New Here - So much to learn

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JennieB

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Hi. This is my first post. I'm looking for some advice and encouragement for my 13-year male, Smudge, who may be coming out of remission. He was diagnosed Feb 2011 with ketoacidosis and heart failure. The vet was ready to euthanize, but I said, "Isn't there a way to save him?" He was hospitalized for 3 agonizing days, had many tests, fluid removed from his lungs, and stabilized. He came home weak, but alive! The vet's only advice re feeding was DM. Over the next 3 months, she gradually had me reduce his insulin, from 2 units twice a day to 1 unit once a day, until one morning in June when he crashed with hypoglycemia, BG of 38. She said to stop the insulin. I told her that I had researched cat foods and had switched him from mostly dry to 99% canned food (Fancy Feast.) I asked her if the dietary change could have affected his blood sugar. She admitted that it could. He has been his old sweet self, very mellow and affectionate, and you would never guess from looking at him what he had been through.

Mindy, our female cat, doesn't like canned food, so I'm feeding her Innova Senior Cat dry food and DM, leaving out a bit for her at night, on top of the clothes dryer, along with wet food on the floor for him. Every morning, both dishes were empty, and I now realize that he was probably eating both. Over the last couple of weeks, he has been acting sick again, with increased thirst and urination, lethargy, and just not being himself. I took him in for a fructosamine test the day before Thanksgiving, and the results weren't ready until just before the end of the day. His fructosamine was 540. The vet said we could bring him in for a glucose curve or do it at home, and to get back to her after Thanksgiving. We opted for at-home testing with the ReliOn Confirm glucometer. She also advised against giving him any insulin until we had the results of the glucose curve.

On Thanksgiving, he was looking so miserable and dazed that I pulled out the PZI insulin he was getting back in the spring, and gave him about 3/4 unit, praying that I wasn't killing him in the process. Within 4-5 hours, he was markedly better, looking more alert, back to purring and wanting to be held. The insulin was 2 weeks past its stated expiration date, but my neighbor the nurse said all that means is that its effectiveness is diminished, which further decreased the chance of my overdosing him. I also started keeping the dry food locked up unless Mindy is eating it under my supervision.

We called the vet and told her that we will try to do our own glucose curve over the weekend, but it's really frustrating after our first couple of attempts. My husband volunteered to be the ear-sticker, and he was able to get blood, but not enough for the glucometer. The blood is also not beading up the way it does on videos we've been watching.

We do plan to contact the vet on Monday. If we are unable to complete the glucose curve at home, we'll have to take him in. I'm thinking we also need to test for ketones.

Regarding his heart condition (cardiomyopathy): He's on atenelol and enalapril and seems to be doing fine.

So, here are my questions: (1) Is it possible that he could have come out of remission because of the dry food he was sneaking into his diet, and is it possible that locking it away (along with the single dose of insulin) could have such an immediate effect? I really wish it was that simple, but afraid to get my hopes up. (2) The 33-gauge lancet, even at the second-shallowest setting, seems to go entirely through his ear, but it's still hard to get enough blood for the test. We're warming his ear, applying a dab of petroleum jelly, and aiming for the "sweet spot" but are thinking there must be something we're overlooking.

Thanks for whatever help you can provide. Again, I'm new to this site, and to forums in general, so I apologize if I stumble around at first.
 
Yes, dry food can bring a cat out of remission. Hopefully a short round of insulin and wet lo carb will get him OTJ.

Did you have something in the back of his ear to poke against? Are you getting his ear nice and warm? Both of those things can really help.
 
Thanks! Don't know what OTJ means - is there a glossary on this site? Re something behind his ear - when my husband tried a bit of paper toweling, the blood immediately soaked into it and we couldn't get any more out. Maybe something firm but nonporous? I think you're right about warming it, don't think we've been getting his ear warm enough.
 
I free hand with the lancet; I don't use the device to do the pricking. I can see the ear better without the lancet pen in the way (I have crappy vision). Try to prick the ear at a shallow angle, rather than straight down; you'll hit more capillaries without perforating the ear as easily.
 
Thanks, BJ - I think my husband will like your idea. He complains that it's hard to see what he's doing with the lancet device.
 
Using neosporin ointment (not cream) with pain relief will make the blood bead up too, plus reduces the irritation of the poking.

I also have clip on magnifiers for my glasses - Ordered them online from Clip & Flip Clip-On Magnifier

These really help when you are using a U-100 syringe and aiming for a dose between the markings!
 
Ointment, not cream, got it. Anything that will make Smudge more comfortable is good. You're right about the need for magnifying glasses. It was sooo hard trying to gauge where 3/4 was. Thanks again for your help.
 
