New Member Cody: This is hard.

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CandB

CandB

Member Since 2020
Hello everybody,

My name is Cody I have a 13 year old Female Domestic Medium Hair cat: Boots! She is a tuxedo cat and the coloring is white chin, belly, white paws and white legs as if she was wearing socks and everywhere else.

She was diagnosed in May with Diabetic Keto Acidosis she was hospitalized for a few days then went home with me and we've been doing the treatment. Starting with 1 Unit of Lantus Glargine every 12 hours (6 am and 6pm) and a prescription diet, I give her a mix of the Wet Food Purina Pro Plan DM and Science Diet DM. I hadn't been doing home testing just spot checks at the vet every 7 to 10 days after a dose adjustment about 6 hours from her first dose. She'd been high each time starting at 309, then 556, 526, 317, increasing the dose each round where at the 317 reading on 6/13 we increased the dose up to 3.5 (was 1, then 1.5, then 2, 3, 3.5).

We haven't done any glucose curves... Boots is very picky she doesn't like to eat at the vet and the vet hadn't pushed home testing on me, I know about it but was a mix being afraid and of thinking my picky cat would hate it and be very difficult and that the Vet knows whats best.

Well on 6/15 that night I noticed she wasn't super eager for the nightly food time, usually she is by my side an hour or two sometimes more ready for food poking at me. That day she wasn't so I thought it was odd but didnt think to much of it as when the alarm went off, she knows the song means food time and came running. She ate the meal and I gave the full dose. An hour or so later I noticed she was walking around sniffing EVERYTHING and wasn't responsive, like she didn't know I was there, or where she was. I brought her in to the emergency Vet, didn't think sugar was needed as she was otherwise alert, but in the car she became more and more unresponsive, I cut my finger up as I drove in the car down the highway trying to give her gravy from a can of food (didnt have syrup with me) when I got her to the hospital she was in the 50's so they kept her over night to bring her up.

We lowered the dose down to 3 units and the ER vet recommended a glucose curve.

Brought her in to my normal vet on 6/19 for a curve but that morning before food and insulin her first reading was in the 50's so insulin was out of the question and they kept her there, syringe fed her and made sure her sugar came up. The night before she had some diarrhea so when I picked her up that afternoon they gave me 7 packets of fortiflora to give her 1 with food each night and we dropped the dose down to 2 units, and they ordered a glucometer for me which would take some time to come in.

Things seemed to go fine until on 6/25 last Thursday, that evening before food she showed the same signs, not at all interested until right when the alarm went off, she ate well, her full meal but I was worried, didnt give insulin and called the ER Vet brought her in and yup she was in the 50's. So they kept her for a few hours to make sure she would come back up, I picked her up after like 3 hours and took her home. Her new dose now lowered to 1 unit. Recommended a glucose curve.

Her diarhea or loose/runny stool has continued sometimes its much more solid, like soft serve sometimes that and a bit watery, the ER vet didn't seem to think it was a huge problem but keep an eye out for it and let them know. I called my normal VET on friday morning and spoke to them, the vet tech didn't seem too concerned and said the glucometer was still shipping, shipping has been slow so they don't know when it will come in but let me know. They are closed for the weekend.

Friday I called the ER Vet and they said they had a glucometer they could sell me so I picked it up on saturday (wanting to give her a little break from so much Vet) and at 12:57PM when they showed me how to use it she was at 130 MG. I tested again at 4:45PM and she was at 110

6/28 12:39 AM 246 MG
6/28 5:22 AM 337 MG
6/28 12:24 PM 148 MG

Her behavior had been normal aside from the soft serve runny poops, her appetite has dropped a lot she doesn't eat nearly as fast as she did before. Usually she'd have scarfed up everything in 10 minutes now she takes 30 or more of me reminding her to keep eating, but super eager for meal times. Clearly I have been clueless and not asking or demanding the right things...

But today even though she seemed good and no problems super ready for food, I thought I better test her:

6/28 5:26PM 59 MG

So I call the ER Vet and they say yeah thats a problem, give her food, wait 30 minutes after she has finished and call us back with the results. So she ate pretty well tonight, not as fast as what her normal had been but better, 30 minutes after finishing food tested her and she was only at

7:00 PM 169 MG

Which they said was still to low so don't give any insulin. They said the safe range is 200 - 300 where she should be at before food. Tomorrow morning if she is at that range before feeding time, its safe to give her the food, wait 30 minutes and do the insulin.


