome Shadow's mom! (we'd love to know your name too!)

First of all, it looks like you're making good choices on foods.....we want our sugarcats eating only wet/raw foods with less than 10% carbs. Here's a list of foods less than 10% carbs for you to look over.

Next, while lantus is an excellent insulin for cats, your vet isn't right about the way you dose it. First, to start, it's based on the weight of the cat. The formula is .25 x weight in kg = starting dose...so for example, a 12lb cat would start at 1.25 unit (or even less) .25 x 5.44kg = 1.36 unit How much does Shadow weigh? Is he overweight, underweight or about ideal?

Once the starting dose is established, you hold that dose for 5-7 days (unless the numbers tell you different) while you gather data through home testing. After that first dosage amount (based on weight), doses after that are based on the "nadir" (the point in the cycle where the blood glucose is the lowest). We want to know how low each dose is taking them. We don't pay a lot of attention to the Pre-shot numbers. The important thing is to find out how low this dose takes your cat...not where they start out at before they get the shot.

Here's our "getting started" shopping list

1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

We can help teach you how to home test, and it's really not as scary as it sounds! It's the only way to keep Shadow safe while also knowing how well he's doing on any particular dose!

Ask questions if you think of them! The people here are very generous with their time and experiences, and only want to help!
 
Sorry about that! My name is Hellen. I'm so focused on Shadow right now that I seem to have forgotten my manners. Again, I apologize.

Shadow is 10.25 lbs. (So his starting dose of 1 unit was right, correct?) He's a healthy weight, only a little plump, but both my vet and I prefer him at this weight due to his CRF and Hyperthyroidism. It's so easy for them to drop weight in no time at all. He has excellent muscle mass with little or no wasting that you might expect to see in a later stage CRF cat. At 20, the docs swear he looks like a cat half his age. I wish we all could age so well.

Thank you for the handy check list.

I'm currently using my own ReliOn Micro and I'm very proficient with it, so we are all set there. We've got the ear pricks down to a science as well. He has very prominent veins in those little ears of his. Good to go!

My Hypo kit is armed and ready. Hoping I'll never need to use it.

I'll be consulting with my doc as soon as she's back from vacation. I suspect I'll be able to convince her to work with me on this. I'll be here to watch him like a hawk and I'll be testing regularly, so that should reassure her somewhat.

I do have one question on feeding schedules - Shadow won't eat half of a 5.5 oz can at one sitting, even if I syringe him. Right now I'm feeding at 6 hour intervals around the clock and that seems to coincide with his nadirs. Would it be better if I clustered the feedings at, for example, AMPS and PMPS +4 instead of +6? And would you still administer a full unit if morning levels were around 150?

This is more than a little intimidating!
 
Hi Hellen and extra sweet Shadow!!

On feeding...most cats do better with more frequent, smaller meals...it doesn't make the pancreas work as hard that way, so several small meals a day is better than 2 big ones

Most of us don't feed after +6, just because by then the insulin is starting to wear off, so we don't want to add carbs during the last half of the cycle, so if you want to feed at PS and +4, that's fine! Feeding schedules you just have to experiment with. Some cats don't do well if they get fed later in the cycle...some do better if they get all their food in the first 3 hours....some do fine being fed up until +10 (we recommend not feeding for the 2 hours prior to preshot tests so the number isn't influenced by food)

Since ECID (Every Cat Is Different), it's something you'll just have to experiment with and see what works best for Shadow!

We have a saying here "Shoot low to stay low", so once we have enough data, and are pretty comfortable with how our cats respond to both food and insulin, we'll shoot anything over 50, but the first few times you get anything under 150, you should "Stall", don't feed, and post to ask for help. Make sure your subject line says something like "Stalling, please help!" so people will notice that you have a problem/question....also, if you add the ? icon it will help too. You do need to make sure the subject line from your FIRST post is the one that's saying what you want it to since that first subject line is the only one we see when scanning the board looking for problems. Basically, you stall and retest every 20 minutes or so (without feeding) so you can see if the numbers come up on their own and as soon as they do, you go ahead and shoot.

In case nobody is around, you should have this page on Shooting and Handling Low numbers printed out and someplace you can find it quickly.

I'd like to invite you over to the Lantus Tight Regulation Forum. There you'll get the most experienced eyes watching out for you and Shadow. We become quite a family over in Lantus Land!

Each day, you make a new post (we call them condo's) with the date, cat's name and AMPS number in the original subject line. As the day goes on and you get more tests, you go back to that original subject line and "edit" it to add the new test results, so for example, one condo could look like this...6/20 Shadow AMPS ###, +2 ###, etc.....

Then in the body of the condo, you give the WCR (Whole Cat Report)..How Shadow is doing overall. Are the 5 P's in place? (Preening, purring, playing, peeing, pooping?) Is he eating well? Any other concerns or questions you have? Any more you'd like to share about your kitty?

Also, in the body, put the link to your prior day's post(condo) so it's easy for people to quickly go back and see what's been going on and what's already been covered. To do that you just copy the link in the address bar for that post, click on the URL tab, and "Paste" the link in between ....it looks like Your link here[url] Hope to see yo...gh...we'll be here to help you along the way!
 
Welcome and WOW, 20 years old! Hope you can get shadow's diabetes under control so he can enjoy his senior years with you.
 
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