NEW MEMBER Miss Katie Lou FurryBum

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Bron and Sheba (GA)

Member Since 2015
A new member has sent me and a few others a PM asking for help. I have copied and pasted the post below for everyone to see.. please help if you can. I’m not sure when I can get back to answer it



Miss Katie Lou Furrybum
Joined:
Aug 11, 2021
New
Help, please.

I have a 17.25 year old torti-tabby. She is much loved, but is now experiencing frequent UTIs. Her second in June, one again in August, and now two weeks later yet another breakout of it.

Her problem, of course, is uncontrolled Diabetes. She was diagnosed in May 2021; came within a whisker of dying that week; and was successfully dosed to near perfect bg readings by August. Her vets were astounded (as I found out much later)—though I caught hell for changing her dosing without permission at the time, and they neglected to give me her fructosamine results for over 6 months.

In the meantime I was sole caregiver to an elderly parent with rapidly advancing dementia whose needs overtook my attention to Katie.

Now we’re in a muddle.

Katie has never been overweight, and I removed all dry food (including the $85 bag of diabetic dry food the emergency hospital fed her) as soon as I’d had a chance to read up on feline diabetes last year. (I never even knew the condition existed before her diagnosis.) She’s been on Tiki cat and human Cloverleaf Tuna mostly. The Fancy Feast seemed to elevate her sugars more, though we use it because she gets sick of tuna, and Tiki cat is over $4.80/can now. Tuna is under $1.50/can, and Fancy Feast at Walmart is $1.70 for a comparable weight.

My questions:

1. Remove all food 2 hours before first bg (am) reading/injection. Correct?
2. The 6 hour reading. Does it also require 2 hours of food abstention? (I’m thinking not.)
3. The 12 hour reading/injection. Does it also require 2 hours of food abstention?
4. The 2 hour post-pm injection. This one must be ok post-prandial. Correct?


I’ve done 8, 12, 16 hour curves before. There’s been no pattern I could see of when nadirs occurred. In fact, on once daily dosing of 1U, her sugars only rose to injectable levels between 22-23 hours. I really wish I could do a FD spreadsheet, but Google docs requires iOS 14, and this machine is not capable of installing that update.

Earlier in the week, I was giving Katie 1.25U in the morning , 1U in the evening but within two days she had a mild hypoglycaemic event. Wobbly, dilated pupils, drifting left while walking, piercing cries, etc. Voracious consumption of food I ran to get. So I reduced dosing. Her water consumption/peeing went back up. Then when she started antibiotics, she hardly ate anything for a day or so also requiring a lower dose.

Lastly, Katie hates the injections (even though I bring the syringe to body temp first—I think the glargine burns), detests the ear pricks, scratches and bites very hard frequently. She often draws my blood first when it’s ear prick time. We stopped doing ear pricks last year because it was destroying our relationship. I heat her ear with a vial of hotish water, yet can prick twice without sufficient blood, then the third will draw a geyser that takes 5 minutes to stop. It stresses both of us.

Miss
 
In answer to your questions
1.Yes, remove the food for the 2 hours before all preshot tests so that the BG is not food influenced.
2. For all other testing during the cycles you do not need to move the food. You can test any time during the cycle. It does not need to be at +6. It can be any time but from +3 to +7 is the best times to see how low the dose is taking your kitty
3.yes. Remove the food for the 2 hours before all doses of insulin when you test the BG preshot
4.I don’t understand what the question is you are asking.

Can you answer a few questions about your kitty please? I can see from your signature that you’re using glargine and are using a human meter.

1. would you be happy to set up a spreadsheet and enter some of the g data so we can help you?
2. are you feeding before every dose of insulin and again giving snacks during the cycles?
3. are you still hometesting the BGs?

I am going to give you a few links to look through

HELP US HELP YOU

HOMETESTING HINTS AND LINKS
Looking forward to hearing back from you
 
3. Yesterday I started glucose testing Katie again. I did both preshots. I also tested Katie at the midpoint between the two cycles, and 2+ hours after the evening shot.

