New member in Sydney - my Burmese just diagnosed

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Danny&Nelson

Danny&Nelson

Member Since 2012
Hi, as above, Nelson my 16 y.o. Burmese male who's been as healthy as a horse all along (!) started seeming a bit unhappy and listless this week. He'd had a tendency towards constipation lately and hadn't gone properly for a few days so i thought it was just that. Then on Wednesday when i woke up he was making unhappy noises in the bathrm near the litter and i thought it was more of the same and he spent the day going back and forth every hour or two trying to go (and drinking more than usual ... which i stupidly thought was a great thing since i want him well hydrated), then in the last 12 hrs before i took him to the vet things really fell apart. I noticed his back legs were a bit wobbly (but there again, he'd had a small operation 3 wks before to remove a small cyst from his hind leg and i thought maybe it was more of the after effects of the operation since he'd barely gotten back to normal after that), and he was becoming more unresponsive and exhausted. I woke up on Thursday to the sound of him whimpering in the bathroom and as i opened my eyes and turned to the bathroom doorway he staggered out and vomited a big watery pool even though he hadn't eaten anything since the night before and then only a small amount of mince. Even as i rushed him to the vet i thought it was bad constipation, maybe he had a blockage somewhere causing him to not eat and vomit. Diabetes never entered my mind! Anyway, he's now being 'stabilised' at the vet till at least early next week .. his initial blood sugars were 28 (should be below 12 ... this is the Australian scale as far as i know), after initial treatment they were down to 9, then when i rang today they were back up to 19 this morning but apparently it can take a few days of insulin to get it down and keep it down.

God what a shock its all been! A 48 yr old man who's been blubbering over his sick cat, but why not, he's been my constant companion for 16 yrs since he was 6 wks old! Of course i'm reading every feline diab website on earth and preparing. No idea of what the cost of the insulin and other accoutrements might be here in Australia, i will do some searching here. They have him on glargine right now, and fluids. I can imagine i'll be hanging around here a lot. Danny in Sydney. nailbite_smile
 
Danny,
Welcome to this site. I am sure that you will find all you need here.
So sorry to hear your Nelson is ill, but you have him on a good insulin, Lantus, and glad that he's being seen by the vet.

Many here home test their cats; it's the best way to keep your cat safe by monitoring his BG numbers. You can get a blood glucose meter from the pharmacy, in the US many use the Relion, but elsewhere, the Bayer contour, and OneTouch are often used. No need to get a meter from the vet as they are pricey. By testing Nelson's BG regularly, much like humans do, you will know when it is safe to give him a shot.

In most cases, a cat will not be regulated in a couple days at the vet office, so it's cheaper for you and certainly less stressful for your Nelson to have you testing him at home where his numbers will not be skewed by stress. Quite often, vets have cats at too high of a dose, then sent home where the cat relaxes and needs less insulin. In most cases, a starting dose of Lantus is usually 1unit twice a day, or even less.

Others will be along with more info and answers to any questions you may have.
 
Thanks for the suggestions. I fully intend to do home testing on Nelson, but of course only once they get him out of this acute phase. The vet mentioned the stress response re BG levels so we'll take that into account. Fortunately i'm pretty fastidious about all things medical since i have my own issues there and i'm pretty good at keeping things organised (if i do say so). There's a large discount pharmacy just up the rd where i'm sure i can get a BG meter, the insulin is another matter. I'm reading that quite a few cats recover completely over time, which would be nice :) Danny.
 
Hi Danny & Nelson. Welcome for FDMB! Everything is going to be ok. I know its rough just being DX. We have all been there & expeirenced that drop in the heart. Its a sad time. Look up now...because you are in the right place to help your furry friend.

Good job on wanting to do hometesting!
What was Nelson's BG at DX?
What kind of diet are you going to have Nelson on? Low carb, high protein is best for FD. Many memebrs feed fancy feast. Not sure if you have that Down under....I think that is what they say...right? When you get a chance read this website www.catinfo.org. It has lots of wonderful info on the site about feline diet. It also has lots of other helpful info about feline health.
Do you know what kind of insulin the vet is going subscribe? Some of the popular ones are Lantus, & ProZinc. One of the ones that arent so good is Humulin N. It is not a long lasting insulin. So if you have a say in,picking your insulin stay away from that one. There are insulin support boards here too. You can find them back on the home page. Once you get your insulin those would be really helpful to visit to help with dosing.

Yes, it's possible for remission. Not every cat goes into remission. Diet change is the biggest part of it. Get those carbs low. Then insulin to help the pancreas it might be possible. It won't happen over night. It might take some time if it's possible.

There will be other members who will stop by with advice & information.
Keep us updated!
Jenn & Baxter cat_pet_icon
 
Hi Jenn & Baxter. BTW my sister lives in Spring, TX (The Woodlands) and brother in Killeen. Family originally from the U.S. Re diet, he loves his raw mince, roast chicken, tinned (human variety) tuna etc. so i think those will all be ok with maybe just small amounts of dry every now and then. He's used to eating many small meals a day so that should also work out well.

Re his BG at DX, it was 28. 9 the next day and up a bit this morn to 19 but as above the vet said it can take a few days to keep it down. Re insulin, he's on glargine (which i think is lantus?) now at the vet, so i assume we'll stick with that. And as for remission, of course it's silly to talk about that when he's just been diagnosed!! Just me getting ahead of myself. :) Danny. ps i changed my username to Danny&Nelson which seems to have worked : / I'd like to put a pic (avatar) up but a 9kb size limit?? Hmm. : /
 
Hi Nelson and daddy Danny from Sweden.


I use glargine which you are correct is the same as Lantus (see Simba's signature below)

What dosage of insulin are they giving Nelson each morning and night now while at the vets? Do you know that.

Your blood glucose numbers 29 and 9 are in international mmol/l, and we use that measurement here in Sweden too.

The initial 28 is high, but it was good that he responded to the insulin and was down on 9. But I really wonder what his insulin dosage is at the hospital to get down to 9.
 
Hi Danny,

I'm in Australia too, we don't have Bayer or Relion meters here. I highly recommend the Optium Xceed meter by Abbott which will also test for ketones - whatever you do DO NOT buy the freestyle lite meter (also by abbott) a lot of us have had problems with that one. You need to get on to the home testing as soon as you can, it is vital to keeping Nelson safe.

