New member with questions/vomiting now

[Laura&Chichi (GA)]

Hello everyone! My kitty Chi Chi is newly diagnosed as diabetic. She is almost 13, current weight 14#. Pre dx wt. was always 18 #(big girl..aka catzilla).Noticed she felt very light one day as I am never home, and she is very fluffly, I just failed to notice sooner that she had lost 4 #. Took to vet next day. Vet tested first number was 454 and took 2 days to get results so I took her off the dry food right then! Took her back in and retested 2 days later and was still in 400s. She prescribed 1u of Lantus twice a day. Bought meter etc. 3 days later for home testing. Started testing when I could, as I am gone 11 hours a day(I know! ugh). My mom is the feeder and feeds her and my other 2 kitties at 7am and 7pm. I give shot at 7:30 am, get home and give shot @ 7:30(vet said was fine).I have done the spreadsheet, but so far havent done a lot of testing due to my crazy work load. I work 6 days a week and off on Tues. only. After one week on 1u, vet said double to 2u as her numbers were still in 400s. That was on Sat. 8 am, so went home and gave 2u at 9am. Came home that night and tested at +10 and she was 76. No shot. 3 hours later, 146. Gave 1.5u next am at 7:30 and have kept her on 1.5 since. Am going back to vet for retest on Sat. 8 am. Heres my dilemma..My mom is elderly and she says since taking away the dry food(Natural Balance green pea and duck grain free) that all the cats and my dog will not stop begging in the am and pm for food. Shes in tears when I get home from the stress that it puts on her. I just need to know if she feeds them at their previous time of 6:30 am/pm, but I dont give shot til 7:30 am/pm is that bad for Chi Chi. I asked the vet if we could feed her several smaller meals and she said no, because it would spike the numbers too much. Help..my poor mom is having a rough time. Before dx Chi Chi always grazed on the dry food and got half can of fancy feast am and pm. Vet said to increase to 1 can am and pm. Is this enough food for her? I am testing with relion confirm. Sorry if I forgot anything.

 

[Liz&Gus]

Re: New member with questions

Hi Laura!

Welcome to FDMB!

It seems that there are several issues, so I'll break them up.

1. Feeding times and amount
- You can feed multiple small meals over the day. In fact, smaller, more frequent meals are easier on the pancreas, which will (hopefully!) help it heal. Just be sure that the overall food amount stays the same.
- Wet food is less calorie dense than dry food. You want to feed 0.5 - 1 oz of WET cat food per healthy weight of cat. So if Chichi should weight 12 pounds (or whatever weight your vet said Chichi should achieve), I would suggest starting feeding Chichi 10 oz of food a day and weigh her weekly, as 10 oz is in the middle of the range. If she is still losing weight, feed her more. If she is stable, excellent! Keep her at that amount. If she is gaining undesired weight, decrease her food by 1 oz per day. Reweigh her weekly and re-evaluate the food.

2. Insulin shooting times
- What insulin are you using? Some insulins are very fast acting and must be given with food. Other insulins are slow acting and you can feed and shot a bit apart.

3. Insulin dose
- I agree that you needed to decrease the dose from 2 units to 1.5 units. You don't want to risk a hypo event!
- You didn't say which insulin you use so I can't recommend anything else on the dosing.

4. Vet curves
- Most cats are very stressed at the vet. This stress can raise blood sugar by more than 100 mg/dl. This Saturday, I would suggest getting a test right before you leave for the vet and then again after you have arrived at the vet. Compare the two numbers!

I hope this helps!

Liz

 

[Laura&Chichi (GA)]

Re: New member with questions

Thank you Liz! Chichi is on Lantus, currently 1.5 twice daily. I am going to start giving her 1 extra can of FF classic daily to total 3 a day. 1 at 7am, 1 at 1pm and last at 7pm. I really need to start testing more often too! Im just a nervous Nellie still, and need my mom to help me with it. Its hard to get amps due to her being so active wanting to eat first thing..wont be still and wants to run to be fed. I just have to dive in and do it!

 

[BJM]

Re: New member with questions

Lantus has a lot of details many vets do not know.