2. I removed her food 2 hours before her two preshots, then returned it to her immediately afterwards. (I’d never done that before.) She was hungry both times after the injections and ate straight away. Otherwise she free-feeds. She has never been overweight.

1. Google Docs/Drive won’t work on this iPad. The iPad’s operating system is too old for those google apps. And Apple stopped supplying updates for this generation iPad two years ago. So I’d love to use the spreadsheet, but it’s not an option.

Last summer when Katie was well-controlled, she got one shot 1U daily. The blood sugar control seemed to last about 22.5 hours. It wasn’t safe to inject before then—her numbers were too low for that—but 24 hours yielded a number much too high for what the vet wanted as her highest blood glucose. (But I also wasn’t fasting her two hours before testing, either).

Her numbers yesterday were 24.3 a.m. (gave 1U), 16.5 6+, 9.7 p.m. (gave .75 unit), 9.6 2+ metric.
 
Thanks you for the information about Katie. I am glad you are a testing the BGs again.
I will tag @Bandit's Mom and she will be able to help you set up a spreadsheet.

Lantus works best if the same dose is given for the am and the pm doses. This is because Lantus is a depot insulin. Information about depot insulins HERE.
If you are finding that you can’t give a dose of insulin at the next dose, then the dose could be too high and may need reducing. Lantus is a twice daily insulin for cats. Once you have the SS set up and we can see some data, we can help you with dosing and other issues you may have.
It sounds as if you are giving the dose of insulin before you feed Katie….the correct way is to test/ feed and then give the dose of insulin.

Do you have a hypo kit set up in case you need it? You will find information about hypo kits in the link above…’help us help you’
 
Thanks you for the information about Katie. I am glad you are a testing the BGs again.
I will tag @Bandit's Mom and she will be able to help you set up a spreadsheet.

Lantus works best if the same dose is given for the am and the pm doses. This is because Lantus is a depot insulin. Information about depot insulins HERE.
If you are finding that you can’t give a dose of insulin at the next dose, then the dose could be too high and may need reducing. Lantus is a twice daily insulin for cats. Once you have the SS set up and we can see some data, we can help you with dosing and other issues you may have.
It sounds as if you are giving the dose of insulin before you feed Katie….the correct way is to test/ feed and then give the dose of insulin.

Do you have a hypo kit set up in case you need it? You will find information about hypo kits in the link above…’help us help you’

I came across a feline specialist site last year where that doc had found that individual cats were highly variable as to the duration of action of glargine. If I remember rightly, he found 14 hours quite common, but had seen lower numbers and much higher ones.

Last year I scoured the Internet for info. If it was in English, I read it. Advice from the UK, NZ, Australia, US, and vet conferences. There was not necessarily much consensus, and most vets had opinions without published research.

Like some on this site, I have limited resources. A box of 100 needles is $45. A vet visit is $350+. To give you an idea of relative cost, minimum hourly wage is $15/hr here.

.....
No, I hand Katie her dish, and then measure her insulin and bring it to body temperature before injecting.

......
I have genuine maple syrup, corn syrup, and honey in the cupboard. I’ve needed them 3x in the past. (Twice because I followed the vet clinic or hospital instructions. The vet clinic has still never told me I should home test, but a friend who is a vet in another province sent me a meter!) I also have Friskies cheese/gravy can that I use when Katie is obviously in distress. I now know her physical presentation signs very well.
 
Google Docs/Drive won’t work on this iPad. The iPad’s operating system is too old for those google apps. And Apple stopped supplying updates for this generation iPad two years ago. So I’d love to use the spreadsheet, but it’s not an option.
@Bandit's Mom
Hi Bhooma can you find a way around this , when this happened to me Linda MrWolfmans Mom found an old version for me and it worked
 
Welcome. Waving from Ontario, formerly of Vancouver Island.

Strips
If you live near the border and feel comfortable travelling in these covid times, strips are cheaper in the U.S.

