New-received diagnosis yesterday

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Jamielvsaustin

Jamielvsaustin

Member Since 2014
Hello everyone!
I'm Jamie and yesterday my husband and I were told our 10 year old (next month) Siamese, Charlie, has diabetes. I'm feeling a bit overwhelmed nailbite_smile My husband and I always joke that we're dog people who happen to have cats-so forgive me if I say something ignorant/misleading. I don't intend to, and I'm open to learning more. We've had Charlie since he was about a year old. He's super affectionate, mouthy and outgoing (a lot of people tell us he acts like a dog). We have three other animals, Bailey and Trooper are our dogs, Pit Bull mixes, ages 8.5 and 9 respectively. And we have another cat, Gus; he's 6...long haired gray tabby-ish?

It used to be that Charlie was the heavier of the two cats, but they looked similar in size because Gus was fluffy. Then we started noticing Charlie was losing weight. We thought Gus might be bullying him out of it (we don't free feed; we feed twice a day-in a place that the dogs aren't allowed). So we started feeding the cats separately. Charlie was still not finishing his food, so we thought it might be that he didn't like the flavor TOTW Canyon River (http://www.tasteofthewildpetfood.com/pr ... e_formula/) so we switched it to Rocky Mountain (http://www.tasteofthewildpetfood.com/pr ... e_formula/).Our primary source of food for them is dry. They each get about a tablespoon of canned food a night. Offhand I'm not sure of the brand, but, admittedly it can't be great-I buy it at the grocery store. We then started noticing more and more urine in the litter box. And Charlie was starting to get kitty litter stuck to the bottom of one (or both) of his back feet. Other than that-everything was fine. We were okay with his weight loss at first, because we thought he was a tad overweight...but then he felt like nothing when we picked him up. He's down to 10.2 lbs. The highest he's ever been was 14, and that was before Gus. I would say he averages (after adding Gus) around 11.5/12 lbs. His personality hasn't changed, his behaviors haven't changed and without the weight loss-I don't know that we would have known anything was up.

He had blood work (as part of his yearly plan) back in March-which came back perfect. Yesterday they did blood work and a thyroid test. We won't get the results of the thyroid test until Wednesday. Whatever number the vet was referring to was over 500. 530...550-I'm not sure. It's kind of hazy and I'll have to call back and get the information again.

I...I just don't even know where to start. There was so much information yesterday. Having to buy insulin (made it sound like it was going to cost around $400) and needles and a test kit...and we'd have to test him on his ear (he's going to hate me, right)...twice a day, at the same times, forever (what if we're at work or school late...forget going out of town)...changing his food (will we have to separate him and Gus while eating forever now). I'm freaked out about administering it (read a little bit about hyperglycemia). Back in 2007 we had to administer subQ fluids to my husband’s childhood cat because he was dying due to an inoperable tumor in his kidney...and I never felt confident doing it.

Blah. Okay, so enough rambling. I need "diabetes for cats 101". I want to know what other things-besides insulin-I can do to make Charlie more comfortable. I'm not against giving it to him-I understand sometimes these lifelong treatments are needed. I just want balance. What kind of questions should I be asking my vet? Is it really going to cost that much, and if so-over what period of time? Is it surprising for his blood work to change so drastically in seven months? Should I consider a second opinion? Or do all of his symptoms point to this? Is a fasting blood test an option in cats, like it is in people?

Thanks in advance for any help you guys can give.