Starting dose is estimated by the lower of current or ideal weight, so 15 pounds.
Convert to kilograms
Multiply by 0.25:
result: 14 / 2.2 x 0.25 = 1.59
round down to nearest quarter unit: 1.5 units to start

Because it is a depot insulin (ie creates slowly dissolving precipitates), the effects build up over time. It takes from 3 to 5 days to stabilize at a dose change.

The dose adjustment is based on the nadir, or lowest point between shots. you'll need to look for that on your day off ... or set a clock for about +5 to +7 hours after the shot and get up in the middle of the night.

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

[Deb & Wink]

Re: New member with questions

Welcome Laura and Chi Chi!

I see you have a SS up and running already to track your BG numbers. You need to make one change, and that is to change the share options to "Anyone with the link" so we can view it. Right now, we can't see it.

You mentioned that you were feeding the Fancy Feast canned food. Is that the classic pates?

Do you give a treat at test time? Something like Halo liv-a-little freeze dried chicken or Pure Bites freeze dried chicken or something pure protein would work perhaps to calm Chi Chi down a bit and allow you to test. Even a tiny bit, teaspoon of the canned food could be used.

Would you also please add some data to your signature, user control panel, Profile tab, edit signature. Something like this would help us to help you better. Thanks.

Laura & Chi Chi girl, age 13
dx date xx/xx/2014
Lantus and Relion Confirm
Eating Fancy Feast
ss link

Please, let us know what other questions you have.

 

[Laura&Chichi (GA)]

Re: New member with questions

Hi Deb & Winks! Thanks for the advice on the signature and ss. As you will see, I have not been testing long and not enough. I need to really make it happen though! If I have to just ask for time off to do a curve I will. Tuesday is the only day I have to do it and setting alarm to do it after pm shot is not gonna fly with my mom,whom I need to help me until I get the hang of it alone.
I just added the third can of FF today as she was always ravenous between meals(my mom said she ate almost all 3 cans but left a little of the 2nd one). I realized after reading post from others, that I should feed several meals and up the amount. I took all the dry food away from all 3 kitties at the same time, so I'm increasing all their wet food too. I have a 14 yo female and a 5 yo female, as well as a 13 yo doggie. Yes I have 3 golden girls in the home. I have taken chichi to the vet the past 2 Saturday morning for her fasting test @ 8am and always in the mid 400s. Vet expected it to higher due to stress. Just wondering if I should go ahead and take her again this Sat. for test? Dr. doesnt know I reduced her 2u to 1.5 last Sat. I feel better going up slower.Or maybe I shouldnt go and just test her myself Sat. 7am and then increase to 2u if still high(300-400). Is this a good plan? And I have to work Sat 11-7 so I could test a few more times before I leave but not again til after I get home. I appreciate the replies here. My sister who had a sugar kitty who since passed, came to this sight and told me about it. I am so grateful!

 

[Deb & Wink]

Re: New member with questions

Or maybe I shouldnt go and just test her myself Sat. 7am and then increase to 2u if still high(300-400). Is this a good plan?

With Lantus insulin, you don't make the decision to increase based on the pre-shot tests. Increases and decreases for this insulin are based on the lowest point in the cycle, what is called the nadir or peak action of the insulin.

With the food change you are doing, to all wet, I'd suggest holding off on any insulin dose changes for at least 3-4 days. Maybe even up to a week to see how the food change affects the BG numbers. One change at a time will let you know if that change is working. If you make too many changes at once, it's much more difficult to see which change made a difference.

I can see that with your working 6 days a week, it's going to be difficult for you to do a curve at home except on Tuesdays. I bet you have lots of other things you need to get done in your life on your one day off.

You said you take Chi Chi to the vet each Saturday to get a fasting test. Is this a single test or does the vet test every 2 hours for a 12 hour period (i.e. a full curve)? A single test 1 hour after the insulin shot and food, will not give you much useful information. Unfortunately, you need to test a bit more at the beginning of this sugardance to find out how the insulin is affecting your cat. By testing, you are trying to find the nadir, and the duration. Most cats nadir around +4 to+7, but some are earlier, some later.