There is also the Bravo meter. There are a few drawbacks.
1. The meter takes a large drop of blood.
2. You can only buy strips online which means you need at least a couple of hundreds strips on hand at any given time (plus 1 bottle for your hypo kit).
Strips are $40/100 plus shipping.
https://diabetesexpress.ca/products/bravo-meter

Syringes
https://www.petsdrugmart.ca/en/Product/UltiCare-Insulin-Syringes-61208/3833 (you want the 0.3cc ones)
https://www.petsdrugmart.ca/en/Product/Eli-Medical-Insulin-Syringes-7350816/3275 (you want the 0.3cc ones - third one down the list)
Plus shipping.
U100 syringes have an orange cap. Make sure you are ordering the U100.
Drawbacks: neither of these have half unit markings. Unless you have excellent eyesight, you may need a dollar store headlamp and/or a magnifying glass to help you microdose)

Insulin
Lantus and its generics are cheaper at a drug store than the vet (shop around).
You can also use PC points at any Shoppers or PC grocery store. If you are a senior or have one handy, take advantage of Seniors Days at Shoppers.

Food
President's Choice brand food carb content can be found in the link below. They are sometimes cheaper than Fancy Feast. Note that different sized cans have different carb counts (don't know why).
Friskies (pates or flaked) might be your cheapest option.
I cannot find the carb content for Walmart's Special Kitty brand.

And some chocolate for yourself for the occasional late night. Goes without sayin'.
 
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Welcome. Waving from Ontario, formerly of Vancouver Island.

Strips
If you live near the border and feel comfortable travelling in these covid times, strips are cheaper in the U.S.

There is also the Bravo meter. There are a few drawbacks.
1. The meter takes a large drop of blood.
2. You can only buy strips online which means you need at least a couple of hundreds strips on hand at any given time (plus 1 bottle for your hypo kit).
Strips are $40/100 plus shipping.
https://diabetesexpress.ca/products/bravo-meter

Syringes
https://www.petsdrugmart.ca/en/Product/UltiCare-Insulin-Syringes-61208/3833 (you want the 0.3cc ones)
https://www.petsdrugmart.ca/en/Product/Eli-Medical-Insulin-Syringes-7350816/3275 (you want the 0.3cc ones - third one down the list)
Plus shipping.
U100 syringes have an orange cap. Make sure you are ordering the U100.
Drawbacks: neither of these have half unit markings. Unless you have excellent eyesight, you may need a dollar store headlamp and/or a magnifying glass to help you microdose)

Insulin
Lantus and its generics are cheaper at a drug store than the vet (shop around).
You can also use PC points at any Shoppers or PC grocery store. If you are a senior or have one handy, take advantage of Seniors Days at Shoppers.

Food
President's Choice brand food carb content can be found in the link below. They are sometimes cheaper than Fancy Feast. Note that different sized cans have different carb counts (don't know why).
Friskies (pates or flaked) might be your cheapest option.
I cannot find the carb content for Walmart's Special Kitty brand.

And some chocolate for yourself for the occasional late night. Goes without sayin'.

Thanks for your quick reply. Katie’s readings have been seesawing this week. From 24 to 5.3 at injection times. Naturally, I can’t inject when she’s normal at 5.3, then 12 hours later she’s back at 22. And that was only after a couple of days of twice daily dosing at smallish amounts. I’m going to see what happens at 0.5U twice daily. I think she’s one of those cats that takes longer to release the insulin into her bloodstream than 12 hours, and after a few days of twice daily dosing she builds up too much of a stored supply that overwhelms her body when it continues to be released at the same rate. Like compound interest, or exponential growth, a little becomes a lot in short order. At least that seems to be what is happening. But neither is that stored supply enough to keep her going 12 hours without dosing. Either that or it’s the hypothetical Symogi (sp?) effect causing the spikes. Or a very erratic pancreas.

I have been buying my needles at Shoppers. They’re the same price as Walmart. And the points are handy for groceries, too. I wish I had thought about senior day at Shoppers for the diabetic supplies. I used it at the pet store for cat food while my mother was alive and lived with me.

I’m also on the Island, so getting to the border requires a ferry ride. I sure wish our Walmart had the earlier (or any) Relion meters—they take a fraction of the amount of blood of One Touch Ultra. That would have been so useful the first few weeks of bloodshed :)

I’m going to stick with half unit syringes. It’s hard enough to figure out 1/4 unit adjustments with something so small. A headlamp is an excellent suggestion! I’m nearsighted, and even so, those spaces are hard to see.