I am very new to home testing & what helped me in the beginning was watching a couple of youtube videos & a flashlight to help see the vein. For the first couple of times I would have my husband hold the light. Now I know by eye where to test. I also, wet a cotton pad & pace it in the freezer for a minute. After pricking I place it on Baxter's ear. I don't know if it really helps with the bruising, but it makes me feel better. Ice helps brusing for humans. So I would hope it would help with cats.
 
To provide something under the ear like a cotton ball can help. I read one idea that I thought might work. Use an old pill bottle filled with warm water on the inside surface of the ear and poke from the outside. It warms the ear to make it bleed easier, and it provides a hard surface to poke against.

Carl
 
Thank you, Jenn & Baxter, and Carl. The bottle of warm water would provide the firm, nonporous surface that my husband feels he needs. The chilled cotton ball sounds soothing. I'm so glad I came here to ask questions. I had visited this site, but not registered, back when Smudge was first diagnosed. It was so overwhelming, and I was running in every direction at once, trying to figure out what to do. You all are the best!
 
Re: New Here - So much to learn - 13 yr-old

We started doing our first glucose curve today.
7:00 am: couldn't get a big enough sample, fed him and let him snooze.
8:30 am: BG = 333, followed by a few bites of food.
11:30 am: BG = 377, not interested in food after, not even freeze dried salmon treats (which I had read were a big hit with most cats.)
He hid under the bed for almost 1/2 hour before coming out to solicit tummy rubs from my husband.
My husband is doing the ear-sticking, and getting better at it. We are determined to keep up the testing until bedtime, hoping that will be enough for the vet to plan a course of treatment. I'm leaning strongly toward giving him 1 unit of PZI after the last test, even though I know the vet will not be happy with me tomorrow when I call with the results. I would rather give him some relief than let his BG go even higher. I'm so afraid of another episode of ketoacidosis.
I would apreciate any comments or advice from all of you who have more experience that we do.
 
Re: New Here - So much to learn - 13 yr-old

JennieB said:
... not even freeze dried salmon treats (which I had read were a big hit with most cats.) ...
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KT says those are only good for knocking down the hallway - now CHICKEN! That's a different story..
 
:lol: Thanks, KT for the laugh. I needed that. We also bought freeze-dried chicken this morning, so we'll give it a try at the next sampling.
 
Jennie,Just so we're all on the same page..... this curve and these numbers are all with no insulin so far, right?

Carl
 
Hi, Carl. Sorry - no insulin since Thursday at about noon. Vet wants the curve without insulin before starting up. Thanks.
 
Good. I just didn't want someone (me ;-) ) to hop in later and say "wow, it sure doesn't look like his insulin is working....

I'm leaning strongly toward giving him 1 unit of PZI after the last test, even though I know the vet will not be happy with me tomorrow when I call with the results. I would rather give him some relief than let his BG go even higher. I'm so afraid of another episode of ketoacidosis.
Click to expand...

That is completely your call. Another episode of DKA is definitely not someplace you want to go. The vet can be happy or not, but one dose isn't going to mess the vet up. He'll be using the "pre-insulin" numbers to make his evaluation. The other benefit to a dose tonight would be that you'd have data to show the vet as to what that dose did for Smudge and his numbers. It might actually help the vet to determine a proper dose.

When you get to that point, if you aren't sure about how much insulin, post any questions here and somebody can help you work it out.
Carl
 
Thank you so much, Carl. I've decided to give him 1 unit after we're done testing, then take him in tomorrow to see the vet and get him checked for ketones. When he was first diagnosed in Feb., we asked about at-home monitoring, but that vet (not the one we use now) said not to bother. When we start the insulin again, we intend to monitor him to avoid any more disasters.
 
We now have four at-home glucose curve test results, at 3-hour intervals. He is not on insulin, had previously been on PZI, max dose 2 units twice a day, min dose 1 unit once a day, in remission 5 months, now coming out of remission.
Our first attempt, at 6:45 am, did not produce enough blood for a sample, so we fed him and tried again later. Numbers after that:
8:15 am: 333 - about 90 minutes after eating Fancy Feast and morning heart meds in 1/2 pill pocket
11:15 am: 377 - after eating normally, along with 1 GNC Senior Cat Multivitamin
2:15 pm: 222 - had not eaten since the 11:15 am test
5:15 pm: 336 - 45 minutes after evening heart meds in 1/2 pill pocket and 1/4 cup boiled chicken

I want to give him 1 unit of PZI insulin, but not sure if I should do it now, then retest at 8:15 and be done with it? Or after the 8:15 and test again at 11:15? He's a white Angora, and his ears look so sore and red.

Thanks for any advice or opinions you might have.
 