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Welcome Jamie and sweet Charlie,

Usually we notice our cats acting strangely when they are diagnosed- drinking lots of water, dropping weight and leaving copious amounts of urine in the litter box. A vet generally gives a fructosamine tests - it's a blood test that is usually sent out and will give you information about the average blood glucose level for the past 2 weeks. If a blood glucose level is taken in the office, it will just be a one shot view of the levels, and it is very likely to be influenced upward by stress because most cats are stressed at the vet. So depending on what test the vet did and what Charlie's symptoms are, it sounds like he might be diabetic or not. :mrgreen:

Here is diabetes 101 for cats:

We have a very successful protocol for feline diabetes:

1. A slow, long lasting insulin. Lantus, Levemir and ProZinc are popular as they have a slow onset; they are not harsh and they are easiest to use for regulation. Humulin and Canninsulin are less popular because, in most cats, they have a rapid onset and don’t last as long. We like new diabetics to start low and go slow. That is, start at a low dose of .5 or one unit twice daily every 12 hours. And increase slowly, by .25 or .5 units as the numbers indicate. As you are not positive if Charlie is diabetic, you might start testing at home and make a diet change first.

2. A low carb, wet diet. We like to feed under 8-10% carbs. There are several food charts you can use: Dr. Lisa’s food chart
Hobo’s Food Chart Rhiannon’s 8% and under list

Whatever food you can afford that your cat will eat in that lower range. BUT do not change over to wet until you are hometesting. With our Oliver, the switch meant an overnight change of 100 points downward. If we hadn’t been testing and had given our usual amount., he could have hypoed. If Charlie is not on insulin yet, you might change the food and see if his blood levels go down.

3. And most importantly, hometesting. We think cats tend to be stressed at the vet
and we know stress raises blood glucose levels. So we test our cats at home. You want to know what the number is before you give the shot to be sure the amount you are planning to give is safe. And testing midcycle will show you how the insulin is working. We use human glucometers and test on their ears or paws. Here is a video that shows you how it is done: Video for hometesting Testing at home will let you know exactly what his levels are, without vet stress, and give you a good idea of whether his levels might suggest diabetes.


Keep reading on this site (there are wonderful resources particularly on the main page) and reading other new diabetic parent's threads will help you. Ask lots of questions and we will do our best to answer.
 
Welcome Jamie and Charlie,
As one member (Sue and Oliver) once said to me, "Breathe Jamie, Breathe"! :smile: I was just as overwhelmed as you when I took over care of my grandkitty, Hank, on September 18th. It does get easier! I would think the first thing to do is get him off of the dry food and onto all wet food. I didn't know that dry food was so bad for cats until I read Dr. Lisa's articles on http://www.catinfo.org. She recommends the Fancy Feast and Friskies pate varieties.I have found that Sam's sells a case of 48 for $22. Switching should be easy since Charlie already eats a little wet food. In my case, Hank won't touch the wet food so I have switched him to a low carb dry food, Wysong Epigen (which I heard about on this forum) and am going to keep trying the wet food. I have heard from several people and Dr. Lisa even says that she recommends a food change. Sometimes that's all that's needed. Also cats, can go into remission from diabetes. In the little over a month that I've been on this forum, I have seen OTJ parties for cats that have gone into remission. That is my goal for Hank, remission.
Don't get overwhelmed! My husband and I watched Youtube videos on blood testing on a cats ear and how to give injections. They're very good videos. It does take a little time to get the hang of it. I'm lucky, Hank just purrs when I start rubbing his ear. Oh, and what really helped me was making a rice sock to warm the ear to get the blood moving before you prick. I'm still a "newbie" so I'll let others give you some advice. But I will say this...the people on this forum have helped me so much!! They've been where we are and are glad to help us get through all this.
I have started a file folder of info that I have printed off: Hypo's and what to do, the jardin (the lingo and meanings of the abbreviations), low carb treats, transitioning your dry food addict to wet food and a few other articles. I have set up a spread sheet to record the BG numbers so others can help me. Someone will probably give you the directions to set it up. I guess what I'm trying to say is, from one "newbie" to another, don't let it get you down. You are not alone. We've all been where you are and we are paying it forward by helping you to get set up. I know you have to wait till the report comes back on the thyroid too. But don't worry, you are at the right place. Do some reading and watch the videos, that will help.

