new here. hi! 5 weeks of home testing and my cat is still very fuzzy about it. need advice on how to treat.

[zero - sigma & mielconejo]

Hello everybody! I am conejo, a colombian girl with 2 10 year old cats I found when they were very small in my country house: Zero and Sigma. Zero has recently been diagnosed with a complex digestive inflammatory issue that has made him vomit almost daily for a long time, this issue is causing him to get high blood sugar even though his fructosamine test came back in the normal range, so obviously the first step for treatment is to treat as if he were diabetic to get his glucose levels down.

I've been home testing for 5 weeks, have watched tons and tons of videos and read thousands of forums, gone back and forth with the vet and still, 5 weeks in, Zero is very problematic at the time of testing. He has never been an aggressive cat but he is turning very aggressive every time it's test time. He is also not a good bleeder which means i need to prick his ears 2 or more times for one drop of blood big enough for the strip. I've lost tons of strips and lancets, he now bites me every time and i can tell he is super stressed which worries me that the high stress levels are getting his glucose readings way higher at the time of testing.

Even though he has shown a lot of clinical and behavioral improvements once the treatment began, his energy levels and hunger levels are both up, his vomiting has receded (went from every day to 2 times in the past 5 weeks) we still can't get a quiet testing and insuline shot session in. And I only have to test before the shot, so in the am and in the pm. he reacts strongly to the insuline shot reacting violently even when i am just grabbing his skin and not even inserted the needle yet. There have been tons of shots that I am left wondering if the insuline went in or if it was just a fur shot because he jumped or moved violently the second i inserted the needle, even yhough i usually have him straddled.

Many times i have had to give the shot without a reading and I end up so frustrated, mad at him and sad that I'm not making it work. I've tried rituals, setting him at the same time in the same spot, warming his ears with a rice sock, playing soft calming music to relax him, giving him lots of cuddles, and rubbing his ears so they warm a lot, but all through that I still can see he is extremely stressed, swinging his tale around and miaowing in complaint. He knows it's test time and he does not relax even though I take time to really pamper him.

I have also tried with just quick sessions with just quickly prick with no preamble to try to avoid the pre-stress and rejection, and still, he attacks. it's been 5 weeks already, i thought it would have gotten easier by now. I found this forum and decided to ask because all the videos i see on techniques to apply insuline and home test none of them show a highly reactive cat like mine.

if anyone has gone through this same scenario please advice, i am very frustrated and i hate yelling at him after getting attacked, but i KNOW this is not as painful as he makes it out to be, he attacks and complains as if it hurt even when i am just placing the gauze under his ear, so i know it is not the prick. can't figure out how to move on.

thank you for any advice in advance.

 

[CORKY]

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

Hi and welcome to the forum. I am sorry you are having so much trouble with getting the BG.
I am surprised the vet started insulin if the fructosamine test was normal. Did he give you are reason why he thought it was a good idea?
How high did the blood glucose level go when he was tested initially? .
Was he given any antinausea medication for the vomiting?

What type and dose of insulin are you giving him now.?
Do you think you could set up a spreadsheet and add some data so we can see what is happening? I will put a link at the bottom how to do this.

What food are you feeding him? And how often?

Have you tried feeding him a little treat as you are doing the testing and giving the insulin?

 

[Bron and Sheba (GA)]

Link to spreadsheet and other useful information
Sticky - New? How You Can Help Us Help You!

 

[zero - sigma & mielconejo]

Hi Bron and Sheba! thank you so much for your reply, and apologies for taking so long to reply back I was making sure I updated all my spreadsheet with all the info I've gathered since Zero was diagnosed. It is all updated now, you can check Zero's Spreadsheet here

So the reason why we started on insulin even though the fructosamine came back normal, is because we identified an extreme digestive issue on him spotted on some ultrasounds made on him due to his history of daily vomiting for years. He used to vomit almost daily and I never thought it was something bad since it happened since he was small and he seemed perfectly fine for years, so I just thought it was due to him being super long haired. It turns out not. I realized he was sick because I noticed he started drinking water excessively and had peed outside of the litterbox but even weirder than the fact that he never does this was that I was confounded to know if it was truly pee or not since it had no usual cat pee smell. it almost did not have any smell at all. So I researched the symptoms on google and was adviced to take him to the vet.

with his vomiting history, the vet prescribed the ultrasound to see the state of his digestive track, and spotted really thick stomach walls, and big spots on the pancreas plus a chance of fatty liver, and when he tested his glucose it was super high sitting at 368. we were hoping the fructosamine came back high as well, since that could possibly mean the digestive issues COULD potentially be caused by the diabetes and not the other way around which seems to be the case. For this reason and all his chronic digestive images, he was not giving any anti nausea medication.