I have, on occasion, bought Friskies at Costco. Included with a case of pâté, I end up with a small stack of high carb gravy/cheese cans for those hypo occasions.

(On a human note, prescriptions at Costco are usually ~$5.50 cheaper per prescription on the dispensing fee than most places. Plus their mail order service is free; handy if the closest store is an hour or more away. Since you can’t earn points on prescriptions anymore in BC, it pays to spend less on each medicine’s dispensing fee. That can really add up to a lot of savings in a year for long term prescriptions or multiple prescriptions in a household.)

Can’t remember the US website I found in Florida where diabetic needles were about 1/2 the cost of those in Canada—even after factoring in a generous exchange rate and credit card charges for foreign currency. They only shipped continental US, for free. If only I was in Abbotsford, pre-Covid days. There are several third party places for delivery in Somass, WA and I’ve used that option in the past in better days. Oh, well.

Beth
 
Thanks for your quick reply. Katie’s readings have been seesawing this week. From 24 to 5.3 at injection times. Naturally, I can’t inject when she’s normal at 5.3, then 12 hours later she’s back at 22. And that was only after a couple of days of twice daily dosing at smallish amounts. I’m going to see what happens at 0.5U twice daily. I think she’s one of those cats that takes longer to release the insulin into her bloodstream than 12 hours, and after a few days of twice daily dosing she builds up too much of a stored supply that overwhelms her body when it continues to be released at the same rate. Like compound interest, or exponential growth, a little becomes a lot in short order. At least that seems to be what is happening. But neither is that stored supply enough to keep her going 12 hours without dosing. Either that or it’s the hypothetical Symogi (sp?) effect causing the spikes. Or a very erratic pancreas.
Without seeing a SS it is hard to say what is happening. But if she is having a preshot of 5.3 one cycle and then going up to 24 at another cycle….it sounds as if the dose is too high and you need to reduce the dose. She could also be bouncing.
Are you getting tests in during the cycles? We need to try and get the SS set up for you so we can see what is going on.

BOUNCING

  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Without seeing a SS it is hard to say what is happening. But if she is having a preshot of 5.3 one cycle and then going up to 24 at another cycle….it sounds as if the dose is too high and you need to reduce the dose. She could also be bouncing.
Are you getting tests in during the cycles? We need to try and get the SS set up for you so we can see what is going on.

BOUNCING

  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Thanks. I’ll stick to a 1/2 unit, twice daily for the next 5 days (regardless of the high numbers) in case it is this Bouncing that is happening. If her numbers do not lower after that, I’ll up her insulin by a minuscule amount at each dose and hold steady again for a week.

Most days I am getting an extra reading during the daytime cycle.

Katie has done extremely well tolerating all of the poking thus far. She’s not growling at me yet, or biting. Neither is she attacking with her claws. It’s a huge change in behaviour from last fall when even the injections triggered attack. She cries out almost without exception when poked. Only rarely does an injection needle slide in without a cry, and even then the glargine insertion always causes her to cry out.

I was going to ask you about the liver’s role, but I realized it was too complex even to formulate a simple question, let alone a simple answer. Hmmm. I guess it’s time to start reading articles a lot more detailed than high school biology ever was. Sigh.

One random thought I had today was magnesium’s role in feline diabetes. There was an interesting paper published sometime since the turn of the century/millennium in a Canadian medical journal by an American professor of medicine. On the human front, magnesium deficiency plays a huge role in type two diabetes. In humans, obesity blocks adequate magnesium absorption. These are the people who after losing sufficient weight can normalize their blood sugar because their bodies can once again get the magnesium they need to their cells. Others who are not obese just lack enough dietary magnesium, and when provided, their blood sugars normalize. There is a final much smaller group where magnesium does not play a role at all. It finally occurred to me to wonder if cats’ biology has anything similar.

Does anyone know a Masters or PhD student looking for a research topic?
 
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