Take care,
Kimmie
 
Hi Jamie and Charlie

I am a newbie too and it does seem completely overwhelming at first but it does get easier. As kimmie and sue have mentioned there are a number of key things you will want to do to help get Charlie regulated. Once regulated there is a chance Charlie can go into remission so it is worth giving it your best shot and this is what I am trying.

If you have not yet started insulin now is is probably the best time to switch to a wet food that has less thsn 8% calories from carbs. In order to avoid upset tummy you may want to change to the new food over a few days starting with 25% new food on the first day, then50% the second etc (advice taken from BJM).

Testing blood glucose was very stressful to start with but once you start a routine with Charlie it does become easier. Read the sticky in the health links forum to show where and how best to get the ear to bleed. I find heating the ear with a warmed rice sock helps the process.

Best wishes

Sarah
 
Oh no! I had a decent size reply typed out and lost it :(

Thank you all very much for the warm welcome. That video was great. It really helped to lessen my anxiety to see how relaxed both the cat and the person were while doing it. Charlie allows me to inspect him pretty regularly, and I hold him quite often, so perhaps testing for us will be relatively easy too.

We have not started giving insulin yet-so I agree Sarah-I want to look into the diet aspect of this as my first priority. After reading around a bit, it sounds like what I've been feeding isn't that bad. I was under the impression that you couldn't get a great quality food at the grocery store...but maybe that's because of what (we) dog snobs tell people. Generally I want to be able to read the first five or so ingredients, and I like the first to be meat.

I'd like to get a test kit on the way home, there's a walgreens close to my house-any recommendations? It looks like I want one that requires a very small amount of blood, but beyond that-I don't know what to look for. Looks like the kit itself won't be too expense, and the lancets are pretty cheap...but the test strips can vary in price. (Do you guys find this to be common?)

Kimmie-do you have a list of acronyms you could share? I read that for certain cats the phosphorus should be less than 250...but I don't know what the acronym was that indicated the specific kind of cat (google says, something to do with kidneys).

I downloaded a spreadsheet found on the forum here, it doesn't make much sense to me now but I'm sure with use (if it turns out I need it) it'll start to make sense and I'll find it useful.

I called my vets office to go back over the info, but the vet I saw yesterday wasn't there (there are 3 vets). It sounds like I won't hear back from any of them until tomorrow (had a really busy day)...that's okay-you guys have helped calm me down tremendously. Just knowing that others are experiencing the same thing makes it easier somehow. A virtual hug of sorts. You guys have to be pretty awesome to regularly deal with people as nervous as I initially felt. Thanks again :)
 
Spoke too soon! Dr. R called, they are recommending lantus and will write me a prescription so that I can pick up anywhere I want (the other vet, Dr. B has her own practice and was really pushing that I buy through her website). Charlie's number was 555 :( Dr. R said, while yes, stress can contribute to a higher number, the likelihood of it happening in Charlie's case is unlikely. He invited us to bring Charlie in anytime tomorrow so they can go over everything with us and show us how to administer the insulin. They'd really rather we not wait to start it.

I still want to get the test kit tonight and try it out. Dr. R prefers the bottles of insulin with separate needles to the pen...but said if we like the pen he'll go over that with us as well.
 
Hi

Most people get the cartridges a box of 5 x 3ml cartridges (or pens) . They work out more economical as you might find you don't use a 10 ml vial before you throw it away. You use a new syringe each dose and just draw up what you need.

See this thread on how to handle it properly: viewtopic.php?f=9&t=151

In fact this thread will answer many of your questions viewtopic.php?f=9&t=18139

Meter wise I live in the uk so we don't have the same ones but I see that relion ? Seems to be used a lot.

