New here, a few questions

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LovingErlend

LovingErlend

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Hello :razz:

Backstory probably isn't essential to answering the questions, so if you're short on time skip ahead :) Erlend was hospitalized with DKA a couple weeks ago. Luckily she survived and we took her home after 48 hours. We started her on low-carb canned diet and 1u Lantus 2x daily (as well as antibiotics and a potassium supplement). She was weak with neuropathy and couldn't jump up on things. Happily, that has continued to improve :) Despite watching videos we were having an extremely difficult time home-testing her... she gets so mad. We brought her in 10 days ago for a checkup as I was concerned about her drinking & urination. The vet demonstrated a blood test (she was petrified & still a little weak, so they had an easy time of it) and her reading was 416. Vet suggested bumping dosage to 2u.

In the days after that I was pleased with her urine volume dropping off and a general return to the habits of pre-DKA Erlend, but recently urination & thirst has picked up again. I've done a couple fur shots in the past week so she went without a couple doses :(. We've been trying to do home-testing when scheduling & Erlend's temperament permits. We've managed several preshot tests this week, which have all consistently hovered in the 300-320 range except the evening after a fur shot which was 380. We've only managed one interim test (I wanted to check the insulin was in fact being administered & working properly) and it was 237 +4. On Saturday we're doing a BG curve at home and will report the results to the vet. After reading this forum it sounds like ketone strips are a good idea too. I'm sure we'll have a better idea of what to do after that, but I"m nervous in the mean time:

1) I've looked at a lot of owners' BG charts here and it seems pretty common for AM&PMPS readings to be in the low 300's for the first few weeks. Obviously not ideal, but is this ok? Is her body functioning properly at that level, and is she in pain? My nightmare is her going DKA again.

2) Without the results of a curve yet, are there general guidelines to follow with feeding times? The vet said there were no restrictions on eating just let her eat as much as she wanted any time. My understanding is that high BG levels prevent the body from processing food efficiently and actually starves it, so I'm concerned that letting Erlend binge (she can eat 2-3 oz in a sitting and has been going through ~13 oz wet food a day at only 6.5 lbs) spikes her BG levels and paradoxically causes her to not gain all the nutrition from the food she eats? Maybe this is just paranoia.

3) Also on the topic of food, we've been feeding her primarily Friskies Special Diet pate flavors. They are a reasonable $/oz, she likes them more than the fancy feast pates and I initially read they had low carb content (4-6% cal from carbs). But I just saw a different chart that listed the special diet turkey & giblets at 11%. Does anybody know which carb% correct? Does anyone feed their cat the special diet Friskies?

Thanks in advance for any advice, this is an amazing forum with such helpful people.
 
LovingErlend said:
1) I've looked at a lot of owners' BG charts here and it seems pretty common for AM&PMPS readings to be in the low 300's for the first few weeks. Obviously not ideal, but is this ok? Is her body functioning properly at that level, and is she in pain? My nightmare is her going DKA again..
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Every cat is different, but that is not an unusual preshot number. What is important is how low she drops and how long she lasts at the lower BG readings. You should try to do your own curve to determine it. This means testing every 2-3 hours in between shots. You can also use ketosis strips (available at any pharmacy) to test her ketones. That will let you know if she is at risk of DKA


2) Without the results of a curve yet, are there general guidelines to follow with feeding times? The vet said there were no restrictions on eating just let her eat as much as she wanted any time. My understanding is that high BG levels prevent the body from processing food efficiently and actually starves it, so I'm concerned that letting Erlend binge (she can eat 2-3 oz in a sitting and has been going through ~13 oz wet food a day at only 6.5 lbs) spikes her BG levels and paradoxically causes her to not gain all the nutrition from the food she eats? Maybe this is just paranoia..
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Right now because her diabetes is not under control, she cannot process food properly. That is why she is eating so much. Your vet is right, feed her as much as she wants. You may want to feed her several times during the day to help keep her glucose levels steady. As her glucose levels become controlled you will see a decrease in her appetite

3) Also on the topic of food, we've been feeding her primarily Friskies Special Diet pate flavors. They are a reasonable $/oz, she likes them more than the fancy feast pates and I initially read they had low carb content (4-6% cal from carbs). But I just saw a different chart that listed the special diet turkey & giblets at 11%. Does anybody know which carb% correct? Does anyone feed their cat the special diet Friskies?
Click to expand...