The obvious path would be to perform surgery and take a test of the compromised organs, but the vet says its way too risky for him and the benefit of that is too little and there are other ways we can manage it, starting by the obvious which is controlling his glucose. so he started him on insulin and adjusted his diet hoping that he gets better and we can see improvements on the digestive area. Having said that, I get scared because its been 31 days since treatment and his numbers are still super high. The vet says its normal for cats to take several weeks to strat responding to the insulin, to not fret since his clinical performance has improved a lot. I was instructed to test only before the shots, so I've never really seen the effect of the insulin on Zero until right before the shot when the effect has worn off, so I get scared that the treatment is not working, but the clinical changes I've seen in him since we started the treatment are immense. He has vomited only twice in the last 5 weeks, he always was not much of a heavy eater, not very excited about food for all his life (he is 10 years old now) and he started eating soo much better and asking for food just like Sigma (his sister) has always done, and he started playing and being much more active.

In the control appointment last week, he was tested mid shot, and i could see his number being 128 which I had NEVER seen before since starting treatment so i could tell the treatment was working.
In the spreadsheet you can see some blank spots on BG and some NS and that indicates the times we've struggled the most at testing or giving the shot, where he gets so aggressive and stressed out that it became impossible for me to test. Unfortunately I live alone, so I have no one that could help distracting him or petting him or feeding him while i test. Not every time is terrible, first weeks were fine, then we had some rough days at week 3 and then it was kind of ok for a few days again and then he gets super aggressive again.
If I had to test continuosly through the day I don't know how I would manage since only 2 tests a day seem a bit too much already for him.

In terms of food, he is still having kibble by instruction of the vet to not take him completely off the kibble since it digests slowly and he needs that for his digestive issues, so he is taking Hill's WD and combined with Fancy Feast Original Pate, but the vet said that had a bit of a high fat content and was not good for him. I was looking for the Royal Canin Glycobalance wet food which was prescribed for him but it was suuuper hard to find here in Colombia, only until today could I find a place to order those cans, so I will switch him to that next week when they arrive. He has always been free fed, and he and his sister have always been extremely picky with food, they never liked chicken or tuna, or any canned food, they even never liked churu which every cat seems to go crazy about, and no treat really calls their attention, so its hard to bribe him with treats. I was able to get him to eat the Fancy Feast cans after 3 weeks of transitioning him, so I really just feed him freely and let him eat when he wants.

I hope that's all the info you needed, I really want to do what's best for him, I wish I can give him more good years of life.

Thank you again for your help.

love, zero, sigma and conejo.

Hi and welcome to the forum. I am sorry you are having so much trouble with getting the BG.
I am surprised the vet started insulin if the fructosamine test was normal. Did he give you are reason why he thought it was a good idea?
How high did the blood glucose level go when he was tested initially? .
Was he given any antinausea medication for the vomiting?

What type and dose of insulin are you giving him now.?
Do you think you could set up a spreadsheet and add some data so we can see what is happening? I will put a link at the bottom how to do this.

What food are you feeding him? And how often?

Have you tried feeding him a little treat as you are doing the testing and giving the insulin?

 

[Bron and Sheba (GA)]

Thanks for the reply. I can’t see your spreadsheet. Have you pressed the share button?
Don’t forget to tell me what insulin you are giving and the dose please.

 

[Chris/China (GA)/Garfield]

@mielconejo , First, we can now see your spreadsheet so thank you for changing the permissions. Next, it looks like you're not using it correctly. What unit of measurement do you use in Columbia for blood glucose? Mg/dl or mmol/l?

In the US, we use mg/dl so normal blood glucose numbers are 50-120 but in unregulated cats, we commonly see numbers in the 300's-500's. Most of the rest of the world uses mmol/l where the normal blood glucose numbers are 2.8-6.7 (on a human meter) and we see numbers in the 20's-30's in unregulated cats.

It looks like you may be using the US (mg/dl) numbers, but when you enter them on the World tab of your spreadsheet, it automatically converts them to the US numbers, so 385 becomes 6930, 275 becomes 4950.

Since our spreadsheet is formatted to color code different blood glucose levels, by entering the mg/dl numbers on the mmol/l (world) tab. they are all registering as being sky high (black). 275 would usually be yellow. 385 would usually be pink. Take a look at Garfield's spreadsheet (in my Signature under this post) and you'll see a variety of colors (although since Garfield is pretty well controlled, most of his numbers are blue or green).

I'd be happy to help you start a new spreadsheet if you'd like (instead of going back and changing everything). You can send me a private message by clicking on my screen name and choosing "send direct message".

As for the food, the dry WD is about 36% carbs, so as long as he's eating that, it will be very hard to get his glucose under control. Your vets concern about the amount of fat in Fancy Feast is probably unfounded. Cats are very efficient at processing fats. If you must have a dry food, please switch to the DM food (same manufacturer as WD). It's about 18% carbs but that's a heck of a lot better than 36%. There are some low carb kibbles, but I doubt if you can get them in Columbia. Our members in Canada can't even get them so I think they're pretty much only available in the US.

Does your vet think he has IBD? (Irritable bowel disease). Kind of sounds like it from some of what you've explained. Thickened intestines are a common finding in IBD (although I understand you said he had thickening in the stomach). Just shooting some ideas out there.

One very good thing though! Your vet put him on Lantus which is an excellent insulin for cats! Now we just need to figure out what's going on and try to get some of those numbers down. Getting the WD out of his diet will only help with that.

@Rebecca & Max (GA) had a VERY spicy cat too. I'll see if I can get her to come and tell you what she went through!