On Saturday, if you were able to test when you first get up (AMPS) then feed, then test 2 hours later (+2), then maybe once more before you go to work (+3.5 to +4) you would have the start of a curve. Then on other days, you may be able to get some tests at other times. This early in the dance, all the data you can get is useful to see how your cat is doing.

It's tough in the beginning, when you need help from someone to help you get those tests. Are you giving Chi Chi low carb, pure protein treats to get her used to the testing?

p.s. Thanks for adding the signature info and you fixed the SS link so we can view it now. Good job! That sure will help us.

 

[Laura&Chichi (GA)]

Re: New member with questions

Thanks again!No, the vet has been doing a fasting test on Sat. 8am each week(past 2) no food til she test and then based on that number she tells me what to dose. Then I get home around 9am and feed, then shoot. Last Sat she was still mid 400 so she told me to up the dose from 1u to 2u. I did that at 9am and went to work. Came home and tested and she was 76, that was about +11 so I withheld. Tested again +13 and she was 146. Next am cut back to 1.5 and havent changed it.So shes been at 1.5 for 6 days now. Im not going to take her tomorrow. I will keep her at 1.5 til Tues. when I can do a curve. I will post her numbers then and hopefully someone can advise. I will take her the following Sat. and have her weighed and talk to vet. Then I may or may not bring her back every week..seems useless and stressful on her. Also, she has been off the dry since she was diagnosed on the 16th and gets only wet fancy feast classic. I just added a 3rd can 2 days ago, so she eats one can 3 times a day..7am, 1pm, and 7pm. I need to master the test and try to manage it alone and not depend on my mom to help. Any tips are welcome here! Thanks again

 

[BJM]

Re: New member with questions

Its time for you to do some more reading to understand how dosing adjustments in Lantus should work. You vet is not following established protocol for dosing, which is based on the nadir, the lowest point between shots. Dose changes are made in amounts of 0.25 units which are often eyeballed as syringes only mark half units at most.

Lantus Tight Regulation Protocol

 

[Deb & Wink]

Re: New member with questions

No, the vet has been doing a fasting test on Sat. 8am each week(past 2) no food til she test and then based on that number she tells me what to dose.

The method your vet is using to adjust the insulin dose is totally wrong for the Lantus insulin you are using. Lantus insulin dose changes must be made based on the nadir or lowest number in the cycle, not based on a fasting test at the beginning of the cycle.

Many vets do not know this. They are trying to base the dosing on the old method you would use for an quick acting, short duration insulin (an in and out insulin) like Prozinc or one of the fast acting insulins like Humulin N or Novolin N.

I will take her the following Sat. and have her weighed and talk to vet. Then I may or may not bring her back every week..seems useless and stressful on her.

Yes, you are correct about having your kitty stressed out at the vet. This can raise the BG levels 180 points and last 90 minutes or longer so those tests done at the vet are probably sky high from stress and not of much use for adjusting the dose in the first place. That's why we suggest home testing if at all possible. You get much more accurate readings.

I need to master the test and try to manage it alone and not depend on my mom to help. Any tips are welcome here!

One of my best tips for home testing, is to relieve your own stress by deep breathing exercises. If you are stressed, then kitty will be anxious and try to get away. Sometimes, you have to be not only an "agile dancer", changing from a waltz to the quick step at need, to help treat your diabetic kitty, but an Oscar award winning actress to convince you cat the testing is no big deal.

Be calm. I know it's hard, but it's one of the best ways to make the testing easier.

 

[BJM]

Re: New member with questions

Relaxation Breathing​

- based on the information in "The Relaxation Response" by Herbert Benson, MD.

Begin by sitting in a comfortable chair with good back support, or lying down. The key thing is to have your body pretty much straight between hips and shoulders so your lungs have room.

Now, breathe out completely. That way there will be room for a full breath in. If you start with half filled lungs, taking a deep breath in won't feel very large.

Pause.

Slowly, take a deep breath.

Pause.

Slowly, exhale.

Repeat, and establish a pattern of slow, deep breathing. Give yourself a good 20 minutes (turn off the phone, close the door) to get into this process. If done at bedtime, you may drift into sleep.

By slowing and deepening your breathing, you often cause the heart rate to slow and relax, muscle tightness to ease away, and blood pressure to decrease.