That is a good choice. The only one you may want to skip is the Chicken & Gravy flavor. That one is higher in carbs. My cat Witn had both CRF and diabetes and that is what I fed her. I had no problems controlling her diabetes.
 
Welcome to the best place ever!!!
Erlend will be safe here and so will you!!!!
I had to feed the special diet due to one cat needing it and one not, so that is what I did and Beans numbers stayed ok!
For home testing, Bean and I picked a special chair, towel and treat (petco tuna flakes), for our pokey poke time....We practiced a couple of days before we did the actual test and did not load the lancet pen....just getting her used to the sound, the chair, rubbing those ears, and lots of praise..... By the time we did the pokey poke, I think she was actually better than her mommy! lol..Mommy was scared to death! We do this alone usually as I have 2 other furry family members.

Good luck with the home testing ..it is the most important part and tell ms. erlend to beee goood a girl ;-)
 
Welcome Erland and your beans to the FDMB
Quick answers to your questions:
1 - Yes, quite common for PS reading to be in the 300's at the beginning. They will go lower! As for her body functioning well - that will also improve with time. The big outward signs you hope to see get better are less consumption of water, less volume with peeing, and an all around better mood. Mobility can tell you a lot. If she's moving okay, not just laying around a whole lot, and not showing signs of back leg weakness, those are positive signs. Pain? Not so much from the diabetes or the BG values. The DKA was painful, so if you poke her gently around the abdomen and she doesn't cry like it hurts, that would be a good sign. When they get really dehydrated, they'll move and feel like they have arthritis. My Bob was so dried out that the fluids in his joints was extremely reduced, so when he moved or I pet him anywhere, it hurt bad.
The best way to keep an eye on another DKA incident would be ketone testing of her urine, so yes, the strips will be a part of your kitty kit.
2 - At first, because of high BG not allowing her body to process food correctly, she can and should eat a lot. The only thing to be aware of is that right after eating (an hour?), the food will have raised her BG some, so you would get a food-induced higher reading. Usually, you want the shots to be 12 hours apart. You test her before she eats, and shoot her after she eats. That can all take place in a 10-5 minute window. So, test, feed, and shoot in that order. She won't get a huge boost from eating, The rise in BG won't hurt her ability to process her food unless she gets "out of control", which wouldn't happen if she is getting regular doses of insulin.
3 - The link in my sig will take you to the food charts (2 canned lists and one dry list are available off that page), plus a lot of other good info on nutrition. Most of us like using Fancy Feast Classics and Friskees Pate varieties. I am not familiar with the Friskees Special Diets. I have seen others say that they use them. I think they are listed on the charts that link goes to. Low carb canned is best, but some people have to transition over time since kitty has been on dry since kittenhood, and some are not all that thrilled with a diet change.

Oh, home-testing. Super that you are already doing that!. With Lantus insulin, you need to as often as possible get the mid-cycle tests in. Lantus dosing is dependent on the lowest BG reading in a 12 hour cycle rather than by the numbers you get pre-shot. The +6 test will let you know how low she goes, and that is what you will be determining her dose on when it comes time to adjust it up or down.

I am positive that many more folks will drop by soon to greet you and answer any questions you might have.
Again, welcome to the group!

Carl in SC
 
ohbell said:
I had to feed the special diet due to one cat needing it and one not, so that is what I did and Beans numbers stayed ok!
For home testing, Bean and I picked a special chair, towel and treat (petco tuna flakes), for our pokey poke time....We practiced a couple of days before we did the actual test and did not load the lancet pen....just getting her used to the sound, the chair, rubbing those ears, and lots of praise..... By the time we did the pokey poke, I think she was actually better than her mommy! lol..Mommy was scared to death! We do this alone usually as I have 2 other furry family members.