 

[Rebecca & Max (GA)]

Hola, Conejo!
My boy, Max, did not want me to test him at all! If not for @Chris & China (GA), I would have lost Max to a hypoglycemic event. I used a CGM (continuous glucose monitor) - the Libre, while I figured out the testing part. I asked my vet and he agreed to try it on Max. It didn’t help that Max did not like to be held, wrapped up, or pushed into a corner to be tested. He would bite and scratch me anytime I got close to him with the lancet. One day, I was in my garden and realized that my leather gloves that I used to cut my roses would be a good thing to try with Max. I also learned he LOVED boiled chicken breast. Using that knowledge, I began to give Max the chicken each time I scanned the Libre and also touched his ears. I fed Max on a counter and decided to test him where he ate because 1) he could leave if he wanted to, 2) he was up high so I didn’t have to bend or sit, 3) it was close to where the chicken was kept (in the refrigerator), and 4) there was a bright light in my kitchen.
When I decide I was ready to try, I put on the gloves and attempted to poke Max’s ear (didn’t get an actual poke). I then gave him a piece of chicken. I tried it again, and gave more chicken. I tried a third time and he bit down on my gloved finger- hard. The look he gave was “Well, crap, what am I going to do to stop her now?” I told him he could bite me all he wanted to, but that I wasn’t going to stop trying to test him because I needed to help him.
A few times a day, usually when he wanted to be fed, I would try to test him. Since I had the Libre on him, there was no pressure to get a test, but that only lasted 12 days. I applied a second Libre on him myself at home, but that one only lasted 6 days. I knew then that it was time to go with ear sticks only. It took us a few weeks, but we got a decent routine. Three pokes and chicken given, no matter if the test was successful or not. Then I gave him a break. I only got really anxious when it was shot time, because I’d almost killed him once by giving him a dose without testing. I made those two tests my focus, but I also learned to test him near the next shot time (so +10 or +11) in case the preshot test was a fail.
I also learned a few things about Max’s ears:
his right ear always bled better, but I made sure to poke them alternately for each test, his ears HAD to be warm to hot to bleed (if he was sunbathing, his ears were hot and bled very easily), and finally, he would love to flick his ear right before I’d get the blood sample. I learned to immediately collect the blood on the back of my fingernail to test it, but if the blood landed on the counter or cabinet door, I’d test it. I even tested it off of my skin once.

 

[Chris/China (GA)/Garfield]

@mielconejo One other thing. Lantus craves consistency so needs to be given at the same dose both AM and PM. You shouldn't increase based on how high the Preshot is. Dosing is based on how LOW it takes them, so if 2U got him into the 100's at the vet, I'd stick with that for now. We also don't do increases in whole unit increments (like from 2.0 to 3.0). Cats are small creatures and insulin is a powerful hormone. Increases need to be done in 0.25 unit increments. If you're using the Lantus pens with the special pen needles, you should get some regular insulin syringes instead of the pen needles. With the pens, you just take the top off and there's a rubber stopper just like you'd see on a vial. You insert the needle into the pen and withdraw the amount you want...using the pen like a "mini-vial". You should get U100, 31 gauge insulin syringes, preferably with half-unit marks. I don't know what syringes are available in Columbia, but Embecta (formally B/D brand) are usually available world-wide but to get the specific ones you want, you may need to ask somebody to order them if you can't find someplace that carries them.

Lantus is a depot insulin which means it goes into the skin and forms a "depot" which gradually releases into the bloodstream over the next 12 hours. You should hold the same dose for 3-7 days (depending on which dosing method you decide to use, Start Low, Go Slow or Tight Regulation) so that depot has a chance to stabilize so that it's releasing the correct amount. Every time you change the dose, that depot needs time to stabilize again or you end up getting wonky numbers.

Can you get the Freestyle Libre in Columbia? Or another Continuous blood glucose monitor? They can be really helpful for keeping track of the numbers while working on your usual poking routine.

 

[squeem3]

Maybe @whitedecay has info on where to buy supplies in South America? They are in Venezuela.

 

[zero - sigma & mielconejo]

Thanks for the reply. I can’t see your spreadsheet. Have you pressed the share button?
Don’t forget to tell me what insulin you are giving and the dose please.

hellooo! i tried turning the spreadsheet public, hopefully that works now!
He is taking Lantus and up to week 5 he had 2 units, but on week 5 he had some really high readings so the vet instructed if he ever got above 350, to give him 3units. his units are on mg/dl and he is being tested on an accu chek human glucometer.

 

[Chris/China (GA)/Garfield]

units are on mg/dl and he is being tested on an accu chek human glucometer.

OK, in that case, you shouldn't be entering your numbers on the "World" tab. If you don't want to try to move all your entries from the World side to the US side, I'd be happy to start a new spreadsheet for you and if you give me access to the current one, I should be able to move all your entries to the mg/dl spreadsheet. If you'd like my help, just click on my name and choose "send direct message".

 

[zero - sigma & mielconejo]

OK, in that case, you shouldn't be entering your numbers on the "World" tab. If you don't want to try to move all your entries from the World side to the US side, I'd be happy to start a new spreadsheet for you and if you give me access to the current one, I should be able to move all your entries to the mg/dl spreadsheet. If you'd like my help, just click on my name and choose "send direct message".