 

[lmummaw]

Re: New member with questions

Another new member here reading this and have a question now. Should I try and get the meter and test trips etc and do a test before I take Baby for her blood test on Friday the 7th. I see members saying the reading could be off by a 100 or more by taking her to the vet. She was over 500 the last 2 times but we are not using insulin yet. I have taken dry food away as my vet advised.

 

[BJM]

Re: New member with questions

Absolutely start learning to home test! It'll give you direct data on how your cat is doing. We recommend an inexpensive human glucometer over a pet-specific one due to the cost of the meter and the test strips. The latter is where you can spend a lot of money!

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

[Wendy&Tiggy(GA)]

Re: New member with questions

Welcome to the board

I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.


If you can't do a pre shot test I would reduce the dose to keep him safe for now.
Wendy

 

[Laura&Chichi (GA)]

Re: New member with questions

I am doing Chi Chis curve today after 9 days at 1.5u. Her amps is 231. Should I shoot now and retest in 3 hours and continue at every 3 hours?

 

[Wendy&Tiggy(GA)]

Re: New member with questions

Sounds good but if she hits blue or green I would try and get tests more often to see how
Low she goes.

 

[Laura&Chichi (GA)]

Re: New member with questions

Ok, Thanks for the reply. I gave 1.5 and will retest at +3 and go from there. I think because I am feeding her more now and giving it 3xday instead of 2, has helped. That amps is the lowest so far, altho I dont have many to compare to yet. I am getting a little better at the testing now and this am went quickly! Going to get some no carb treats today for post test for her. She has been looking and acting somewhat better lately and have seen her grooming herself again.

 

[Laura&Chichi (GA)]

Re: New member with questions

Just did a +3 and she is 247. Its higher than amps and wonder is that a food spike? She ate right after the amps at 7am and I shot 30 min later to keep the 12 hour cycle(7:30am/pm). Also, do I still feed her according to normal schedule today while doing curve? She eats 1 can classic fancy feast at 7am/1pm/7pm. Thanks for the replies!

 

[Deb & Wink]

Re: New member with questions/testing curve today

Yes, the +3 could have been a bit of a food spike. Or it could have been a bit of meter varience, that +/- 20%. Or it could have been because the Lantus has a slightly later onset with Chi Chi.

Go ahead and feed Chi Chi as you normally would. Don't change anything when you are doing a curve.

A mini-curve is every 3 hours.
A full curve is every 2 hours.

Nothing right or wrong with doing either one, your choice on which curve to do.

That's fantastic news that Chi Chi girl has started to groom herself more! It's always a good sign when we see our sugarkitties returning to their old behaviour. It tells us she's feeling better.

 

[Laura&Chichi (GA)]

Re: New member with questions/testing curve today

Ok...I have been testing today and posted the numbers on the ss. The last test was at 7pm then fed, but not shooting til 7:30(12 hour mark). I will test her again if it is advised, and wondering what times are better. I can do +1, +2, etc. She was highest at this last test(260). If someone can check her ss # and advise please as to what next. Do I increase, or stay at 1.5. I am off Friday also, so I could increase then and do some more test during the day on Fri.to monitor her #s. Thanks

 

[BJM]

Re: New member with questions/testing curve today

Yes, you probably can increase another 0.25 units.

Note that food tends to result in spike about 2 hours after eating. You may want to shift feeding a smidge earlier than the probable nadir.

When using a depot insulin, you want to test, feed, and shoot within about 15 minutes.

 

[Deb & Wink]

Re: New member with questions/testing curve today

Nice gentle curve for Chi Chi today. We would like to see those numbers lower, more down into the blues and even some greens (<100).

I agree with BJM on a dose increase, up to 1.75U. When you do increase the dose, I think you want to be around to monitor a day or 2 later. It usually takes that long to see the affects of a dose increase with Lantus.

How was Chi Chi with the testing today? Is it getting better, easier for the two of you?

We would really like to see a test before every shot, to make sure that Chi Chi is not too low to give her the insulin. A test at night, "the one last test before you go to bed test" is also a nice one to get on a regular basis. Many cats go lower at night, so getting those PM readings is important too.

Do you think you could do that?