So yeah I am insanely stressed, I feel even more so like I am failing her and have messed this all up and my normal Vet has just let it all happen.

So I have a lot of questions and fears as I prepare to talk to my vet tomorrow or think of just switching to the ER Vet permanently (they are a 24 hour animal hospital and Vet)


First I'm not sure if this is the right place for all this so I'm sorry and will happy let it be moved or can repost it. But...

Have I been doing it all wrong?
Is this normally this hard?
Is my vet awful?

Tomorrow morning the plan is test her before food time, if she is in the 200-300 range, feed her (which I will anyways of course) but if she is in that range its safe to give the insulin after 30 minutes) previously I was told by my normal vet that can give insulin as she eats as long as she has ate half. The ER Vet says you gotta give food and then wait 30 minutes. The normal vet just said if she doesn't eat at all you give a half dose and then if next meal still doesnt eat, no insulin an call them. But if she eats at lest half can give the full meal.

Is that all correct? Did I get it wrong from the ER vet do I need to test before food, test after food and then Insulin?

What should be my plan going forward? I'm just super stressed with all this. And I'm sure this is all a mess. But thank you.
 
The most important thing first:
I once went screaming across town to the emergency vet with Rover who had been showing signs of blindness. Before we left, I loaded him up with corn syrup. He was recovering by the time we got to the vet but they don't always. The forum has seen a few cats that took a long time to recover.

I'm just finishing off my grocery order (it has to be in by midnight). When I'm done, I'll come back and try to answer some of your questions.
It is not normally this hard but it's not your fault.
There is a wealth of experience and knowledge on this forum. Vets get few hours training in diabetes. The people here have lived it 24/7 and have done their research.
Back as quickly as I can.
Breathe – you've come to the right place.
 
Good for you for taking the initiative and getting your cat to the ER vet.

Before I overload you with information and a few questions, I want to stress two things.
1. Some cats that have had hypos become insulin sensitive and require a lower dose. It is good that the ER vet kept dropping the dose.
The dosing increases were much bigger and only based on spot tests at the vet (cat was most likely stressed) and the occasional curve at the vet (the cat would not eat and was most likely stressed).
Not all cats have their lowest number during a cycle at 6 hours. That is what home testing is for – to gather the information you need to keep your little one safe. A spot test or curve at the vet where the cat will not eat will not give the information needed.

The meter from your vet is likely an AlphaTrak. The take action number on an AlphaTrak is 68. Be warned, the strips are expensive and you will go through more than you think.

2. With DKA in the recent past, you have to be watchful of the numbers and the appetite to make sure the cat does not fall into DKA again.
The recipe for DKA = not enough insulin + not enough food + an infection or inflammation or something else going on.
Here is some information on DKA:
You can get ketostix at a local pharmacy and test your cat's urine daily. Otherwise, you may want to look at Blood Ketone meters.

You may need to feed a slighter higher carb food to ensure that the cat will eat.
What were you feeding before the diagnosis? And did your cat have diarrhea before the food switch (the new food may have triggered it)?
There's nothing special about diabetic cat food except the price. A lot of people here feed Fancy Feast pates and Friskies pates – they are lower in carbs than the vet food. Take a look at this food chart. Theoretically, you are looking for foods under 10% carbs but if your cat will only eat slightly higher in carb foods at the moment, the insulin dosage can be worked around that.


CandB said:
Did I get it wrong from the ER vet do I need to test before food, test after food and then Insulin?
Click to expand...
The protocol with Lantus is:
1. Test – to see if the numbers are high enough to give insulin
2. Feed – to make sure your cat will eat enough.
3. Shoot – some people shoot while their cat's head is in the bowl. You don't have to wait unless very little has been eaten. Lantus is more forgiving than some insulins which do require waiting 30 minutes. As long as the cat eats a fair majority of the meal you should be fine.

Insulins work best if cats are given small snacks throughout the cycle. Just pick up food two hours before shot time to make sure the test at shot time is not food influenced.