Thank you for all the instructions, I re-did the spreadsheet and updated my signature. here is the link to the updated spreadsheet. A little update is that i finally was able to get him on royal canin glycobalance, and its the first time i've had 2 readings below 200. that gives me so much hope. : )

 

[zero - sigma & mielconejo]

@mielconejo , First, we can now see your spreadsheet so thank you for changing the permissions. Next, it looks like you're not using it correctly. What unit of measurement do you use in Columbia for blood glucose? Mg/dl or mmol/l?

In the US, we use mg/dl so normal blood glucose numbers are 50-120 but in unregulated cats, we commonly see numbers in the 300's-500's. Most of the rest of the world uses mmol/l where the normal blood glucose numbers are 2.8-6.7 (on a human meter) and we see numbers in the 20's-30's in unregulated cats.

It looks like you may be using the US (mg/dl) numbers, but when you enter them on the World tab of your spreadsheet, it automatically converts them to the US numbers, so 385 becomes 6930, 275 becomes 4950.

Since our spreadsheet is formatted to color code different blood glucose levels, by entering the mg/dl numbers on the mmol/l (world) tab. they are all registering as being sky high (black). 275 would usually be yellow. 385 would usually be pink. Take a look at Garfield's spreadsheet (in my Signature under this post) and you'll see a variety of colors (although since Garfield is pretty well controlled, most of his numbers are blue or green).

I'd be happy to help you start a new spreadsheet if you'd like (instead of going back and changing everything). You can send me a private message by clicking on my screen name and choosing "send direct message".

As for the food, the dry WD is about 36% carbs, so as long as he's eating that, it will be very hard to get his glucose under control. Your vets concern about the amount of fat in Fancy Feast is probably unfounded. Cats are very efficient at processing fats. If you must have a dry food, please switch to the DM food (same manufacturer as WD). It's about 18% carbs but that's a heck of a lot better than 36%. There are some low carb kibbles, but I doubt if you can get them in Columbia. Our members in Canada can't even get them so I think they're pretty much only available in the US.

Does your vet think he has IBD? (Irritable bowel disease). Kind of sounds like it from some of what you've explained. Thickened intestines are a common finding in IBD (although I understand you said he had thickening in the stomach). Just shooting some ideas out there.

One very good thing though! Your vet put him on Lantus which is an excellent insulin for cats! Now we just need to figure out what's going on and try to get some of those numbers down. Getting the WD out of his diet will only help with that.

@Rebecca & Max (GA) had a VERY spicy cat too. I'll see if I can get her to come and tell you what she went through!

omg you have no idea how grateful i am for all your detailed instructions, i updated my signature and my spreadsheet as per your instructions, it seems to be ok now. i have read soooo mcuh about food for diabetic cats that it seems really odd that he still wants him on kibbles, he usually is a very picky eater, not even eating chicken (he doesnt even try it, or tuna or any other delicacies, neither cooked nor raw, so i was very worried to be able to get him into wet food, but he seemed to like the fancy feast classic pattes a lot, and this week i was able to FINALLY find cans ROYAL CANIN GLYCOBALANCE and thank god he lovedd them, ate the whole thing. then on his first day on it, i got his first reading below 200. this made me cry of happiness to be honest. its been 5 weeks of struggles, and yesterday was the first time i saw a number that low. I will try to move him into ONLY wet food, slowly so that he doesn't get even more stressed than he already is with the testing and the insulin, but it seems so far like it won't be a problem, and slowly monitor him for mood changes. His intenstines' walls were very thick yes, might be IBS but he didn't say so. It seems more like masses since the ultrasound besides the thick walls, showed some blurry spots indicating pressence of mass. they said the only way to know for sure if it was tumors was by doing organs's tissue test, but they don't want to put him through that surgery yet, and i tend to agree. my main focus right now is trying to get his BG down, and so far he has not vomited any more, which might be a really, really good sign for his condition.

Again, thank you so much for all your love and care on your answers, hopefully you have better data now to work with. <3

 

[Chris/China (GA)/Garfield]

I re-did the spreadsheet

That's a LOT better! Good job! And thanks for getting your signature done too!

Unfortunately, Lantus isn't dosed based on the Pre-shot number. A sliding scale like your vet has you on hardly ever works with Lantus. Lantus dosing is based on how LOW it takes them, no matter how high the PS are, so when you can, you need to start getting some mid-cycle tests (at least one around 5-7 hours after the shot). It's also important to get a "before bed" test on the PM cycle since most cats go lower at night. You want to make sure he'll be safe while you're sleeping! Getting a +2 (or +3) can sometimes act kind of like a crystal ball in predicting where he might go later in the cycle. If the +2 is lower than the PS, that's your "early warning" that he might be dropping a lot lower later and it's those nights where you might need to stay up later or set an alarm to get a test later in the cycle.