Whatever the vet advises dose wise I would just be cautious when changing food and starting insulin at the same time. I can't remember the exact saying on the forum but in essence better a day high (blood glucose) thsn a moment too low. Between now and then I would read all the stickies in the main forum and in the lantus sub forums to get you head around testing and lantus. Don't worry though there is so much to take in but you will get there. Make sure you have treats for when you poke Charlie's ear

Best wishes

Sarah
 
phlika29 said:
Hi

Most people get the cartridges a box of 5 x 3ml cartridges (or pens) . They work out more economical as you might find you don't use a 10 ml vial before you throw it away. You use a new syringe each dose and just draw up what you need.
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We would recommend the pens instead of the vials. Most vials become ineffective in about 2-3 months, though sometimes you can use them up until 5 months. If you are hometesting, you can tell when the insulin is starting to become ineffective.

Because the pens are packaged in smaller container, you are able to use almost every drop. With With, her dose was 2 units, twice per day. One package of pens would last about 10 months.
 
If you have a Walmart near you the meter most use is the Relion Micro or Confirm. It takes a very small amount of blood to test. The meter is about $15 and the strips are inexpensive compared to others I think I paid about $20 for 50 strips. I would also suggest that you buy ketone test strips. With glucose that high there is the risk of ketoacidosis.

Just wondering if the vet tested for pancreatitis.

As for food, most folks use Little Friskies Classic Pate or Fancy Feast Classic and make sure to stay away from those with gravy as those have higher carbs. An easy formula to use for low carb is 100-(protein+fat+moisture+ash). A simple formula to remember and a quick way to calculate carbs. It is not unusual for the glucose levels to drop when you switch to wet, low carb food. That switch will also help to lessen the chance for your other cat to develop diabetes in the future. So I would transition both cats to wet food.

To answer your question about phosphorus. Phosphorus levels are all important to cats with kidney failure (which mine has) but I would still look for phosphorus as low as you can find. And watch the BUN, Creatinine, Phosphorus, and Calcium levels on your test results. I found until the onset of kidney failure (caused by a blood clot due to a heart murmur) that the kidney values can be a little high until the glucose is regulated.

We were lucky in that Squeaker's diabetes was the result of depomedrol and changing to low carb food and using Lantus we were able to get him into remission in 2 months. The possibility of remission after switching food is another reason to home test. Even if your vet isn't an advocate and many aren't.

Anita and Squeaker
 
Kimmied said:
Hi Jamie,
Not sure what you mean.
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Oh...I was referring to this...I thought you might have something that could help decipher the acronyms...no worries. Thanks for the food link :)
Kimmied said:
I have started a file folder of info that I have printed off: Hypo's and what to do, the jardin (the lingo and meanings of the abbreviations), low carb treats, transitioning your dry food addict to wet food and a few other articles.
Click to expand...
 
Welcome Jaime! Your Charlie is so adorable! cat_pet_icon

I wish I had done the same and sought out this board as soon as I found out about Tyler's diabetes. Some quick thoughts from a newbie to another newbie: w/ information overload, so much worry about your cat's well being/quality of life, and of course, the underlying worry of the cost of treatment...I just want to quickly mention that human meters are much more affordable, readily available at the grocery/big box stores, easier to interpret results and use recommended dosing protocols (especially if there is ever any cause for concern over low #s and less hassle w/ purchasing a human meter vs. a pet meter (calls/scans/faxes either I or the vet office had to make to get a script for the meter, the test strips, and the silly lancets!). The unnecessary calls for pet scripts/scans/faxes is not what you need when you're trying to wrap your arms and head around all this...the cost - certainly does not help...the consistency of using the same measuring system is easier to digest as a newbie...

I just did a breakdown of how expensive it was to use a pet meter so it is very fresh in my mind. You will do yourself a huge favor by getting a human meter...the yearly cost for a pet meter like Alpha Trak can run up to $1.5k per year in just test strips and lancets while the yearly cost for using a human meter like Relion was $75!

PS - I was in the same boat as you! This entire time I thought store bought pet food was the "McDonald's" of cat food but wow - what I've learned here and at http://www.catinfo.org - the expensive prescription food I've been buying this entire time was not helping! Nor the other expensive brands I thought were supposed to be of higher quality. Turns out that Fancy Feast at the local Target helped put my diabetic cat into remission (off of insulin!!!).
 