Lantus: read the Stickies on the Lantus forum, especially this one. It's a lot of information and just take in what you can before you see your vet. From your post, it looks like you've done some of the reading already. It will all become second nature in no time at all.

Lantus is NOT dosed going by the preshot number. It is dosed based on how low a cat goes during the cycle (the nadir). Lantus craves and works best with consistency in dosing. Home testing will give you (and us) a good idea of what a good dose is for the cat. We can help you with that, help you keep your little one safe, and help you to breathe.
 
WELCOME TO FDMB! Youve already received excellent advice not much I can add except to say NO you ARENT failing Boots (who is ADORABLE BTW) Your vets are failing her. We get so many of the same stories. Sigh...I shouldnt exactly say they are failing her in that its more like the system is.
The good news is you've found us! Theres so many people here that live eat breathe diabetes, they dont have university letters after their names but help so many people through this difficult learning curve that is diabetes. You are family now and will be treated as such. WE CARE. Hold on for more welcomes and advice.

One of the things that will be asked of you is to set up your signature and spreadsheet. The signature is important because it gives helpers at a glance first hand info like type of insulin , your name and food you feed etc.
The spread sheet is VERY important for helpers to track trends and where the insulin takes Boots. You can for that info here:
Suggestions, Tech Support & Testing Area

Again BREATHE youve landed in a safe place!

jeanne
 
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Make sure your signature is up-to-date.
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
 
Red & Rover (GA) said:
What were you feeding before the diagnosis? And did your cat have diarrhea before the food switch (the new food may have triggered it)?
Click to expand...

I do have the Alpha Trak meter. The kit came with like 25 but I've just gotten 50 more and 100 more of the lancet things. I've been using the spring pen to do it. I do have a question sometimes it doesnt read right away and I have to get a bigger drop and touch it, if I touch it to a drop and its not reading yet, do I need a new strip? Or is there a window where its okay or will it error out if there was a problem?

Before the diagnosis in May I had been giving her various types of the Fancy Feast, she'd become more picky with food (which I'm sure was the beginning of the DKA and such and me not realizing it) so I tested out a bunch she seemed to settle on Pate, so the Fancy Feast Chunky Chicken and Fancy Feast Pate Beef and Chicken.

When she was diagnosed in may I started on the prescription diet of Purina Pro Plan DM and Hills W/D which she actually really likes and has been eating great, the appetite drop has only been the past few days. The diarrhea/loose stool was pretty occasional and normal just like it can be with us humans but one night it happened multiple times so I started mixing in Fortifloria that the vet gave me, one packet a day for 7 days starting on the 19th. Which went well but on the 25th I started happening every poop so instead of one poop is was like split into 3 of varying consistency though most leaning to war soft but not runny. This morning she had a solid normal pop.

Since I got the meter on saturday I've been doing testing see where she is at and it seems with a dose every 12 hours, that 12 twelves hours shes been super low and before all this was just dosing blindly and causing problems.

I feed her at 6, so insulin depending how she eats between like 6:10 or 6:30 or so.

Her readings last night

5:20 PM 59 MG (so skipped insulin and gave meal at 6 and tested at 7)
7:00 PM 169 MG
9:24 PM 97 MG (was about to go to sleep but felt worried so I tested and was alarmed that it dropped)

So I took her in and when they tested her

10:21 PM 149 MG
and then they did again a bit later and she was up in the 250's (was on the phone and didnt get that one exactly)

This morning

6/29 5:43 AM 295 MG (gave 1 unit of lantus at 6:19 PM after meal)
6/29 10:30 AM 193 MG

I had some ideas of keeping going with the testing every two hours but I realized she was just done between the vet trip and my testing so far, so thought it best to back off and trust pre-shot test and inbetween perhaps then the curve.

Of course I was really worried about the appetite and the poop problems and just the numbers so I had them run tests and examine her, they sad liver and kidney numbers are good and nothing they can see wrong to be causing anything. They are thinking she may just need one Insulin dose a day and its lasting longer on her so I have a plan now where I test before meal/shot time and if she is in the right range I will give insulin and it not skip it.