Also, while the canned Glycobalance is better than the kibble, it's still a little higher than we like in carbs. It's also very expensive for what it is! There's absolutely nothing special in "prescription" foods that treats diabetes! If you compared the ingredients to pretty much any food you can buy at your local store, you'll see a lot of the same things and nothing that requires a prescription. The entire "prescription" food industry is nothing but a clever marketing tool by the food manufacturers. By claiming it's a "prescription only" food, it gives consumers the perception that it's somehow special. It's not. There's a great website, written by a vet with a special interest in feline nutrition that goes into the myth of "prescription" foods (as well as tons of other information). It's well worth the time to read! www.catinfo.org

Most of us feed our own cats Fancy Feast pates, Friskies pates, or 9-Lives ground, but I'm not sure what's available in Columbia (although some version of Fancy Feast and Friskies are almost everywhere....Purina is a huge, world-wide company). There are also higher quality foods like Weruva, Wellness, BFF, among a lot of others. They cost about the same as the Rx foods, but have MUCH higher quality ingredients.

 

[zero - sigma & mielconejo]

Hola, Conejo!
My boy, Max, did not want me to test him at all! If not for @Chris & China (GA), I would have lost Max to a hypoglycemic event. I used a CGM (continuous glucose monitor) - the Libre, while I figured out the testing part. I asked my vet and he agreed to try it on Max. It didn’t help that Max did not like to be held, wrapped up, or pushed into a corner to be tested. He would bite and scratch me anytime I got close to him with the lancet. One day, I was in my garden and realized that my leather gloves that I used to cut my roses would be a good thing to try with Max. I also learned he LOVED boiled chicken breast. Using that knowledge, I began to give Max the chicken each time I scanned the Libre and also touched his ears. I fed Max on a counter and decided to test him where he ate because 1) he could leave if he wanted to, 2) he was up high so I didn’t have to bend or sit, 3) it was close to where the chicken was kept (in the refrigerator), and 4) there was a bright light in my kitchen.
When I decide I was ready to try, I put on the gloves and attempted to poke Max’s ear (didn’t get an actual poke). I then gave him a piece of chicken. I tried it again, and gave more chicken. I tried a third time and he bit down on my gloved finger- hard. The look he gave was “Well, crap, what am I going to do to stop her now?” I told him he could bite me all he wanted to, but that I wasn’t going to stop trying to test him because I needed to help him.
A few times a day, usually when he wanted to be fed, I would try to test him. Since I had the Libre on him, there was no pressure to get a test, but that only lasted 12 days. I applied a second Libre on him myself at home, but that one only lasted 6 days. I knew then that it was time to go with ear sticks only. It took us a few weeks, but we got a decent routine. Three pokes and chicken given, no matter if the test was successful or not. Then I gave him a break. I only got really anxious when it was shot time, because I’d almost killed him once by giving him a dose without testing. I made those two tests my focus, but I also learned to test him near the next shot time (so +10 or +11) in case the preshot test was a fail.
I also learned a few things about Max’s ears:
his right ear always bled better, but I made sure to poke them alternately for each test, his ears HAD to be warm to hot to bleed (if he was sunbathing, his ears were hot and bled very easily), and finally, he would love to flick his ear right before I’d get the blood sample. I learned to immediately collect the blood on the back of my fingernail to test it, but if the blood landed on the counter or cabinet door, I’d test it. I even tested it off of my skin once.

OMG Rebecca, so much of what you said sounds really familiar to me! thank you so much for sharing your experience.

Unfortunately, Zero never has shown any interest for boiled chicken or any other type of delicacies, and even switching his kibble has always been a loooong adaptation process, (long meaning more than 3 months to get a success), so that has not been possible for me, but now I just yesterday found that he loved the cans of royal canin glycobalance, (which are hard to get here, but finally managed to find a place that imports them) so i feed him right before testing and even though he still meaows in complaint, he is allowing me to do it as a trade.

after a really nasty 2 days of aggressive attacks until i lost my temper and yelled at him only to then feel guilty and like a terrible cat mom, i came into the forum to ask for help, but then started reading so many posts and started to plan another strategy. i cut off his nails, and now i always test with thick long sleeve sweaters on, so when he attacks its not a bloddy scene anymore, and allows me to stay calm and not get mad at him, he has gotten better at the test, but i also see he shakes his head and i lose the blood sample, so i tried to collect quickly in my nail if he's fuzzy, and that has worked 3 times already since my first post.

Due to his numbers being soooo constantly intensely high until now, if a test has been too rough and a failure, i leave him be for another hour and try again, if it fails again, i just give him the shot and monitor him closely, but i think this disposition has helped for him to understand that im not gonna torture him with any more than 2 pricks at a time. now, when it comes to the insulin shot, i think my technique might be not the best and he really complains and moves violently when trying to give the shot, so sometimes the dose does not go in completely, and that is when i have had to record a NS on the spreadsheet since i have no idea how much of the dosage actually went in. he tries to bite me when I try to give him the shot, but now its not vicious and violent, just like a complaining reaction so i let him and tell him i understand he is in pain and uncomfortable but that we will be done soon. he usually lets me finish after he's bitten me (not hard at all since that horrid time we fought and i yelled at him) and he sees i don't get mad at him anymore, so he calms down.