What has Nelson been eating? If you've been doing your research you've probably already discovered that you want to get him off carbs. The low carb tinned foods we have available are Natures Gift, Whiskas - loaf varieties ONLY, Ziwipeak if you can get it and Ultimates. Don't be fooled by all the talk about feeding Fancy Feast by the Americans - their Fancy Feast is different from what we have available - ours is canned cereal! If Nelson has been eating other foods, especially dry DO NOT change his diet until you are home testing. The blood glucose can drop dramatically from a change in diet alone and you can find yourself overdosing Nelson on insulin if you're not home testing.

Did the vet find any other health issues with Nelson or just diagnose the diabetes? High blood sugar can result from some other illness or infection in which case it is likely to be transitory - you want to be home testing to catch this.

It's not too early to be talking about remission at all, in fact you want to start thinking about it immediately to have your best chance. For your best chance of remission you would want to follow the Tight Regulation protocol if you're able to. This has a remission rate of 84% in newly diagnosed cats but can be a bit labour intensive. Glargine aka Lantus is the insulin you want to be using for this. Whichever protocol you want to follow you will want to set up a spreadsheet for Nelson so that people are able to help you to help him better. I'll be right back with the link.
 
Here is the link to help you set up a spreadsheet http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 you will want to use the world version. You enter your (Australian) numbers in the world page and the clever spreadsheet automatically enters them into the US page translated for you into numbers the rest of the board can understand. The calculation is easy at any rate, you just multiply your Australian number by 18 to get the American version.

Just saw your next post - you will want to get rid of the dry food altogether. The other things you are feeding him are probably ok carb wise but are not nutritionally balanced for a cat. There is a raw diet you could make for Nelson yourself but this would involved buying a grinder so you can crunch up chickens and/or rabbits yourself, bones and all - this is not for me! Many small meals a day or free feeding is excellent - you just don't want to give him food from 2 hours before your shots so you can get a clean blood glucose reading (no food bumping it up) before you shoot.

Here is a link to a site that will shrink your photo to avatar size for you (free) http://www.shrinkpictures.com/create-avatar/

Here is some info about the TR protocol for you http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 If you follow this protocol you will want to post a regular thread (most people post daily) in the insulin support group - lantus - tight regulation forum so that peole can get to know you and Nelson and be able to give you the best help possible, the Lantus experts can help you with dosing etc. You will find that all you need your vet for is the insulin prescription!

Even if you follow another protocol using lantus you're going to want to post there at some stage, people there can help you out with all things lantus even if you're following another protocol

Welcome aboard

Serryn
 
Hi Ann & Scatcats .. I don't know what dose of insulin they're giving Nelson but they are terrific, experienced vets so i'm happy for him to be in their hands till i get him home. All i know atm is 2x/day long acting glargine but not how much.

Hi Vyktors Mum, thanks for the info. I'll call the big pharmacy tomorrow and see what they have. I did call one earlier and they only had a OneTouch version for $49 but actually less than that coz of cash back from the manuf (dunno what thats all about). Anyway if the vet recommends a decent one which is not astronomically exp i'll take his advice (unless its the Freestyle Lite!) Do you know the situation on buying the insulin? Do i just get it from the vet or are there less exp outlets (online or elsewhere here in Aust)? I wouldn't want to buy from just any old place whose credentials i can't verify though of course.

Re eating, as above, he grazes throughout the day on his favourites, raw mince, roast chicken, tuna, and i give him some of the tinned ones with whole fish pieces which he loves as well. Since all of that is mostly protein it should be ok i think.

On other health issues, he *has* been heading towards having to be on a kidney insufficiency medication, his creatinine and urea have been somewhat elevated, but as a result of this week's disaster that's put off now till he's stabilised. No problems up until this 16th year.

Would love to know more about this TR protocol! (just saw that you posted it, thanks.) Danny.
 
You are better off getting a prescription from your vet and buying the lantus from the chemist, much cheaper that way. One Aussie lady paid $250 to get it from the vet, it should cost you about $90 from the chemist for 5 cartridges, these will last you for months unopened and refrigerated (not in the door of the fridge, right against the wall or where it will get bumped around). Ring around to price it because it will vary from chemist to chemist but most will match if you say you found it cheaper.

For meters the One Touch or Accucheck might be okay too, but I think they both require more blood than the Xceed and neither will test for ketones. You will also need syringes, we can't get syringes with the half units marked here. What you want are the BD ultra fine 3/10cc 0.3ml insulin syringes, 31 gauge. The shorter needle (8mm) are more popular than the longer needles. It would be a good idea for you to ask the vet to shave a patch on Nelson's scruff to begin with, it makes it a lot easier to see what you're doing.

Nothing against your vet and obviously I know nothing about them but you are pretty much guaranteed to find that the people on the lantus board have more experience with diabetes than your vet. We often find that vets that might be great for everything else are just not up to date about diabetes and are really off on their dosing - often starting the cat too high and increasing in increments that are too large. Around here adjustments are usually made by 0.25 at a time. It is encouraging that your vet is using lantus instead of canninsulin or some other insulin that is really not suitable for cats though.
 
One touch is a very good meter, but it does require a larger blood sample. However, if that is all you can get, you won't go wrong using it. It's the one I used for Maui. Also, the manufacturer is very good, that if you have a problem of any kind with the meter, just call them and they will address it, even if it means sending you a new meter. The only caveat, don't tell them you are using it on a cat, tell them it's for your child.

And welcome to the group.
 
Welcome Danny & Nelson -

As everyone has stated, you've found the right place to learn and get help for Nelson's condition. I'm awed that Glargines remission rate is so high. I had read that overall, that about 35% of cats may go "off the juice" or OTJ. We've got one, Cathy and her cat Kitten on Prozinc that will officially celebrate her OTJ party around 6:30 this evening (Eastern Time - US)! It never hurts to be hopeful!

I test frequently, so economics was important to me. When you decide on a meter, look at the cost of the testing strips. This is why some meters give you a rebate, or you might even get it for free. Here many strips cost about $1 each. I use a ReliOn meter from WalMart, which I understand is not available there - unless maybe through Walmart.com - and the test strips in the store come out to about $.36 each. Half that on line. With the global economy, you should be able to find something that will work for you. It's nice, and especially convenient, to be able to purchase the strips 24-7 just down the street.