Jennie,
I might think about skipping, or maybe .5 units. See how his number dropped after noon? That looks like he's producing some insulin of his own. The 8:15 and 11:15 tests were both after eating, so some of that number is "food boosted". The 2:15 reading would be about the time the food had been digested and the number is lower. His own insulin would do that.

The 5:15 number is also "food boosted".
I would check him at 8:15 and see if that number came down on its own. If so, you might skip the shot, or like I said, a smaller token dose like .5 or less.

Carl
 
Hi, Carl. I do recall reading about BG levels being boosted by food, and appreciate your take on what Smudge's numbers mean. "So much to learn" really does say it all. You're right - if needed, the dose should be absolutely as small as possible. Thanks again. Jennie
 
carlinsc said:
Jennie,
I might think about skipping, or maybe .5 units. See how his number dropped after noon? That looks like he's producing some insulin of his own.
Click to expand...

Or his kidneys are working overtime to filter out the extra glucose because his numbers are over the renal threshold.
 
Jennie,
Have you been checking all along for ketones?

Carl
 
Carl,
No we haven't. That's something we'll need to discuss with our vet tomorrow. It's the ketones that scare me.
 
What Deanie said makes me think that the .5 dose might be a better idea.... If he's in the 300's most of the time, then he's above the "renal threshold", and might be more at risk of ketones (especially given that he's had them in the past).

Carl
 
Carl,
This all makes sense. Our plan is to check him at 8:15, then give him 0.5 unit if he's still in the 300s, then test one last time at 11:15. I'll follow up with the vet re presence of ketones. Thanks!
Jennie
 
8:15 PM - BG = 298. Since the 5:15 PM test, he had eaten a few bites here and there, but only about a teaspoon at a time. 10:30 PM he finally ate about 1/4 can of Fancy Feast Classic, so we gave him 1/2 unit of PZI insulin. Not sure we're up to drawing blood again tonight, as we're exhausted. Thanks for getting us through this. Jennie
 
Jennie,
So all in all, a good day. And you all made it through it! I promise, it does get easier. You've had quite a learning curve so far. Most days won't be anywhere near this chaotic/hectic.
And....you now have plenty of information to share with the vet tomorrow, along with everything you've learned here.

Let us know how that conversation goes!

Carl
 
Called the vet's office 8:00 AM, gave the glucose curve results. I believe the woman who took the call was a vet tech. She said that his numbers were fairly consistent through the day, with no huge jumps. She said I would hear from the vet later today. Called back 4:30 PM, found out that his test results had not been looked at. I was told to do nothing until I hear from the vet, who has surgery tomorrow morning, so won't get to me until tomorrow afternoon. I believe the 1/2 unit of PZI we gave Smudge last night helped, as he's perkier today. We do not want to wait until tomorrow afternoon. We plan to give him another 1/2 unit after he eats this evening. So frustrating. :YMSIGH:
 
Hi, Sue. Wow, I had no idea such a thing existed. I was able to pull it up and load in Smudge's information, although I didn't use the dosage columns, since we didn't give him any insulin until just before bedtime. We also didn't have a pre-shot number for the morning, as our first attempts at drawing blood were unsuccessful. It will prove useful once we start Smudge on his new insulin protocol, which I'm hoping could be as early as tomorrow.
Jennie
 
It is a great tool for you and for us, to help when you need dose advice. If you got it to come up, now you can add it to your signature so we can see it.

First, save your copy to your favorites. Then go to the share button and choose " share to anyone with the link." Then go over under the title to File. Choose Publish to the web. A new URL will come up. Highlight and copy it. Then come back to FDMb.

Choose User Control Panel, the Profile, then Edit signature. Paste the URL you copied in the box. You might also add your insulin and what you are feeding. Then choose Submit.

Every time you post, your info and updated spreadsheet will come up.
 
I want to see if the numbers from the spreadsheet show up now that I added them to my profile.
Today we had to take in our other 13-year-old cat, who has been throwing up for three days (ever since we started locking up the dry food unless she's eating it under supervision. We begged the vet clinic staff to have someone give us some guidance on Smudge's insulin needs. We were told to get a BG reading at home, which we did: BG=304 at noon. We were then advised to start Smudge on 1/2 unit of PZI insulin twice a day. Nothing about home monitoring, just come back in a month or so. The vet we spoke to said that his numbers don't look too bad. We don't want to poke him twice a day, and are considering doing it once a week. Again, I welcome comments, suggestions, etc.
Jennie
 
Well, you probably know we will discourage testing less than twice a day. Shooting blind is, frankly, dangerous. It is too easy for the levels to change - particularly for a beginning diabetic. And you really have no way to get your cat into regulation or remission just guessing about bg levels and doses.
 