I can see in his eyes right after he bites me he feels terrible, its like he can't avoid it but i know he doesn't want to bite. when i finish the shot i cuddle him and it seems even more than treats he loves to be praised and kissed and stroked more than anything after everything is done.
I also have another cat who gets very curious about why am i paying so much dedicated attention to him so I started doing the entire fake routine with all the implements on her, and that has gotten Zero to allow me to do it without as much as an issue.

Since that week when we had really hard testing tries and fails, i asked the vet for the continuous monitor, which I got. I got the Free Libre 2, (extremely expensive down here) but I thought would be worth the investment to give his ears and his pre-stress a break for a couple of days, and also to be able to maybe see the insulin in action, since i only do pre-shot tests and only ever see the high numbers, my anxiety has been over the roof thinking its not working, so i though maybe seeing him enter the normal range after the shot would also help my state of mind. Unfortunately, even though i told my vet in all the videos i saw they always used surgical glue, he didn't have any available and he tried to place it on him, to no avail, the thing fell right off. So that money went to the bin. I got really frustrated. Nevertheless, after breathing, very very deeply, I tried contacting the pharmacy and reporting the thing did not stick, they offered to do a replacement foe no extra fee, so I now have a brand new Libre and I am awaiting for the sticky patches i saw a vet use on a cat to place the libre on, and when they arrive I'll try to put it on myself and see how we do.

That is my overall update, thank you so much for all your help, it feels relieving to feel I'm not the only cat mom struggling with this, it felt it was all my fault. But now I think I am learning a lot of skills to keep in my tool kit to manage crisis with him.

I tahnk you again for you care and your time in explaining your story and your techinques, I wish you and Max never have to experience a hypogycemia event ever again.

Much much love from conejo, zero and sigma.

 

[zero - sigma & mielconejo]

@mielconejo One other thing. Lantus craves consistency so needs to be given at the same dose both AM and PM. You shouldn't increase based on how high the Preshot is. Dosing is based on how LOW it takes them, so if 2U got him into the 100's at the vet, I'd stick with that for now. We also don't do increases in whole unit increments (like from 2.0 to 3.0). Cats are small creatures and insulin is a powerful hormone. Increases need to be done in 0.25 unit increments. If you're using the Lantus pens with the special pen needles, you should get some regular insulin syringes instead of the pen needles. With the pens, you just take the top off and there's a rubber stopper just like you'd see on a vial. You insert the needle into the pen and withdraw the amount you want...using the pen like a "mini-vial". You should get U100, 31 gauge insulin syringes, preferably with half-unit marks. I don't know what syringes are available in Columbia, but Embecta (formally B/D brand) are usually available world-wide but to get the specific ones you want, you may need to ask somebody to order them if you can't find someplace that carries them.
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Lantus is a depot insulin which means it goes into the skin and forms a "depot" which gradually releases into the bloodstream over the next 12 hours. You should hold the same dose for 3-7 days (depending on which dosing method you decide to use, Start Low, Go Slow or Tight Regulation) so that depot has a chance to stabilize so that it's releasing the correct amount. Every time you change the dose, that depot needs time to stabilize again or you end up getting wonky numbers.

Can you get the Freestyle Libre in Columbia? Or another Continuous blood glucose monitor? They can be really helpful for keeping track of the numbers while working on your usual poking routine.

wow, amazing the amount of information you guys already have in this.
ok, so: I've been using the needles you mention since day 1. I only this week was advice to manage the amount of units depending on his numbers, but i understand what you say and it makes total sense to me. I think i will stick to the original 2 units and see how it goes, specially now that since he tried the glycobalance only yesterday i immediately got my first number under 200. so that seems to have the best potential to work moving forward.
I did get the Libre 2 but my vet had never placed one before, and didnt listen to me when i said all the videos i saw they put surgical glue on, he tried to place it as it comes and ruined it. it obviously did not stick. that thing is extremely expensive down here, so I was very bummed, but i tried calling the pharmacy and said it was for me and it didnt stick, and they offered to do a change, so i have a brand new one. I am waiting on some sticky wipes a vet on youtube using a libree on a cat recommended, so i ordered them and when they arrive I will attempt to place it on him myself.

I do have a question on timelines, is it really usual for the insulin effect to start going down to take this long? I am entering week 6 today and it's still pretty high on pre-dose. I this normal?

Thank you for alll your help. this forum has really helped me not feel so alone and frustrated and to keep trying. : )

 

[Chris/China (GA)/Garfield]

Trying singing a silly song when it's testing/shot time. Cats are VERY good at picking up our emotions. If we're feeling scared and nervous, they're going to think there's a reason they should be scared and nervous too. When you sing, you use a different part of your brain so it's much harder to send those bad signals (although your cat may look at you like you've lost your mind....LOL)

 

[zero - sigma & mielconejo]

Trying singing a silly song when it's testing/shot time. Cats are VERY good at picking up our emotions. If we're feeling scared and nervous, they're going to think there's a reason they should be scared and nervous too. When you sing, you use a different part of your brain so it's much harder to send those bad signals (although your cat may look at you like you've lost your mind....LOL)

well, he does have a favorite artist that everytime his music comes on, he stands near the tv to hear it and watch him, so i started playing it before the test for him, and it seems to lower a tiny bit his stress level.
Lol i always sing and dance when we have a successful test and shot, and he does look at me like maybe i am insane and that is why i randomly decided to start pinching him one day, lol. maybe i should sing also when the test is a failure.