Someone mentioned a meter that tests for ketones too. I've actually just ordered one on line, as my boy Grayson has had MODERATE ketones, which can be VERY dangerous and result in DKA if not caught early, treated and kept in check. The meters take strips, which I would assume are going to be somewhat pricey. You can also get a little bottle at the pharmacy. Here they cost about $6 for 50 strips. You hold it (or dip it) in the stream of urine (or collected urine), and the litmus-type paper changes color to a code on the bottle. Anything more than a trace requires attention. I understand the meter actually catches them earlier than when urine is expelled from the body. I don't want to take any chances, as treatment for DKA can be several thousand dollars. I refer to the test strips as a $6 bottle of insurance!

Serryn will be able to give you some good advice, as it helps to have someone closeby when you're starting out... or even later in "dance." Another member here lives in my town, so she was able to help when I was learning to get blood for testing and when I just needed advice. What a godsend!

People are usually on the board all hours of the day and night - some times are busier, but you are usually able to get some response most any time. If it's something specific to your insulin, that board is the logical place to post. But if you've got a different issue, the general health board (this one) is another great place to start. Read and absorb as much as you can, and ask questions - we've all been there!

Again, Welcome!

Lu-Ann
 
Hi Lu-Ann. I read that the remission rate was higher, up over 50% over a period of months but whatever, i haven't even got him home yet. When you say you 'test frequently' .. how frequent is that? how often should one routinely test? (if you don't want to be a complete obsessive that is). economics is important to me too, since i'm not working and probably won't be anytime soon. i can afford his treatment but i really want to economise where possible. i just rang the bigger pharmacy warehouse down the rd here and they told me they are associated with the diabetes association (i think that was the name, but the national umbrella group), so they have all the supplies and their costs are very good, so thats good news. she said they sell several brands but the only one she named was accucheck so i'll wander down tomorrow and have a look at what they've got. i guess i'll get an initial pack of everything from the vet (except maybe the meter which i might have bought by then) when (i'm hoping not if) i get nelson back here this coming week and after that i'll source my own stuff. As for the urine strips, thats a problem for me if it depends on a colour change because i'm seriously colour blind. i can see changes in colour but i wouldn't want to rely on my colour vision :(

General Update: Called the vet today and his BG (after the initial 28), as i said b4, came down to 9 the first day, yesterday afternoon it was back up to 19 and today she said it was 18. She said it will sometimes take several days of persistent dosing to keep it down and they are planning to slightly increase the dose tomorrow if it's still above the range (they can't today because it's sunday aft/eve and there will be no-one there to monitor him after an increased dose shot so he gets the regular dose for his 2nd one today and the increase tomorrow). The good news from my point of view was that he finally had a bowel movement after nearly a week (i guess it all goes together, the diabetes onset, the borderline kidney issues, the dehydration that comes with those, and the constipation). anyway, they gave him a small enema and he produced something reasonably substantial which was such a relief for me to hear coz i was worrying last night that if the constip (or possible obstipation) went on for much longer they'd have to put him under anaesthesia to remove the fecal matter and he wouldn't be strong enough right now for that. so at least that emergency has been averted for now. he's also eating, which is obviously good, but they've said that he's 'angry' ... i guess he's in an unknown environment, on a fluid drip, with people he doesn't know poking and prodding so i can't blame him, plus i'm sure he doesn't feel particularly well. so he's not out of the woods yet but some hopeful signs maybe (the b/movement and the eating at least). danny.
 
Hi Danny, thank you for updating us. Nelson is very handsome!!

You asked about testing. Many members try to test anywhere between 4-7 hours after a shot. This is usually when nadir is. Which is the lowest point the insulin bring BG. Of coarse you will always want to test before the meal. Some test 2 hrs after a meal. I don't work so I test throughout my day. Take a look at Baxters SS if you want to see how often I test.

Ok so now to the constipation part. Constipation will cause higher BG numbers. It stresses the body. Stress=higher BG. Its good he isn't constipatated anymore. Moving forward this is what you can do to help Nelson. Start adding water to his canned food. I add about 3 tablespoons warm water. I also add a product called Miralax to Baxters food. 1/8 tsp with warm water mixed into food. I use to mix it into both of his meals, but had to cut back to just one meal. Miralax doesn't have any sugar in it so its safe for FD. Its Dr.Lisa Pierson recommended. She is the dr from the website I provided last night.

Hope this answered a couple of your questions.

I really hope Nelson gets to come home very soon. Im sure you miss him so very much.
Jenn & Baxter cat_pet_icon
 
The vet was encouraging when i asked if it was ok to stop in and see Nelson this afternoon, so really looking forward to that. I'm going to take his brush in and see if a bit of brushing and patting from me can improve his mood. They've said he's a bit 'angry' : / Being brushed is really his favourite thing. In fact i'm going to go every day from now until he's back! They're just up the road. :smile:
 
No reason to not go see your friend. He is going to be so happy to see you!
I'm sorry I might have missed why he is staying at the vet so long?
If he is angry there his BG numbers won't be accurate. They will continue to be high. So it will be difficult for the vet to regulate him there. Then they might have you give Nelson a high dose. Which will be to high once you get him home.
Once you get him home his numbers will be accurate & you can dose accordily. The members on Lantus can help you with that.
So if there isn't any major health problem with him I would speak to the vet about bringing him home.

Have a wonderful visit with you friend.
Jenn & Baxter
 
hi danny! i wanted to stop in and welcome you also. i'm sorry that Nelson's gotten this diagnosis, but want to tell you that you've hit the jackpot in terms of feline diabetes help. this website is full of people who understand how diabetes works in cats and can help you get nelson regulated, and of course, we all hope off of insulin. some cats don't go off, but you can have him healthy and regulated either way.

Like Serryn (vyktor's mum) we use the Tight Regulation Protocol - interestingly, it was developed at the University of Queensland. Great track record and not too difficult to follow while keeping nelson safe. one step at a time.

i'd second jenn's comments - if he's mad and stressed at the vet's, the amount of insulin they will have to give him to bring down his blood sugar will be too much when he gets home. my cat never spent the night at the vet getting stabilized. if you get him home, we'll help you from there. Take a look at the Lantus TR Insulin Support Group - don't be scared by the talk of colors (i was!) as they refer to our color coded spreadsheets where we record the blood sugar numbers.

glad you're here - we're looking forward to getting to know Nelson and will be glad to teach you what you need to know to help him.
 