Hi, Sue. Understood. We're struggling with this, trying to find a midpoint between checking before every dose, and following the vet's advice, which is the same dosage every time and only checking infrequently. The amazing thing is that, after only a couple of shots, he's showing marked improvement in his appetite and general demeanor.
Jennie
 
It might help if you go over to the PZI forum and check out people's spreadsheets. It will amaze you how often a kitty suddenly throws a low number. If you aren't testing, you can overdose your cat. And to be blunt, hypos can kill.

Testing can be stressful, particularly at first. But not knowing what is going on and possibly dealing with a hypo is much more stressful.
 
We were told to get a BG reading at home, which we did: BG=304 at noon. We were then advised to start Smudge on 1/2 unit of PZI insulin twice a day. Nothing about home monitoring, just come back in a month or so. The vet we spoke to said that his numbers don't look too bad.
Click to expand...

Hi Jennie,
"too bad" is a relative term. No, numbers in the 300ish range are not extreme. There are kitties here right now who are up in the 400-500's at times. But numbers as "low" as 300 can still present big problems. That number is over the "renal threshold", the point at which the kidneys have to work harder, and the glucose is spilled into the urine because there is too much glucose in the body. Below even 300, high glucose can damage to the cells in the pancreas that produce insulin, making it that much harder for the pancreas to heal and manufacture insulin, without which, you have to remain the source of supplying insulin.
Here's a couple articles you can read to see how all of it ties together:
http://petdiabetes.wikia.com/wiki/Renal_threshold
http://petdiabetes.wikia.com/wiki/Glycosuria
*note, interesting that towards the bottom of that page, there's a link to an FDMB thread! That's on the "old board", but many people who took part in that thread are still posting regularly here. I found it very "small world"ish that one of the participants is "kelly and loki", who posted on FDMB yesterday after a long absence!

How does this tie in to home-testing? If you aren't aware of where Smudge is on a daily basis, it is very unlikely that you will be able to control his numbers. Maybe not "OTJ" numbers, but numbers that will keep him below the point where other organs are at risk of short or long-term damage. It is extremely important, as Sue said, to make sure that you aren't shooting blind into a number that may cause a hypo incident. Those can kill quickly. But it's also important if it is within your control to keep the numbers in a range that won't kill him slowly by making his pancreas, liver or kidneys suffer damage over a long period of time.

It is wonderful that after only a couple of shots, you can actually "see" an improvement. The picture of the "whole cat" is very important. But it's what you can't see that may be causing problems that won't be visibly evident until long after you could done something about them.

Carl
 
Thank you, Carl, for explaining it so well. You're right, of course. I need all the information I can get to provide the proper care for Smudge.
Jennie
 
My vet also told me that I only needed to test every now and then, and do a curve once a week. The problem is that it's 1. Very hard to adjust insulin doses when you have no idea how your cat is reacting to the insulin from day to day and 2. It's dangerous to shoot insulin if you don't know what your cat's blood glucose is. There was one day when Bandit, who had been getting mostly high numbers on 1u of insulin since he had been diagnosed, all of a sudden dropped to 46 right before his pm shot. If I hadn't tested and given him his regular dose on insulin, I could have killed him.

Carl gave you a lot of great information, but I also wanted to mention rebound, which is another reason why daily testing is necessary. When cats have been in high numbers for a period of time, their bodies become used to those high numbers as "normal". So when the insulin lowers their blood sugar to a normal number, glucose is released into their bloodstreams to counteract the "low" number. This can lead to very high numbers one cycle, and very low numbers the next cycle on the exact same dose. Without daily testing, you could could determine that the dose needs to be increased when in reality the dose is already too high, leading to a chronic hypoglycemic situation. Too high a dose will keep a cat's blood glucose just as high overall as too low a dose because of this effect. Daily testing allows for greater control over blood glucose numbers because it allows you to see the whole picture with how the insulin is affecting your cat's blood sugar.

I kind of see it this way--dosing insulin is like aiming for the bullseye on a dart board. It's hard enough as it is--do you also want to try and do it blindfolded? Diabetic people on insulin test themselves several times a day for the exact same reason. Can you imagine if a doctor told a person they were testing too much and to shoot their insulin blind?

It's hard to contradict your vet, but if you have a good vet, they will be happy that you're being proactive about treatment. When I told my vet I was no longer taking dosing advice from her, and showed her the research I had done that recommended a different dosing protocol, she told me that she was very happy I was researching the subject myself and that she was confident that I would be able to handle it on my own. Good vets understand that there may be gaps in their knowledge, especially since there's a lot of research (like the studies that support regulation via frequent home testing) that's been published just in the past few years.
 
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