Good luck with the home testing ..it is the most important part and tell ms. erlend to beee goood a girl ;-)
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We have a soft towel-lined box elevated on our table that is her special place she associates with chicken treats (plain baked chicken... this shouldn't be driving BG #'s up, right?). If we leave the chair out she'll hop up there and wait patiently in the box hoping treats are coming :razz:

But she won't sit still when we try handling her ear... she folds it up at the touch and becomes restless. We've had to resort to the burrito wrap. The first couple times she was compliant, probably because she didn't know what was going on. But now that she knows what's happening she gets angry, writhes her head and tries biting. Seems like she's growing less tolerant with time, despite treats & praise through the whole process :-| The curve on Saturday is going to be tough, but we know how necessary it is!

Neither of us are able to test individually yet, but hopefully it'll get easier with time and experience. We're going to try to get a reading as close to +6 as we can tonight.

Thanks for all the responses, you've been very helpful.
 
Ugh this is very stressful. We just tried to test before bed and she was more fractious than ever. Got one begrudged poke but she immediately shook her head and smeared it. Once agitated, her head is impossible to keep still to poke. She was able to back up out into the wrap and hide her head, and we let her out fearing she was gonna completely lose it. I don't know how we're going to do a whole curve Saturday if just one test is becoming impossible :(
 
Yes, it is hard in the beginning, especially if the kitty doesn't want to co-operate .... are you warming her ear before you try and use the lancet? making a rice sock (sock with rice in it) warming it in the microwave and putting it on her ear for a minute, should make the blood come much easier. I also use a cotton ball I put in the ear and aim for the vein running around the ear. I find I do better if I stay close to the edge.

Does she like treats? certain foods? find some things that are okay and she likes and associate them with the test. Seriously, in time she will calm down, sometimes they sense our fear .... in your mind keep saying you need to do this to keep her safe. You should change your subject line (go into your first post and pick edit) and add advice needed for hard to test kitty, or something like that and tomorrow you should get some great responses.

Test frequently for ketones, the big fear of kitties who have had DKA .... keep a good eye on them.

If you haven't you should also visit the Lantus group, they have really great stuff to read and they are very willing to help you with your dosing.

We have all been where you are in one way or another but it will get easier .....

Nancy and Payne
(survived DKA 4X)
 
Welcome! This message board and the main site are a great place for FD info! I found this place when waiting for confirmation on my cat's FD on good Friday and never left! :smile:

I too have difficulty with the home testing. Cedric handles it pretty weel, I just don't always get blood out of him! It was a little tough at first, but he's used to it now. I hope it gets better for you.
i do stick the treat containers in front of his face, so that helps. :lol:

My step mom bought this for him about 3 years ago, and he doesn't use it, but when he was dx, I used the heating pad inside to use on heating his ear (I burned the rice sock sent to me by Lori & Tom):
http://www.petsmart.com/product/index.j ... lmdn=Brand

I don't know if she actually got it at Pet smart, as pet stages sells their product in lots of places. Heating the ear does help. Good luck tomorrow!
 
We're glad you're here!

My guy hates to have his ears tested, absolutely won't let me. So....we test his dew claw and have no problems. It's the one higher than the pads of his feet and there's one on each side. I put some baked chicken down and he lets me grab his leg, poke away, squeeze and test, all the while he's munching on his snacks. Never even a flinch!
 
Bandit acted the same way in the begging, and it sounds like you're doing exactly what I did, lined box, burrito. Warming the ears, and Neosporin + pain relief were two things that helped calm him down. I basically held a death grip on his ear with the hand holding the tissue so he couldn't shake it on me.

Testing WILL get better. Bandit bit and clawed and tried to bolt and shook his head in the beginning, and now he jumps in his basket and lies down when he hears the glucose meter beep on. He sits perfectly still for me while I test, I don't even have to hold him. If someone had told me that he would eventually act that way with testing during the first couple weeks, I would not have believed them.
 