Jenn .. re his time at the vet, well, he went in in a pretty bad state, going off a cliff, and i don't feel confident at all of looking after him myself although after today's visit with him i'm thinking a little bit about trying it but i'm going to talk to the vet about it tomorrow. I absolutely want to be sure that whatever i do won't endanger him. he's still on a fluid drip for dehydration. he responded to my visit (i stayed an hour), he snuggled into my hand and enjoyed being brushed, i almost but not quite got him to purr a bit, and almost not quite got him to eat some of his wet food. they said he'd eaten some dry earlier (special dry for diab of course) and had another decent bowel movement. BUT his gluc is stubbornly high ... initially i said it had come down to 9 (from 29) on the first day. actually it was 12, not 9. next day 19, then 18 and today (after a morning increase in insulin dose) it was 24 (!), but they said it can take a full day or two for the dose increase to take effect. obviously i can't keep him on a fluid drip here at home so if he needs to be on that then i will keep him at the vets for as long as need be, but i sort of do want now to try and get him back here to a calm, quiet environment he knows where i might have a better chance of getting him eating more regularly and getting his gluc down. i feel reasonably confident about the home testing etc. after all my reading and watching online videos. the other thing the vet mentioned was that the suddenness of it all may indicate pancreatitis but its hard to know. so its all a little up in the air. i didn't like that 24 today!! hoping for a reduction tomorrow when i visit again. oh and he didn't seem 'angry' to me .. there was a dog in the enclosure below and off to the side from him that was making some noise which was a bit annoying and i'm sure he'd prefer not to have that, but he seemed pretty calm and ok considering everything. danny.
 
Just spoke to the vet, he said the added stress of being at the vets w other animals around etc. might account for 3 or 4 points but at 24 today that's still a problem. If we can get him down just into the low to middle teens steadily in the next couple days or so he said definitely getting him home would be a good idea. here's hoping. danny.
 
hi danny! as long as nelson isn't eating well and needing fluids, then yes, he should be at the vet's. there's a couple of things that jump out at me from your last post that i want to ask you more about.

for us to guide you after he does come home, it would be important to know 2 things - did he have Diabetic Ketoacidosis when you brought him in? it's abbreviated as DKA. his breath might have smelled different, like acetone (nail polish remover). ask the vet specifically about that, because a cat that has had ketones is a cat that needs to be treated extra carefully so that they don't get them again.

also, if he had a diagnosis of pancreatitis. that is most accurately diagnosed with a specific blood test called fPL.

at some point when you're talking with the vet, make sure and ask about those. both of them are conditions that can reoccur.
 
oh - another thing i was going to mention. i'm a little puzzled by your BG reports. how many times a day is the vet checking BG? I'm just wondering if they understand how Lantus (glargine) works. It has a "rhythm" to the BG when the cat's at a fairly close to good dose. dosing of lantus is based upon the lowest point the cat gets to in between shots - usually somewhere around 4-7 hours after the shot. if they are only checking right before the shot, you will want to ask them to check about 5ish hours later to get a better idea of how the dose is working.

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

There are also a few things that can affect the numbers. One is a dose increase. We call it "New Dose Wonkiness" because when you icrease the dose, it's common for cats to have a corresponding increase in their BG. This link describes NDW.

There are also bounces, which are described in the same link, farther down in the posts.

stress and infection can also increase numbers - cats are sensitive little critters. your vet mentioned 3 or 4 points could be attributed to stress. we've had cats soar as much as 200 points (divide by 18 to get the mmol difference) if the cat is very sensitive. I would think that nelson wouldn't have that much of a stress response still to the vet's when he's spending nights there, but i don't know.

Here is the Rand/Roomp protocol that we use for Lantus dosing. you might want to print it out, read it and share it with your vet. i'll be curious if this is the protocol that they follow.
 

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Well, the vet mentioned ketones when i spoke to him after the first 24 hours (in amongst many other things ... this was the call when i was shocked to find out Nelson was having a diabetic episode so my mind was reeling a bit), so yes, he said ketones were an issue, and i know ketones have been present in Nelson's urine, which is why he's on the drip .. to clear them and also for the dehydration. we talked about possible pancreatitis today, which he said might be indicated by the sudden onset of this, but as i think back, and as i think i mentioned earlier, in retrospect i recall noticing that Nelson had been drinking more and urinating more for several weeks before this catastrophic day (last thursday, on which, when i just read the list of signs of DKA Nelson had almost all of them). of course i was happy he was drinking more for those weeks because i want him well hydrated, but i'm thinking tonight that maybe a several week onset is less indicative of pancreatitis than a 2 day onset (Nelson being just a bit off Wed and then really off Thurs) but i don't know. I'm afraid i've been bursting into tears every hour tonight coz i just feel hopeless about his numbers going in the wrong direction, but then my rational mind kicks in and i say well, he's only been on the starting dose for 3 days and the slightly increased dose for less than 1 day, and i've read that it can take up to 2 weeks to stabilise some cats. apparently his creatinine, while still elevated, hasn't gone higher than before this episode, so i'm holding onto that as a good sign for his kidneys. anyway, i'm going to visit him every day until this is resolved. i told them i'd be happy to take a folding bed and move in. will def ask when the testing is done and about the fPL. danny.

julie & punkin said:
hi danny! as long as nelson isn't eating well and needing fluids, then yes, he should be at the vet's. there's a couple of things that jump out at me from your last post that i want to ask you more about.

for us to guide you after he does come home, it would be important to know 2 things - did he have Diabetic Ketoacidosis when you brought him in? it's abbreviated as DKA. his breath might have smelled different, like acetone (nail polish remover). ask the vet specifically about that, because a cat that has had ketones is a cat that needs to be treated extra carefully so that they don't get them again.

also, if he had a diagnosis of pancreatitis. that is most accurately diagnosed with a specific blood test called fPL.

at some point when you're talking with the vet, make sure and ask about those. both of them are conditions that can reoccur.
Click to expand...
 