Welcome Jaime!

You definately found the place to be for all things feline diabetes! This site saved me when Tucker was diagnosed this summer-- and unlike your vet, mine didn't tell me to home test. As a nurse it totally threw me that a medical professional I trusted would ask me to blindly give insulin without knowing what his glucose levels were. I came here to tell my story and the people here were amazing! It was such a relief to know I was not alone!!

If you are on Facebook there is a Feline Diabetes page affiliated with this group. While they do not give dose advice they are another source of support. Many of us are on both places.

If you haven't seen it yet, there are forums on the homepage here for each type of insulin. I recommend you taking a look at them. There should be a stickie for each with protocols.

I know it is a lot to digest. Just keep breathing! And ask questions. And test :mrgreen:

Jen
 
Welcome to FDMB.

All insulin doses are increased based on the nadir, the lowest glucose level after a shot.

Lantus and Levemir are insulins which have overlapping effects from shot to shot. These are called depot insulins and work best for most folks with a relatively strict 12 hour dosing schedule.

ProZinc can be a bit more flexible in scheduling than Lantus or Levemir and as you collect mid-cycle data, you can adjust the dose based on the pre-shot test since you have some idea of how low a dose will take the glucose.
 
Hi everyone :)
Thank you for the continued advice and support, I'm truly grateful. I'll be sure to talk to the vet about ProZinc, BJM. If they really prefer lantus, I'm okay with using that for now until I get more comfortable asking questions and making better informed decisions. But if they don't mind I'll ask for that. I also like the idea of the pens vs the vials-watched a video on how to withdrawal the medicine and found it very helpful. I'm so nervous about all of this, if I mess something up, I'd much rather waste a pen vs a whole bottle. I'm a little nervous about measuring properly, but I get the feeling so long as we're consistent in how we measure it shouldn't be too bad. We're going to go to the vet tonight around 5 (after work) so that Dr. O (we have 3 practicing vets at our office) can show us how to test...hopefully she can show us (with saline, perhaps) how to administer the insulin as well (we haven't picked up the prescription yet). Of the three vets, Dr. O is my favorite, so that lessens my anxiety.

I looked up discount "drug" cards online yesterday based on the suggestion of the pharmacy tech at Publix. I found one, but I don't know if it's legit-worth a shot though. Without a prescription in hand, none of the pharmacies could tell me if it was something they accepted. Of the three pharmacies I called the cheapest was my work's pharmacy at.....drum roll please....$235, the others were $251 (Publix) and $257 (Wal-Mart). I need that discount card to work.

I also picked up a test kit (The ReliOn as some of you have suggested), some strips for it and the ketones strips last night. Ugh, I tried testing him last night-what a disaster (for me, not him). I was crying. He was happily eating chicken...the husband was trying to be helpful. So I put the test strip in the machine way too soon. It ended up timing out and turned off. I finally was able to milk some blood of out his ear after stabbing him (not really, but you know, that's what my heart felt like I was doing) like 5 times. Put it in the test strip (it was enough!! yay) only to realize it turned off. So on the instructions it said when the machine turns on, make sure it says "F6" (or something to that effect) so you know it's reading properly for this specific machine. When I took the blood filled strip out of the machine and put it back in (figuring it'd turn the machine back on) it said "E3". Tried a couple different things, started getting stressed out (which Charlie picked up on....and the husband) and couldn't figure it out. Ended up wasting 2 strips. Austin (husband) calmed me down and reminded me we had an appointment today to go over all of this-and it didn't really matter what the test said-because we couldn't do anything to change it. True. But I was hoping to give the vet a more accurate reading-I know Charlie is stressed at the vet. He turns into a loaf of bread and sheds like crazy. Anyhow, I just felt defeated.

How and when do I use the ketone strips? What am I looking for when I use them? Does it have to be mid stream?