UPDATE: Saturday we attempted the curve. Got the AMPS reading (higher than those during the week, 380bg vs 320bg), but the +2 was impossible ohmygod_smile We spent a good 25 minutes trying a number of different methods but she is too fractious (with ear pokes... she's perfect and sweet the other 99% of the time :roll: ). Took her to the vet for the curve instead. Her AMPS was 400 (a little higher than we're used to at home, maybe stress), and it only dipped to low 200's at +6. Per vet's advice we're upping the Lantus dose from 2u to 3u. This sounds like a lot for a cat on an all-lowcarb canned diet, but I guess all cats are different? Hopefully these numbers will start coming down.
 
Hi there - glad you were able to get some numbers at the Vet. I would ask some advice here before making that big jump. We usually only increase by 0.25...there are some experts on board that will give you their thoughts.
 
as mentioned, bumping the dose by 1 unit at a time is too much. You really need to consider 0.25 or 0.5 units at a time otherwise you could miss the right dose. I know it doesn't seem much, and her numbers are still highish, but patience really is important.
 
Glad you're getting some tests in, but give it some time, patience, and treats--even the most fractious of cats end up coming around. You'll get better and the cat will get better the more you do tests. Just don't give up. Eventually, Erlend will resign herself to the testing.

Here's a link to the Lantus dosing protocol: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf. Here's a link to the article that speaks to the safety and remission rate for the Latnus protocol: http://www.ncbi.nlm.nih.gov/pubmed/19592286. I urge you to print both of these out and give them to your vet. I have the full text of the article if you need it. 80+% of newly diagnosed cats go into remission when this is followed.

With nadirs (the lowest point in the cycle) in the 200s, the dose should be increased by .25u, not 1u. Most cats on a canned diet only do not need much more than 1u. You also have to take into account vet stress--Erlends numbers are going to be higher than usual at the vet because cats blood sugar will raise when they are stressed out. Also, if you're not testing daily with lantus (before each shot and one test mid cycle to see how the insulin is working), then you don't know if the high blood sugar is because the the dose is too high. Like I said, most cats on a canned diet do not need much more than 1u. Too much insulin will keep blood sugar just as high as too little insulin, since the cat's liver dumps glucose into the bloodstream to combat low blood sugar. If this is Erlends situation, raising the dose to 3u could be deadly, especially since she didn't get to the 2u following the protocol (EDIT: I don't mean to say that it is wrong or a criticism to have her at 2u! With DKA you want to have a higher starting dose because of the risk of ketones, but we don't know how the dose is affecting her without testing, which is what I meant) . If the dose is too high, the only way to catch it is to get the mid-cycle test in every day, because you'll have high preshot numbers nearly every day, and some high mid-cycle numbers every few cycles as well. The low numbers can only be caught once the high blood sugar produced by the liver clears for a cycle.

I urge you to keep testing and try to get at least the three tests I mentioned. If your goal is remission, this is absolutely mandatory. The more quickly you can get your cat's blood sugar under control, the greater Erlend's chances of remission are. The only way to get tight control is through dose adjustments via daily home testing, and regulation and remission are nearly impossible to achieve with vet testing.
 
Julia, just a caution. I'll say it publicly so that everyone can read it, but it isn't criticism

I would really caution talking about remission so early in the discussion. Most people when they first hit this board don't even know remission is a possibility. And it IS a possibility, but right now, I'd say that getting the cat stabilized and learning the ropes is more important. And keeping the cat safe from over dosing AND underdosing.

Jen
 
I understand your concern, Jen, but I disagree. The large majority of newly diagnosed cats go into remission with the combination of a low carb canned diet, Lantus, and tight regulation via hometesting using the Lantus protocol. I think remission should always be the goal with newly diagnosed cats, and you're right, many people don't even know it's a possibility. My vet originally told me only 25% of cats went into remission, so I could likely expect to give Bandit insulin for the rest of his life. As it turned out, if I had continued to follow her dosing advice it's possible he would have been on insulin the rest of his life, because her dosing advice and home testing recommendations (She told me to do a curve once a week, and that I didn't have to do any other tests unless I suspected a hypo incident) were not correct.