 

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Danny your picture of Nelson makes me so sad. You talking about visiting Nelson brings back memories for me. My first cat Kacoo was Siemese & he got so sick. He stayed at the vet hospital for 4 days. I would visit everyday & stayed for 2 hours brushing him & just loving on him. He had a drip & a bandage similar to Nelson's. Kacoo got to come home, but the vet wasn't far behind following us to my house. She was so kind to us & very sympathic. She gave me a cat angel pendent I wore I on my shirt for weeks after. That was July 2003.
Medicine & medical education has come so far since then.
With all the help from the board & with all the knowledge to be learned by reading Nelson is going to be okay. He is going to recover & be home with you very soon.

Please keep in mind the sooner you get him off dry food the sooner BG will drop. Even if the food is diabetic food is dry. It tends to have high carbs & lack the moisture needed. You want to get those carbs down low....low like 10% or less low. In the website www.catinfo.org. Dr.Pierson talks about transitioning from dry to canned. Some members even see a 100 point drop in BG levels just from switching to canned. I don't know how the 100 point converts to your system. Please keep trying the canned food. Maybe mix a little with the dry. I had to do that with Baxter. Keep trying, don't give up. Maybe try fish flavors at first. Remember high protein, low carbs. Just like a human diabetic diet.

Enjoy your visit with Nelson & keep us posted.
 
heehee i always laugh at that advice, jenn. i took off my sweatshirt and left it for punkin when he was staying at the vet's and it got returned to me in a plastic bag. he'd peed on it. :lol: not sure what THAT message from him was! :-D

danny, if he had ketones it's really good he's staying there and getting stabilized.

don't despair - we've seen so many cats recover and thrive. have hope!
 
Good idea, i'm taking in the shirt i've been wearing overnight and his blanket as well! Going in an hour or so. danny.

Jenn & Baxter said:
Oh forgot to tell you take a shirt that you have worn & leave it up there in his crate. It will help calm him. ;-)
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Nelson rallies!!

Wow, i was feeling pessimistic as i walked up to see him just now, but he seems to have responded to the first incremental increase in insulin overnight, BG down into the mid teens today (they are testing before the day's first shot, 5 hrs after and later on as well). While i was there for an hour, he sat up! he ate, drank and purred when i brushed him (was fairly unresponsive yesterday), he yawned and stretched out and enjoyed me rubbing under his neck, he rubbed his face all over his fav brush which he loves to do ... in short i saw a lot of the old Nelson back today! What a roller coaster. No guarantees but things are looking up and if this keeps up i can get him home by week's end. Danny.
 
Shirt on the left. He really was a bit happier than he looks in this photo :)
 

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Oh poor guy. He hates that "Pink" bandage.
Is that canned food I see in there?
So good to hear there is improvement. When is he coming home?
 
So glad to hear Nelson is doing better.
You may find he will eat better once you get him home too.
I had to be out of town for nearly 2 weeks last year. Poto was boarded at the Vet we always see but was VERY unhappy there. He would not eat even though I provided his usual food from home and they were checking his BG four times a day to know how much insulin to give him.
Taking in a worn shirt was a wonderful idea and I will sure remember that if I ever need to leave him again.
Hugz,
Carol
 
Nelson's home!

OMG, unexpectedly Nelson's home now! His blood gluc is still a little high but he's stable and eating and doesn't need the drip, so they said it was ok to get him home. He's a little unsteady on his feet and has been thru the wars but he's v happy to be home. I'm armed to the teeth with insulin, glucometer, syringes, strips etc. and going to do 2x daily testing for a while and a curve next Thurs. as per the vet's advice. They said they usually do the curve in there but she seemed confident i'd be ok to do it myself (me too). Danny.
 

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Hi Danny & Nelson.
The first thing I would recommend is start testing for ketones. Since his numbers are high & he has a history you want to keep testing. You can purchase the strips at the pharmacy.
You are going to hometest which is really good.
You also want to start getting rid of the canned food out of his diet the sooner you do this the sooner you will see some lower BG. You will have to start slowly transitioning the dry to canned.
If you have dosing advice or questions go over to the insulin support board. They will help you. There are some very expiernced members over there.
If you have any questions about diet or anything else, just start a new thread & you will get lots of help.

I bet Nelson is so very happy to be home. I am happy he is at home with you! You are going to do a good job! You have everyone here to help just ask..ok.

I hope some of this helps,
Jenn & Baxter
 
Nelson is getting better by the hour, he jumps up on the bed while i'm doing stuff on the iPad and hops into my lap just like our old routine. I'm amazed at his improvement just overnight. I'll post about BG results later on. It took me a few tries to draw enough blood the first time but i switched to the lancing device and that works great. Totally confident on the testing after just 2. Keeping him on 2units Glargine every 12 hrs for the time being. Have some thoughts on the diet issue too, also later on. We're both pooped and heading for bed now (i keep strange hours, bed at 7 or 8 am and up in the mid afternoon. It works for me :) Danny.


Jenn & Baxter said:
Hi Danny & Nelson.
The first thing I would recommend is start testing for ketones. Since his numbers are high & he has a history you want to keep testing. You can purchase the strips at the pharmacy.
You are going to hometest which is really good.
You also want to start getting rid of the canned food out of his diet the sooner you do this the sooner you will see some lower BG. You will have to start slowly transitioning the dry to canned.
If you have dosing advice or questions go over to the insulin support board. They will help you. There are some very expiernced members over there.
If you have any questions about diet or anything else, just start a new thread & you will get lots of help.

I bet Nelson is so very happy to be home. I am happy he is at home with you! You are going to do a good job! You have everyone here to help just ask..ok.

I hope some of this helps,
Jenn & Baxter
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Welcome, Danny and Nelson!

Since you're using Lantus and we use ProZinc and you're in Australia and we're in America - there's lots of things I can't help you with. Sorry. I can say, reading through this thread, that you've received some great advice already. What a good daddy you and what a lucky fella Nelson is to have you!

Spend lots of time reading the information/threads on here, checking out other people's SS (spread sheets) and asking lots and lots of questions. You have found a treasure in this group!!

Again, WELCOME!!!

Libby (and Hershey, too!)
 
SO happy to hear Nelson is home! dancing_cat dancing_cat dancing_cat

We are Lantus users and would like to invite you to come check out the Lantus board. http://www.felinediabetes.com/FDMB/viewforum.php?f=9There are several 'stickies' towards the top of the board that are overwhelmingly full of good information about Lantus, Tight Regulation, etc.