The type of wet food we're currently feeding is Purina Beyond (I'm pretty sure it's part of the "pro plan"...instead of the "one"...the symbol next to the "p" is a little box of squares). Trout and catfish recipe. It's grain free. I couldn't find on any of the 3 websites suggested for food so I went to the purina site (which was a joke, it was like I was using a dial up modem to access that stuff). Talked to a representative and these are the numbers he gave me:
The ingredients in this product are as follows: Trout, chicken, liver, fish broth, catfish, carrots, egg product, potassium chloride, guar gum, taurine, salt, choline chloride, thiamine mononitrate, Vitamin E supplement, zinc sulfate, ferrous sulfate, niacin, calcium pantothenate, Vitamin A supplement, copper sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), manganese sulfate, pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.
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He told me that the protein was 10% and that the carb % wasn't available at this time because the product was too new. But based on what Anitafrnhamer posted here, I asked him to give me the percentages for fat, moisture and ash.

The fat content is 5%, the ash content is 3%, and the moisture content is 78%.
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Based on that, carb % should be 7, correct? That's good right? Except these are teeny tiny little cans. It didn't matter before, they weren't getting a lot of it. Now that it looks like Charlie needs to be fed only wet food (and really we should put Gus on it to prevent this from happening to him) I need to think more economical. For now, since it's what they're used to-and what they're already getting, I'm not going to change it. I don't want too many changes for these guys at once.
 
Hi Jamie,
I looked on the food chart for your brand of canned food and did not see it. There were some Purina One canned pates that were in line (under 8%). Just because it says it's grain-free, doesn't mean it is. My suggestion... donate what you have to a shelter and try the Fancy feast or Friskies pate flavors for your kitties. It really is what's best. I'm trying 3 different kinds to entice Hank to "get on the boat" with the wet food; 9 Lives, FF and Friskies (only flavors from the chart). I hope your vet visit goes well. Good luck!!

Kimmie
 
Hi Jamie,

Jamielvsaustin said:
We're going to go to the vet tonight around 5 (after work) so that Dr. O (we have 3 practicing vets at our office) can show us how to test...hopefully she can show us (with saline, perhaps) how to administer the insulin as well (we haven't picked up the prescription yet). Of the three vets, Dr. O is my favorite, so that lessens my anxiety.
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I feel for you. :YMHUG: I was where you are right now a few months ago (and many times since!), but things won't always be this overwhelming. Once you get the hang of it, testing will very quickly become second nature. Also, once you start testing Charlie regularly, more capillaries will grow in the test site and it will be much easier to get a blood sample. As you get more familiar with the testing and injections and as you learn more, it won't be so scary.

I remember being really nervous about giving injections. It helps to practice on an apple or an orange. :smile:
 
Hi Jamie! Welcome!

Just one thing I wanted to be sure you know...do NOT let them sell you the pen needles for the pens, they aren't accurate enough for cat's mini doses and can only work in whole units. We raise/lower the dose by .25 units. You'll find the same kind of rubber seal on the pens as the vials when you remove the cap.

Spreadsheet:
AMPS - 'AM pre-shot' test number
PMPS - 'PM pre-shot' test number

The +1, +2, etc is the number of hours since injection. We have members all over the world, that way everyone can tell where you are in the cycle with a quick glance.

HUGS!
 
A few more bits of insulin info:

ProZinc comes in a 10 mL vial. It is a U-40 insulin which means it has 40 units per mL

Lantus and Levemir come in 10 mL vials, 3 mL pens, and in some countries, 3 mL cartridges. They both are U-100 insulins which means they have 100 units per mL.

All of them are withdrawn using a syringe for use. Usually, the syringe matches the insulin concentration (U-40 or U-100), however it is possible to use a conversion chart and use U-100 syringes with U-40 insulin which let's you measure as small a dose as 0.2 units. You'll want to get 30-31 gauge, 3/10 mL, short or long needle, U-100 syringes. Depending on your state, you may need a prescription. It can help to practice shooting on an apple to get a feel for it.
 