250 MG and above give insulin
Below, that at about 200 or lower no insulin

Then if she is low around the 60's make sure to monitor her for any bad signs, give food make sure she comes up.


How close to my 6AM and 6PM meal times/insulin times should I be testing?

The other plan is for a glucose curve, I could do it at home, she is tolerant to testing but the more I do it the more testy she gets so I fear while I'd get some tests she might get too mad for me to get the critical pre shot tests. So I'm hoping to do the first test in the morning and bring her to the vet for the curve and hopefully the stress doesnt effect it too much, but if it does I'll buckle down and get the curve.

But otherwise test before shots and then maybe a 6 hours or as needed but not more, so I can slowly keep training and acclimating her to the shots and not break the good mojo we have going. I also just emailed my vet a break down of my notes with her (I keep detailed feeding notes, how she is eating and how much and when, when give the shot) I will work on getting that on a spreadsheet.

Thank you for the warm welcome and help, really everyone. This has been so stressful especially the last few weeks. I dunno how any vet lets you go home with a diabetic cat and not a glucose meter and at the VERY least testing before shots, seems crazy. Clearly though I should have been more demanding and upfront about my concerns and less fearful.
 
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If you can transfer the info above to the spreadsheet template, it will make much easier for members here to guide you so they can see those numbers in reference to shot times. I’m a bit confused by the numbers you posted above for 6/29. And the signature too so we don’t have to scroll up looking for the info in your thread :cat:

The protocol is test, feed, shoot. So if you’re giving insulin at 6am you want to test right before that. Then feed and then give the shot. The other important thing is to make sure your cat doesn’t have any food for 2 hours prior to the pre shot tests so the food doesn’t influence the test result and you don’t give more insulin than you should. For the rest of the day it’s fine to free feed

here’s the thing about Lantus, it needs consistency and it only lasts for 12 hours so you should NOT be only giving Lantus once a day. Please go back to twice a day morning and evening. I’m sure others will jump in as well but if 1 unit is too much then decreasing to .75 or .5 twice a day is much better than 1 once a day. Your cat will not be able to get regulate that way. Do you have 1/2 unit marked syringes btw?
 
CandB said:
I do have the Alpha Trak meter. The kit came with like 25 but I've just gotten 50 more and 100 more of the lancet things. I've been using the spring pen to do it. I do have a question sometimes it doesnt read right away and I have to get a bigger drop and touch it, if I touch it to a drop and its not reading yet, do I need a new strip? Or is there a window where its okay or will it error out if there was a problem?

.
Click to expand...

this sometimes would happen to me with the alphatrak2. i found that if i were quick enough to wick up a little more blood, then the reading would be good and i didn’t need a new strip. if you don’t get enough blood wicked in the time window, then yes, you’ll get an error and need a different strip. don’t get too frustrated if this happens to you a bunch in the beginning. after a few days of testing, you’ll get really good at judging how much blood will be enough.

and, welcome to fdmb
^jw
 
Hi and welcome to the best place you never wanted to be:smuggrin:

I know this seems so scary and overwhelming but it will get much easier as time goes by, just remember it is new for you and your cutie pie:cat:

I also use alpha track and like many others we use the free style lite strips as they are both made by abbot and side by side comparisons are very close if not spot on. You can usually find them on eBay for much less than AT strips.

I do always keep a full vial of AT strips in case Dre is going low and I want to be sure he is safe but otherwise we use the freestyle lite.

You have tons of great info -- take your time and remember to breathe:bighug:
 
Hey everyone,

Been a bit I know got a new vet, been doing lots more testing so I have more data (and concerns lol) I'm trying to fill out this data spreadsheet but I don't get it much and cant find instructions beyond getting the file. Not sure what all the fields mean and where to put what

For example if I did a test at midnight where does that go?

I have data like this since I started testing and not sure what goes where cause of the times and such.