Great job getting started hometesting! Sounds like it went really well. Now that you are getting numbers, can you try and get a spreadsheet up soon? If you have trouble just post and we will help you. Well, someone with techy skills will help you, that person is not me. :lol: :lol: A spreadsheet is a great tool for keeping track of dose, BGs, and any other day-to-day info about Nelson and will really help us see what's going on with him. Serryn (Vyktors Mum) posted the link earlier in the thread.

Again, it's great that he's home! Now you both can start feeling better. ;-)
 
Whoo hoo, yay for Nelson coming home and well done on the testing - you are officially part of the vampire club!

Since you can't use the urine test strips with your colour vision issues I do hope you got the Xceed meter that can test for ketones for you. Ketones are very very serious business, DKA can be lethal so you really want to keep an eye on those to catch them early if they come back.

I see that the vet has advised you to test just twice a day (I assume before you shoot and did they give you a don't shoot number?) I'm going to disagree with the vet already and advise that you do need to get the midcycle tests as well. Dosing with lantus is based on the nadir not on PS (pre shot) numbers. We need to see how low Nelson is going not just how high he is when he's due for insulin. Since we don't yet know when Nelson's nadir is I would move that mid-cycle test every cycle i.e. test at +4 on cycle one, +5 on the next cycle etc up to +8.

When you do a curve it will help you to see where Nelson's nadir falls ECID (each cat is different), however if when you try to take the curve you find that by mid-cycle the numbers have not reduced abandon ship and try again the next day. This would likely indicate that Nelson is having a bounce off a lower number.

I saw that you noted earlier that you read it can take up to two weeks to get a cat regulated, prepare yourself for a longer roller coaster ride Danny. Most cats on Lantus bounce around for the first 4 to 6 weeks. It can be quite discouranging but you just have to remind yourself that it's normal and that Nelson will settle down once his body starts getting used to lower numbers again and we will be here to support you :-D
 
Thanks everyone for the ongoing 'moral support' and encouragement. I've been giving Nelson some 'intensive care' the last couple days i.e. watching him like a hawk, spending tons of time talking to him, brushing etc etc. and just generally comforting him after the 6 day disaster. He's still doing well, the only 2 things are that his BG is still stubbornly high (but vet assured me that as long as he's on the insulin that is not a big problem in the short term and obviously we can't just go ramping it up recklessly) and he's still a tiny bit unsteady on his legs although thats getting better each day too. I notice it when he jumps down from the bed. Maybe not surprising since he was immobile for 6 days with a bandaged front leg on a drip, so i'm not too worried about that. I'm going to start setting up a SS today i'd say, having a look at that link (thx Serryn) .. again the colour coding i see on most ppl's SS's could be a problem for me with my colour blindness but i'm really planning mostly to just put up the numbers, not diet, at least not at first. I'll post what numbers i have below. The vet is going to call me back shortly to see if i should increase his glargine from 2U to maybe 2 1/2 or 3. I'm thinking yes, but i'll wait to hear what he thinks. Oh and i will *definitely* be doing his curve next Thurs. myself, here at home, 1. because i'm totally confident about doing it after testing him for a couple of days and 2. i don't want to stress him with another big visit to the vets for a day. Re food, i know a lot of ppl here seem to be down on dry food but the vet wanted me to feed him *only* the dry prescription M/D diabetic food which i'm doing, mostly because he loves it and actually eats it, as opposed to the wet food, which he was mostly ignoring at the vets. I'm also giving him little treats of small amounts of tinned tuna which he loves as well. I can really see that the sick cat/diabetic cat industry is quite a profitable racket (!) with the exp food, the BG test strips ($50 odd for 100 at my chem warehouse), the lancing refills and all the rest of it. The BG meter was cheap (i got the Accu Check Performa which seems fine) but they get you on the strips .. i've seen apparently legit boxes of them on Australian ebay for half the price, from very high rated sellers, but i'm leery of buying that way right now. Any opinions?

BG results so far (mixture of pre-shot and +6):

Pre shot: 23.8
+6: 13.3
Pre shot: 32 (!)
Pre shot: 23
+6: 21
Pre shot: 31.9 (!)

These are from the last 2 days, he's been on the 2U upped dosage of glargine since Monday. They didn't give me a 'don't shoot' number but super dramatic falls don't seem to be an issue right now.

Ok, going to look at spreadsheets ... danny.
 
hi danny! don't be discouraged by those high numbers, but i will tell you that the best chance of success for having his pancreas heal and him be able to go off of insulin is found by transitioning and feeding only canned low carb food. i suspect nearly all of us arrived at this site giving dry food - but the TR protocol that you've been given links for, that has such a great success rate for newly diagnosed kittie - feeding a canned low carb diet only is a requisite for being able to follow it. i don't know why your vet is interested in the dry food - you might ask. we have cats going off of insulin regularly and while i won't say it never happens on a cat eating dry food, in the 15 months i've been here i've seen somewhere around 50 cats go off and every single one was eating canned low carb food.

time after time we've seen cats BG increase by as much as 200 points from a few bites of dry crunchies and then stay there for as much as a day. personally, i much preferred feeding dry, but this is what it is.

you'll want to do some research and decide what you want to do about that.

if you decide to continue feeding dry you will need to give higher doses of insulin to compensate for the carbs. the protocol that you can follow is called Start Low Go Slow - follow the link to the TR Protocol above and there is info on that page that refers to the SLGS protocol.

if the leg issue is neuropathy (does he walk on his "elbows?") you can give him methyl B-12 (xobaline) and often people see great improvement over a month or so.

yes, many people buy strips on ebay from sellers with a good track record. make sure you don't buy any past the expiration date. it's a good idea to keep 50 extra strips in case you run into a problem, like low numbers, where you need to test more than you expected.

you asked how often people test. we follow the TR protocol, even though punkin has acromegaly, because the goal is to keep punkin as healthy as possible. that protocol needs at least 4 tests a day - the preshot tests and one test mid-cycle to see how low the dose is taking him. i usually test 5 times a day if i'm home, because that's what my cat needs. every cat is different, however, and when people are starting out, their first goal is to gather data to understand how their cat's body responds to food and insulin.

i'd suggest that you edit your signature line and add "DKA 3/2012" so people know this important bit of info when they are giving you advice. did you get a definitive answer on whether or not Nelson had pancreatitis? if he did, please add that as well. kitties who have been sick with these are treated more aggressively because they can reoccur. none of us wants that to happen!!!!
 