The key to remission is getting the cat regulated as soon as possible, so I think it's important to let new people know up front that this is not only a possibility, but likely with the right treatment. Finding that right treatment path sooner than later will only help, not harm. Not to mention be much safer for the cat.

Erlend has been DKA, which is why getting her stabilized is incredibly important, far more important than remission. However, the steps taken to reach remission are exactly the same steps taken to stabilize Erlend's blood sugar, so I see nothing wrong with adding it as an extra incentive to follow the correct treatment guidelines. Too high a dose keeps the cat as risk just as much as too low a dose.
 
I don't disagree that remission is a great and healthy goal, but not all cats can achieve it despite the best efforts. And not all humans can test frequently. If I was the OP and read this in the state I was in back in 2002, I would have freaked. Balance is a good thing.
 
LovingErlend said:
Per vet's advice we're upping the Lantus dose from 2u to 3u. This sounds like a lot for a cat on an all-lowcarb canned diet, but I guess all cats are different? Hopefully these numbers will start coming down.
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Too mcuh of a jump. If you look at my cat's chart, towards the end of his usage of Lantus, vet said to up from 2 to 2.5. I was home testing and I did all 3 curves that have been performed on Cedric, so my numbers were a little more "accurate." It's possible that your vet is not realizing that the cat's stress level is elevating the numbers. nothing against your vet. Mine has a FD and a diabetic dog at home, so he's familiar (although tottaly surprised that Cedric went into remission so quickly).

Last night we tested in front of the stray cat (who was outside on my porch eating the food I put out for him). It took several pokes efore I got a tiny bit of blood. I really didn't think it was enough for a reading, but it was! Cedric got his treats, as did Dallas the stray for watching. :lol:

When I took Cedric's dry food away, the vet had given me a "proticol" to follow. i think I have since tossed it, but it was give no insulin if # is under 100, maybe 1 unit if between 100-150 and then 2 units if more. As it turns out, I winged it with help from the folks here (who are so used to it) and 2 days later, normal numbers. His remission was a combination of several factors.

i guess what I am trying to say is that I am not sure I would be comfortable upping the dosage to 3 units each time if I am having troulbe with hometesting. Not trying to confuse you more, but sometimes mom's instinct might be better than proticol? did I even spell that right?
 
Jen & Squeak said:
I don't disagree that remission is a great and healthy goal, but not all cats can achieve it despite the best efforts. And not all humans can test frequently. If I was the OP and read this in the state I was in back in 2002, I would have freaked. Balance is a good thing.
Click to expand...

See, I found that having the information about remission motivated me. I just wanted to get Bandit into normal numbers as safely and as quickly as possible. Regulation and remission became my incentive to test at least three times a day (I work two jobs and go to grad school, and my vet was telling me daily testing wasn't necessary, so it was easy for me to justify not testing as much as I needed). Life does get in the way of testing, but the extra time it took me testing then is now saving me loads of time that I don't have to test or shoot insulin or be home in exactly 12 hours now. Also, with a history of DKA, you really want to get to a regulating dose as soon as possible, and the best and safest (from both hypos and ketones) way to do that is with more testing. I'm sorry if that causes someone stress to say that, but it's the truth and should be considered up front, so perhaps arrangements can be made with friends, family, or a pet sitter to help out with the testing. My stress levels went WAY down once Bandit was regulated, even before remission. Not all cats make it there, but whether they do or not you still want regulation to be your goal. And you can't get to remission without regulation.
 
Thank you for all your responses. We will up the dose gradually rather than straight to 3u. I see it said a lot that "too much insulin exhibits the same signs as too little"... What pattern in BG test readings would show that she's being given too much insulin?
 
depends on the insulin type so I will let lantus users answer that one. Typically though, higher flat numbers...the body tries to protect itself by using glucagon from the liver. It can't continue forever and at some point the cat will crash. It is called rebound or somogi effect.
 
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