The vet visit went well! I only got teary eyed-no actual crying :) We did give him saline, each of us-the vet, me and then my husband. It was so easy. Charlie didn't care one bit! That was very reassuring. The vet also had a lot of resources to share-a lot of which I have already been given by you guys and friends...AND, she recommended this board. Not only was it great to hear the places/things I've been researching are good/valid/legit/insert correct word, it was nice to see a vet who is (or in my eyes, seems to be) "with it". She was honest in telling us she isn't an expert in this, but she does know the basics. I can understand that. Vets are sort of jack of all trades, masters of none. On the dog forums we're on we always warn owners that vets may not be well versed in nutrition.

There were a couple things we talked about that contradicted what I found on here or through here, so if you guys could speak to them a little more I think it'll help me make my decisions.

She was under the impression that the test kit would give a more accurate reading if it was specifically for cats.

I expressed a lot of concern about testing, and so that may be why but, she made testing seem...not as important as you guys have made it out to be. Could it also be that his numbers are currently so high-that really, it doesn't matter...and until they're a bit lower (over some XYZ time frame) we really don't need to test? He'll be getting 2 units twice a day. She did tell us to monitor his behavior and to note we might have to make changes based on any sort of extreme.

She did tell us not to shake the insulin, but encouraged us to roll it back and forth a couple times in the palm of our hands before we pulled anything out of it-that's okay right?

While she was showing us on saline and I get how that can be different than insulin...she pulled out more than she need and then pushed the remaining (unneeded) amount back into the bottle. She never once said not to do this with the insulin. On this, I think I'd rather just be cautious and work toward not doing that.

She wrote us two prescriptions:
1) Lantus opticlick pen cartridge
100 units/mL
#5 cartridges

2) Insulin syringes (U-100)
0.3 mL size
#1 box

She also recommended we get "Wholistic Digestive Enzymes" to add to his food, she explained it starts the break down process so the food is partially broken down when he eats, making it easier for his body to get more nutrition from the food. She gave us some printouts, talked about the ketone strips, suggested a certain kind of litter that won't absorb so you get a better urine sample...and answered all of my questions-even if I asked them more than once. She spent a good 45 minutes to an hour with us. She was very reassuring and made me feel a TON better.
 
Pet-specific meters are quite costly if you test daily before each shot or more often:
Ex at roughly $1 per strip * 2 tests per day * 30 = $60.
If you also monitor around the nadir, the lowest glucose level after a shot, that ups it to $90.
And if you add a before bed test so you can sleep knowing your cat is probably safe, then its up to$ 120.
That doesn't even include when you on hypoglycemia watch and making sure that cat doesn't go too low, nor the meter cost itself.

If you follow a Tight Regulation protocol, with the intent of getting your cat into near normal numbers and maybe even off insulin, you need those 4 tests a day.

We have reference numbers for using human glucometers; see my signature link Glucometer Notes for some details.

Lantus and Levemir do not need rolling as they are not mixtures, nor suspensions. ProZinc and PZI are suspensions and require the gentle rolling to resuspend the insulin molecules evenly.
 
And no, do not discharge excess insulin back into the container; you may contaminate it with bacteria.
 
The calculation for a Lantus starting dose is this:
What is your cat's weight?
What is your cat's ideal weight?
Takd the lower of those 2 numbers.
Convert to kilograms if in pounds (divide by 2.2).
Multiply by 0.25.
Round down to nearest 0.25.

Note: syringes can come with half unit marks; you want those. They do not have retail syringes which can measure 0.25 or 0.75 fractions.
 
I think vets do fall into the trap of thinking people won't test and therefore they don't emphasis it. However on this board most people are aiming for their cat to be in the normal range for as much of the day as possible and you can only achieve that on the right dose and to monitor that and tweak it you need to test.

Most people here use a human monitor and so my advise would be to go for that as a) it is cheaper and b) easier for others to give advise c) whilst every cat is different I have learnt a lot from looking at other cats blood glucose results and so using comparable monitors makes that easier.