Crisis overnight

Crisis overnight, i tested him twice within a few minutes and both were above the range of my glucometer (only goes to 33.3), it just said 'hi' (this was 3 hrs before his scheduled next dose of lantus), so i cabbed him to the 24h vet hosp and they did a half hr workup to see exactly what was up, his BG was 37 and he was mildly to moderately ketoacidotic ... he actually had seemed ok at home except for the spike readings and drinking somewhat more. they now have him on IV short acting insulin so they can monitor him hour by hour to try and stabilise and the plan right now is if they *can* stabilise him and give me some idea of how much i should increase his dose by, and all other things are reasonably ok, then i can get him home on monday (48 hrs from now). they have done the fPL for pancreatitis but that won't come back till next week sometime. if they *can't* stabilise him or his kidneys get worse because of all of this, then i'm afraid i'm going to have to seriously consider the worst option (you know what that means) 1. because i can't stand putting him through all of this again and again, crisis hospitalizations, on a drip, having all sorts of stuff done to him in a strange and stressful environment (we had a beautiful 3 days together here, almost back to our old routines) and 2. i had set aside some money for this sort of contingency but i haven't worked for several years now (because of my own health issues and other things) and after this w/ends hospitalization, according to the estimates they've given me, i'm reaching my limit financially, and of course there's no guarantee at all that if i can get him home relatively stable on monday that there won't be another crisis 3 days after that, in which case i would also have to take that worst option because of reason 2 (and reason 1 of course).

as for the dry food thing, i don't know why people talk about the carbs in it ... the prescription m/d is *low* carb, specifically for the purpose of treating diabetes! for the life of me i can't see any difference between him eating dry food or wet food as long as the content is the same, i.e. low carb specifically designed for diabetic cats, and the vets agree. anyway, let's not argue about that. i'm upset, and exhausted from only getting a few hrs sleep. i probably won't post for a few days until i have some resolution monday/tuesday. thx for listening. danny.
 
Hi... I am so sorry you are going through this stress with your kitty. I have never had a DKA kitty but it seems like people say that once they have have been in DKA, they tend to be prone to ketones again. This is something you can keep an eye on at home so you can take steps to mitigate if ketones start creeping up (you can monitor either using the urine strips or the meter mentioned upthread) but I know your colorblindness is going to make that challenging. Violet & Garland and Sasha&Tara are two members I know of who have dealt with DKA in their kitties, and who had to do the follow-up care at home. I know there are a lot more too but I'm just not the most "plugged-in" member here. I will send those two folks a PM and see if they can offer you any words of wisdom. Mainly I just wanted to say I'm really sorry you are going through this, and that from what I have seen here there is hope for Nelson. Hugs to both of you as you try to manage a very stressful situation.
 
So sorry to hear that Nelson is back in hospital (((Danny))). Those hideous high numbers are probably caused by bounces, Nelson's body is not used to being in lower numbers now so when he hit those yellow numbers (in the 200s) his liver released stored glucose and hormones to 'save his life' and get him back up into the high numbers his body is currently used to. With ongoing lantus treatment, as his body readjusts to being in lower numbers the bounces should decrease and the numbers flatten out.

Number translation:

03/28
+7: 396
PS: 428
+6: 239
03/29
PS: 576
PS: 414
+6: 378
03/30
PS: 574
+2: 259 - this is a massive response to the insulin Danny - a good sign it will be able to help him given time :smile:
+4: 232
+6 454 - bounce caused by the rapid drop to lower numbers than Nelson is used to
+9 666

Please don't think that this episode of ketones means that it will reoccur again and again for Nelson. Many kitties just have ketone issues the once (like Vyktor), usually I would think early on in the diagnosis like Nelson. Ketones only occur when a cat has very high BG, if you can keep Nelon's BG regulated you won't have further issues with ketones. Also many people on the board that do have ketone prone kitties have learned to give subcutaneous fluids at home to ward off the ketones and the associated expensive vet visits. I know how much you love your Nelson so I'm sure you would be able to learn to do this for him too if necessary.

On the food issue - Although the MD is supposedly designed for diabetic cats it is still much higher in carbs than LC wet food, if you check the ingredients you will see it contains flour/rice and such like. Eating any food will cause BG to rise but dry food tends to take longer to wear off. Unfortunately vets can/will only recommend food from their specialty suppliers :? When Vyktor's vet kept insisting I feed him the wet MD, since I was absolutely adamant about not giving him the dry food, I took in a tin of what I wanted to food him (Ziwipeak) in and compared the ingredients with him. Although he said he couldn't recommend the Ziwipeak because there weren't any studies on it he agreed that the ingredients looked better for a cat and stopped insisting on the MD.
 
Hi ppl ... well i've resurfaced again, after total exhaustion yesterday i had a long sleep and woke up feeling more determined to manage this as aggressively as i can. The place he's at now is an emergency vet teaching hospital at Sydney University and he couldn't get more intense and skilled treatment anywhere, they're monitoring all the time, using short acting insulin so they can monitor that closely and adjust, they've sent off the urinalysis for the possibility of UT infection, which i doubt, also the pFL etc, and she said today that after higher numbers the first night he's coming down now into the teens. I've been thinking about food timing if/when (i'm going to really push for it) i get him home tomorrow afternoon, whether i'm giving him the dry m/d, chicken breast meat (no skin/fat), tuna etc., and i will prob give him a combination of those, i'm thinking that i should only feed him say, within the hour before and for maybe for 3 or 4 hours after the shot, then withdraw food altogether until before the next shot, to try and help prevent any possibility of a food component contributing to spiking numbers in the end third of the curve. then do the same, some food before and for a while after the shot and then withdraw. Obviously while still keeping the closest possible eye on him and testing. Before i was just feeding him small amounts all through the day which is what he's used to. Does this sound like a reasonable plan? Also, if he does start to spike in the hours leading up to another shot, i guess i will give him the next lantus shot maybe an hour or so before it's due and if need be i can take him up the rd here to my local vet. they can't take the incredible detailed testing-everything care that the teaching hosp does but the teaching hosp is also astronomically expensive, i won't even mention how much i'll be paying for the 3 days he'll be there.