 

[zero - sigma & mielconejo]

That's a LOT better! Good job! And thanks for getting your signature done too!

Unfortunately, Lantus isn't dosed based on the Pre-shot number. A sliding scale like your vet has you on hardly ever works with Lantus. Lantus dosing is based on how LOW it takes them, no matter how high the PS are, so when you can, you need to start getting some mid-cycle tests (at least one around 5-7 hours after the shot). It's also important to get a "before bed" test on the PM cycle since most cats go lower at night. You want to make sure he'll be safe while you're sleeping! Getting a +2 (or +3) can sometimes act kind of like a crystal ball in predicting where he might go later in the cycle. If the +2 is lower than the PS, that's your "early warning" that he might be dropping a lot lower later and it's those nights where you might need to stay up later or set an alarm to get a test later in the cycle.

Also, while the canned Glycobalance is better than the kibble, it's still a little higher than we like in carbs. It's also very expensive for what it is! There's absolutely nothing special in "prescription" foods that treats diabetes! If you compared the ingredients to pretty much any food you can buy at your local store, you'll see a lot of the same things and nothing that requires a prescription. The entire "prescription" food industry is nothing but a clever marketing tool by the food manufacturers. By claiming it's a "prescription only" food, it gives consumers the perception that it's somehow special. It's not. There's a great website, written by a vet with a special interest in feline nutrition that goes into the myth of "prescription" foods (as well as tons of other information). It's well worth the time to read! www.catinfo.org

Most of us feed our own cats Fancy Feast pates, Friskies pates, or 9-Lives ground, but I'm not sure what's available in Columbia (although some version of Fancy Feast and Friskies are almost everywhere....Purina is a huge, world-wide company). There are also higher quality foods like Weruva, Wellness, BFF, among a lot of others. They cost about the same as the Rx foods, but have MUCH higher quality ingredients.

Yeah, thank you for this info, I already spent crazy amounts of money trying to secure the glycobalance, but evidently, i am aware of the industry and its misleading claims. since my vet has been very adamant that I should feed ONLY foods that clearly state they are good for diabetes, i was afraid of straying away from that but most everyone that has gotten their cat into remission have stated feeding them the FF classic pates, so that's what i got him at the beginning. Since i am new at this, i felt i shouldn't stray from the vet's instructions but some things here and there hint me that he hasn't treated a ton of diabetic cats maybe, like the fact that he ruined the one freestyle libre 2 i saved to purchase trying to place it without any other adhesive help. I think i will do all the things suggested here, try to switch him to an entirely wet food diet and not lose the FF classic pates which he also seems to love. I will also try to test him once more between the cycle and see how his numbers are doing. I do notice that at night something different is going on since his AMPS are usually always higher than his PMPS.

maybe it would also be good to seek a second opinion with another vet in terms of treatment and nutrition, just to compare how much of a delta can there be between vets.

thank you so much! i am learning more and more every day, and one thing has become clear to me: i really need to become good at monitoring everything on him. his mood, his food, his drinking habits and pee amounts, and test a bit more often than just the PS-

i was checking china's spreadsheets to try to get an idea on other cat's responses in time to insulin, i will try to read more and more to see if i understand better the notes people make, but this was very informative. thank you so much.

 

[whitedecay]

Hi Conejo! Welcome to the forum

I had a friend who lived in Barranquilla, he used to buy the syringes for me. He doesn't live there anymore so I've been buying them from Amazon, but back in the day they seemed to be pretty common so I'm sure you'll find them in any pharmacy. I used to buy the BD Ultra-fine ones, the most important thing are the half-markings.

 

[zero - sigma & mielconejo]

Hi Conejo! Welcome to the forum

I had a friend who lived in Barranquilla, he used to buy the syringes for me. He doesn't live there anymore so I've been buying them from Amazon, but back in the day they seemed to be pretty common so I'm sure you'll find them in any pharmacy. I used to buy the BD Ultra-fine ones, the most important thing are the half-markings.

View attachment 78051

thank you so much! I am able to get these from a marketplace similar to amazon but focused in latinamerica calles mercadolibre.

@mielconejo , First, we can now see your spreadsheet so thank you for changing the permissions. Next, it looks like you're not using it correctly. What unit of measurement do you use in Columbia for blood glucose? Mg/dl or mmol/l?

In the US, we use mg/dl so normal blood glucose numbers are 50-120 but in unregulated cats, we commonly see numbers in the 300's-500's. Most of the rest of the world uses mmol/l where the normal blood glucose numbers are 2.8-6.7 (on a human meter) and we see numbers in the 20's-30's in unregulated cats.

It looks like you may be using the US (mg/dl) numbers, but when you enter them on the World tab of your spreadsheet, it automatically converts them to the US numbers, so 385 becomes 6930, 275 becomes 4950.

Since our spreadsheet is formatted to color code different blood glucose levels, by entering the mg/dl numbers on the mmol/l (world) tab. they are all registering as being sky high (black). 275 would usually be yellow. 385 would usually be pink. Take a look at Garfield's spreadsheet (in my Signature under this post) and you'll see a variety of colors (although since Garfield is pretty well controlled, most of his numbers are blue or green).