6/27/2020
12:57 PM 130 MG

6/27/2020
4:35 PM 110 MG

6/28/2020
12:39 AM 246 MG
5:22 AM 373 MG
2:24 PM 148 MG
5:20 PM 59 MG
7:00 PM 169 MG
9:24 PM 97 MG
10:21 PM 149 MG

6/29/2020
5:43 AM 295 MG
5:43 PM 183 MG
 
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CandB said:
For example if I did a test at midnight where does that go?
Click to expand...

hi,
it's a grid system that is time of day agnostic.
and based on the time relative to the shot, am and pm.
so AMPS means morning (am) pre-shot. PMPS means evening (pm) pre-shot
if, as an example, your evening shot is at 6pm, then +6 would be your midnight.
but, if your evening shot is at 5pm, then +7 would be your midnight

with everybody using the same system of number of hours from shot time, it's easier to be helpful.
for example, it's hard to know what midnight means because everybody is in different time zones.

there's a sticky that explains it here
https://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

it sounds like you've started a spreadsheet. just a reminder you should pick the one that has a template for the meter you've chosen (human vs pet).
explainer is here
https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

and then it would be good to add the spreadsheet link and other info in your signature
this link explains signatures
https://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/
 
JOJI and Kit said:
hi,
it's a grid system that is time of day agnostic.
and based on the time relative to the shot, am and pm.
so AMPS means morning (am) pre-shot. PMPS means evening (pm) pre-shot
if, as an example, your evening shot is at 6pm, then +6 would be your midnight.
but, if your evening shot is at 5pm, then +7 would be your midnight

with everybody using the same system of number of hours from shot time, it's easier to be helpful.
for example, it's hard to know what midnight means because everybody is in different time zones.

there's a sticky that explains it here
https://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

it sounds like you've started a spreadsheet. just a reminder you should pick the one that has a template for the meter you've chosen (human vs pet).
explainer is here
https://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

and then it would be good to add the spreadsheet link and other info in your signature
this link explains signatures
https://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/
Click to expand...
@JOJI and Kit Thank you for giving Cody the links
I was about to do it but have been helping someone else
I can also tag @Chris & China (GA) to set up his SS if she is having trouble doing it
Thanks again :bighug::cat:
 
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Cody please set up your signature. JOJl and Kit just gave you a few links to read. If you have trouble setting up the spreadsheet we have a member that will set it up for you, Let us kniw ok. Make sure your signature is up-to-date.
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.
 
I want to correct the information that @jayla-n-Drevon posted:
I also use alpha track and like many others we use the free style lite strips as they are both made by abbot and side by side comparisons are very close if not spot on.
Click to expand...
The use of Freestyle strips in an AlphaTrack meter is NOT recommended. There is a discussion on this topic in the Think Tank forum.

A significant number of people here use a human meter rather than a pet specific meter for several reasons. First, the cost of strips for a pet meter is high -- usually around $1.00 per strip. If you have to monitor closely due to low numbers, this can get prohibitively expensive. Strips are not readily available at pharmacies -- you must mail order for pet meter strips. If you are using a human meter, you can usually find strips at any drug store. (And we all seem to run low on strips at the most inopportune times.) Finally, all of the dosing methods we use are based on human meters. Pet meters are calibrated a bit differently and it can make your brain hurt trying to figure out what the equivalent numbers are between a human meter and a pet meter.

I know we're slamming you with a great deal of information. It would truly be helpful if you could get your spreadsheet and signature set up. We are very numbers driven and I suspect your experience with Boots dropping into lower than expected numbers makes you appreciate why we want to see how your cat is doing. In addition, as other have noted, with a cat that is post-DKA diagnosis, we are especially careful. DKA is a serious complication that can be life threatening. Either testing Boots' urine for ketones or getting a ketone meter will allow you to keep track of ketone levels and keep your kitty safe.
 
As I said I do keep a vial of alpha track strips but as you can read in the think tank others use freestyle regularly. It is a personal decision and for us I have never had a number more than 10 different than alpha track, in fact I have had more difference between alpha track vs alpha track. I am not telling anyone it is what THEY should do and I understand you are new and it is scary. I used strictly AT for a few years and thats ok too but whatever makes your kitty safe and your comfortable with....do your own comparisons.
In the think tank a good question was also brought up about using human meters on a animal? I get the protocol was designed for that but not everyone is using the TR or the slow.
I respect Sienne and her wisdom but I think we all want what is best for our kittys and Dre was dx at 16 and he is now 21 which I thank God for and the help I have received on the forum. Sometimes we can disagree.
 
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