Serryn, i hope you're right re the bounces and the lantus working better over time. I'm eagerly anticipating his arrival back home tomorrow but a bit scared of course of what might happen despite everything. Giving him subcut fluids at home is something i haven't thought of, it sounds daunting, but i'll do some research. I'm going to ask the vet more tomorrow about the food issue. Getting him home would be amazing, every day he's at home at this point is a huge bonus! Danny.
 
The first month is the worst Danny, it is all so overwhelming and the numbers are discouraging because they bounce around but your love for Nelson and the support you receive here will get you through it :-D If I didn't already, I invite you to start posting Nelson's daily numbers on the lantus-glargine tight regulation forum - you don't have to be following the TR protocol to post there but do put in your signature line that you're not so that people will adjust their advice accordingly. You will become one of the family there and will find all the advice and support that you receive absolutely invaluable.

Food plan not so good. You definitely don't want to feed in the 2 hrs prior to shot time (maybe a bit longer with dry food because I think that the increase in BG from dry food lasts longer) because you don't want any food affecting your PS BG test, this is very important. Quite a few people do end up 'front loading' with food, i.e. feeding small meals at +1 +2 +3 and maybe +4 for better numbers for their particular cats but IMHO there is no need for you to be looking at food managing the curve yet and I would keep letting him eat as he's used to with the exception of removing the food in the hours before shooting. The more normal you can keep things for him the less stressed he will be. I have not changed Vyktor from free feeding and we are having excellent results - after the obligatory horrible time at the start.

For the first 4 to 6 weeks it is expected that they will bounce around but the highs will get lower and the bounce duration shorter as the right dose is found and the cat adjusts to being in lower numbers again. You just need to be a bit patient with it (ok I admit, it requires a lot of patience not just a bit!). In regard to shooting early it is not generally recommended. Lantus likes consistency with both dose and timing also it means that your schedule will be constantly moving which is likely to make things extremely difficult for you.

I'm glad you've got your dire beasties boxing gloves firmly back on ;-) the whole of the board will be cheering you on from ringside.
 
Vyktors Mum said:
The first month is the worst Danny, it is all so overwhelming and the numbers are discouraging because they bounce around but your love for Nelson and the support you receive here will get you through it :-D If I didn't already, I invite you to start posting Nelson's daily numbers on the lantus-glargine tight regulation forum - you don't have to be following the TR protocol to post there but do put in your signature line that you're not so that people will adjust their advice accordingly.
Click to expand...

Ok, will start posting there when i get some numbers going again. With all that's been going on i haven't really had time to examine the TR protocol in any detail yet but its on my list.

Vyktors Mum said:
Food plan not so good.
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Ok great, thx for that advice, that makes sense. Nothing for at least 2-3 hrs before and then after i can put out a decent plate for him, but as i said, he grazes and doesn't like to eat a big amount all at once.

Vyktors Mum said:
In regard to shooting early it is not generally recommended. Lantus likes consistency with both dose and timing also it means that your schedule will be constantly moving which is likely to make things extremely difficult for you.
Click to expand...

Yes well i definitely wouldn't do it any earlier than 1 hour, and i'd try not to even do that. The vet did say there was a leeway either side of maybe an hour, but if he's spiking an hour before the shot is due is it still not a reasonable idea? Again, no more than an hour max!

It *is* helpful to hear that many others have had a very difficult period for the first weeks but have gotten through with their cat intact, it really gives me something to hang onto. Because it's all so new and shocking after 16 yrs of good health you can really tend to think the worst and be plagued by very dark thoughts at all hours of the day. From last night i decided to think more positively as much as i can, not that you can necessarily always force that, but while he's alive (which he is!) i want to focus on keeping him that way, as opposed to sinking into despair about his imminent death (which prior to last night was really getting me down). With intensive care from me and hydration and monitoring at the (less exp!) local vet if/when needed, it seems possible he may get through now. Of course all cats are going to die, but if this is at all preventable right now i'll keep doing everything possible. Danny.
 
I wanted to mention just a couple things.

About the dry food, there are some cats who are VERY carb sensitive. My Shadoe could jump from around 12 to a 27 BG, just by stealing a small mouthful of dry food from a civvie.
So, YES, the dry food CAN make very very big difference in Nelson's numbers.
Shadoe knew she was not supposed to eat any dry and she would grab a mouthful of maybe 4 pieces, run to a corner, drop the pieces from her mouth and then eat them one by one... just saying, that dry food and even the 'snacks and treats' that are dry may be contributing to the high BG.
The dry food is like eating burgers and fries from a fast food restaurant; it's just not good for a diabetic.

Shot time changes are done by many but there is one very important thing to remember about giving a shot early. The insulin lasts 12 hrs or so. If you give shots at 8am/pm for example, and want to give a shot at 7am, remember that you have also moved your pm shot time, so your shot times are now 7am/pm. Then if you move it again another day, to 530am, well, that means your pm shot time is now 530pm.
With really high numbers, there is always the temptation to move the shots earlier, but it may just be that the dry food is adding to the high BG numbers, and the Lantus dose needs adjusting. The Lantus dose can take up to 3days to settle.

I had a question about the urine sticks. Despite the color blindness issue, it may be an idea to look at the color coding legend on the side of the KETOSTIX container to see what the colors look like to YOU. They are really more like shades, and they may be worth a try for you, especially with ketones in Nelson's history. Google online search of images for KETOSTIX and you can find an image of the container and the sticks, plus the color chart.. it will help you determine if you can make use of the sticks. I bet even if the chart is just shades of greys, it will still let you know if ketones are present or not.
Also on colors, you can change the color settings on your ss so that the fields use colors that YOU can see/differentiate.

If the pancreatitis test result comes back positive, ask the vet what is the result number. The condition is very painful, so pain meds should be obtained from the vet when you come home.
You can give Nelson fluids at home if needed; many people here can help you as fluids are needed for many issues, sometimes every couple of days, and you would run into quite an expense taking Nelson to the vet so often for something that can be given in the comfort of your own home and for a fraction of the cost, that's in addition to the fact that Nelson would be happier too.
 
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