 

[Laura&Chichi (GA)]

Re: New member with questions/testing curve today

Thanks! and yes, she normally eats at 1 pm but today my mom didn't think she was supposed to feed her! I told her I was testing her all day and she was just a little confused, so Chi Chi ate late. I will increase to 1.75 on Friday and do another curve. And I thought 1.5 was hard to eyeball, so will go buy some syringes with half marks and practice first. I really do think she feels better because she is walking around more and grooming again. She went crazy for those pur bites I bought today for the after testing too! I think Im gonna need some treats for my mom now, since she told me today that it stresses her out when I poke Chi Chi's ears.

 

[Deb & Wink]

Re: New member with questions/testing curve today

To clarify, for both you and your mom.

No food, for 2 hours before the pre-shot tests.
Food at other times before and after other tests is just fine.

I think Im gonna need some treats for my mom now, since she told me today that it stresses her out when I poke Chi Chi's ears.

Oh yes, treats for the beans (human beings) are important too! A little bite of chocolate, a sip of wine, whatever you love is a good treat and it doesn't have to be food. A relaxing book, a favorite movie, even sticking your head out the door to breath in the fresh air is a nice treat in my book.

Since it can take 3 days or 6 cycles to see the effects of the dose change, you should wait to do your curve after that period of time. So that would be Monday.

 

[Laura&Chichi (GA)]

Re: New member with questions/testing curve today

The test today were easier for me, but chi chi was getting a little squirmy on the last couple times. I think she knew the treats were waiting by! I spoke to my mom tonight and we agreed that we will do our best to test, feed and shoot within 15 min. every day am/pm. I will do extra test on day off and before bed. I tell ya, of all 3 of my cats, Chi Chi is the only one who I believe I can put her through anything, bless her heart, she is such a sweet and gentle soul. God help if our alpha female Molly(14) ever has to be put through this. I can not imagine! I cant even touch her anywhere below her neck. And the 5 yo turns Ninja on me for nail trims. I am keeping a positive attitude and am going to persevere..for Chi Chi! We will get through this thanks in part(big part) to all of you on here giving advice.

 

[Laura&Chichi (GA)]

Re: New member with questions/testing curve today

I Forgot to comment about the increase. If I increase starting tomorrow, then I am off on Friday, which will be post 3 days, I can monitor then? I will still do am/pm and pre bed test of course til Friday. Good idea? Otherwise I can wait and do the increase on Sat. and monitor Tuesday. I would prefer Sat. as this gives me time to get the syringes with half marks.

 

[Deb & Wink]

Re: New member with questions/testing curve today

I will still do am/pm and pre bed test of course til Friday. Good idea?

It's always a good idea to get the pre-shot tests and the before bed test.

Your choice on weather to increase today and monitor more on Friday, or wait until Saturday to increase.

Of course you can wait to do the increase. Chi Chi's numbers aren't horribly high, just a bit higher than we like to see. So, waiting until Saturday to do the increase is fine. Those tiny 0.25U increment doses are hard enough to measure, even with those 1/2 unit markings on the barrel of the syringes. It would be easier for you with the new syringes, so maybe wait until Saturday.

Basically, you eyeball those doses the best you can, trying to be as consistent as you can.

Perhaps, these pictures will help you to see where the top of the plunger goes with the 0.25 dose. Just a bit between the lines. It's tricky.

Here's a pic with 0.25U (click on pic for larger view)


Here's a picture with 0.75U (click on pic for larger view)

 

[Laura&Chichi (GA)]

Re: New member with questions/testing curve today

I need advice asap! My mom just called me and said ChiChi has thrown up 4 times since 9am!! I told her Im coming home to test. Do I need to feed her in the mean time?

 

[KPassa]

if she'll eat, yes. I would also consider taking her to the vet ASAP. That doesn't sound too good. :sad:

 

[BJM]

Repeated vomitting is serious for a diabetic; go to the vet.
Have your mom give some Karo or honey in case it is hypoglycemia.
Check the glucose when you get home.


Once it is not an energency:
Vets often recommend a bit of rest before you attempt to feed again.
Some Pepcid AC (1/4 of a 10 mg tablet of plain Pepcid), can calm an acid stomach and may help her keep food down.