I'd be happy to help you start a new spreadsheet if you'd like (instead of going back and changing everything). You can send me a private message by clicking on my screen name and choosing "send direct message".

As for the food, the dry WD is about 36% carbs, so as long as he's eating that, it will be very hard to get his glucose under control. Your vets concern about the amount of fat in Fancy Feast is probably unfounded. Cats are very efficient at processing fats. If you must have a dry food, please switch to the DM food (same manufacturer as WD). It's about 18% carbs but that's a heck of a lot better than 36%. There are some low carb kibbles, but I doubt if you can get them in Columbia. Our members in Canada can't even get them so I think they're pretty much only available in the US.

Does your vet think he has IBD? (Irritable bowel disease). Kind of sounds like it from some of what you've explained. Thickened intestines are a common finding in IBD (although I understand you said he had thickening in the stomach). Just shooting some ideas out there.

One very good thing though! Your vet put him on Lantus which is an excellent insulin for cats! Now we just need to figure out what's going on and try to get some of those numbers down. Getting the WD out of his diet will only help with that.

@Rebecca & Max (GA) had a VERY spicy cat too. I'll see if I can get her to come and tell you what she went through!

I wanted to come in here and give an update because the past few days have been a total game changer after reading all your reccomendations.
Frist off, I stopped upping the insulin amount and am just sticking to the initial 2U the vert recommended, since you explained lantus craves consistency.
The last week, I tried following the advice of doing the whole process with my other cat, and I think that made a HUGE difference in Zero. He watched from afar, and Sigma was always jealous of me spending so much dedicated time with zero anyways so she was happy to volunteer for teh fake test and fake shot. I tried taking as much time as it takes me with him, and she was totally happy and never complained. To my surprise, when I was done with her, he was next in line waiting for his turn. He let me test him even though he still complained, and I also learned from pictures in the forum the correct way and depth to insert the needle and i think that made it better because he complained but didn't jump or bite.
It's been 4 days now, with no issues, so I decided to try to test mid cycle and he let me!
Both my cats are reaaaally picky when it comes to food, they don't like chicken, or tuna, or any treat. Transitioning them into wet food has been discouraging and I have had to throw away tons of leftover food they wouldn't even touch, they are EXTREMELY addicted to kibble, but I have decided I cannot be bent by them and so i decided that i would closely monitor them to make sure they eat but definitely not give kibble since 2 days ago.
Today they finally ate it all and licked the entire plate! I didn't have to throw away any food! I am so happy
and OBVIOUSLY, today was the first morning reading for zero that was below 200, and all day was really good. because the AMPS was 192 i was kinda worried that he would drop too low and specially because he wasn't eating kibble that i tested him at +4 and it was 64 which showed red on my accu ckek meter, i got a bit nervous that he would drop below that so i gave him a couple of kibble to eat, and tested 30 mins later and it was up to 71 which made me feel easier.

Too many wins that I have never seen the past 5 weeks, only today. I hope this continues to go on, it's the first day he is not drinking water excessively and even more energetic and playful than ever.

I wanted to thank you sooo much to everyone who have responded, you gave me courage and so much information.

I have 3 pending questions: 1 is: is there a common time to expect the nadir to hit after applying the shot on lantus? any similarities between what you've seen? maybe mid cycle? or is this not predictable at all?
2: is 64 considered dangerously low? I read the instructions for when they have a hypoglycemia and it says below 65 is considered hypo, so i turned to a handful of kibble to try and avoid it getting lower. is this correct?
3: is churu diet a good treat to give for diabetes?

 

[squeem3]

Nadir is typically around 6 hours after insulin but it does vary among cats. Some have it a little earlier or later. My cat is a late one.

64 is fine but it also depends when in the cycle it is. If you get a 64 2 hours after insulin and you know your cat has a nadir at 6 hours, that 64 could still drop and result in hypoglycemia. If the 64 was at 8 hours after insulin and nadir has already come and gone, your cat is fine.

High carb canned food is better for a hypo than dry food. Gravy based canned foods are usually high carbs. I'm not sure what brands are available in your country. Corn syrup or honey works too but the effect tends to be pretty short.

Which Lantus protocol are you following? Tight Regulation or Start Low Go Slow? Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Some people do give Churu as treats. Healthier treats are freeze dried meat or seafood treats (made for pets) or plain cooked chicken.

 

[Chris/China (GA)/Garfield]

What a great update! So glad to hear you're making such good progress with testing too!

Lantus usually nadirs around 5-7 hours after the shot, but by getting more tests in (as you get better and he's more cooperative) you'll start to figure out where Zero usually nadirs.

62 is a wonderful number, but as @squeem3 said, it depends on when it happens in the cycle. You can always give a small snack of their regular food and test again in 30 minutes to see if it helps to level him out or bump him up a little.

I use Churu's as a reward for Garfield, but it does have a small amount of tapioca starch which can raise the BG of cats that are very carb-sensitive. I believe the same type of tube-treat made by Tiki Cat doesn't contain any tapioca starch.