Have you managed to change food yet or chosen a new one to try?

You will want to add some basic info in your signature. Insulin to be used, glucose meter using, other issues, etc.
 
Hi Jamie,

Testing is vital, even at the higher numbers. Several reasons spring immediately to mind:

1. First and foremost it is the best way to keep Charlie safe.

2. It will give you real time data on how Charlie is reacting to any given dose of insulin and help you to adjust doses for optimum results. It will also help you to catch unexpected lows (see point 1).

3. Even at the higher numbers, the more data you gather will help you to learn Charlie's BG patterns. As you accumulate more and more data, it will get you into a position where you are 'data ready' for administering insulin safely and effectively when Charlie's numbers get lower.

4. Knowing where Charlie's BG levels are at will give you much more peace of mind, and save you an awful lot of stress and worry.

Your vet sounds great, btw. :smile:
 
Charlie got his first dose of insulin this morning. EEK! I hated to do it, but I just kept telling myself-he needs this. He couldn't have cared any less. Didn't flinch. Didn't look back. Just kept on eating. It's such a small amount of medicine that it barely feels like I've pushed the plunger at all. I had to check it when I was done.

There's so much change right now. And we're already SO busy. I still feel overwhelmed. Last night after work I went to the gym, then went to pick up his medicine. One place wanted to charge me $359 for three 5mL pens. Wouldn't sell them individually and the bottle (10mL) was $236. I ended up at Wal-Mart. They sold me an individual pen for $75 (well, $74 and change after using the discount card). I could buy five 15 mL (it actually only looked like about 12 mL because there was a giant stopper in there) for $386. They sold syringes pretty cheap-$13 for 100...but they didn't have the half marks...so I kept the prescription (lots of places around here won't sell you syringes without a script) and went to Walgreens. Bought 32 cans of Friskies pâté (in 4 flavors). A sharps bin. And 100 half marked syringes for $17. Do these prices seem reasonable? I'm on the East Central side of Florida.

I didn't get home until after 8:30, and since I leave in the morning about an hour before that I thought it best not to give any medicine last night.

(sorry for all the numbers, I'm a financial coordinator so I'm always doing a cost analysis in my head)

Last night I fed as usual-dry food with a tablespoon each of wet food. This morning I did half of the dry food amount and half a can of the Friskies for both cats (as in, I didn't use a whole can...each cat only got a quarter of a can). The recommendation on the can suggests 3/4 to 1 ounce per pound of his ideal weight. Right now he's at 10.2lbs so my guess is his ideal weight would be around 11 pounds. That's two cans of food a day. It seems excessive. Is it reasonable?

I did not test him this morning. My husband will be giving him his second shot tonight and very likely won't test him. (since the vet didn't make a big deal about it, he's not concerned with it either) I'll try to test him when I get home. I want to do it, I want to make it a habit, make it part of the routine-as uncomfortable with it as I am, I really agree with you guys that it's an important tool to monitor him. His tests might tell me something is up before I can notice it otherwise.

So...the pharmacy tech at Wal-Mart tried to talk to me about Novalin. He said it was a 70/30 (what does that mean)...explained that isn't as slow releasing as the lantus but it'd probably be the closest and most cost effective ($34)...thoughts? Oh, and we might have to give it 3 times a day instead of 2, but the timeframes would be more flexible. Is it one that's not recommended? How difficult...or what is the thought process behind switching insulin? We're nowhere near ready yet-I'm not going to waste a $75 pen unless it's causing Charlie an issue. But just for future reference-how does it work?

In other news:
This weekend (The Savage Race) and next (Halloween with family in Daytona) we're scheduled to be out of town. Before I left work yesterday it dawned on me. We need someone to give Charlie his medicine while we're gone. It's hard to explain without sounding too crazy...but there aren't a lot of people we trust with our animals. And we haven't had to (knock on wood) board them...and really rather not. Most people we know are average to slightly irresponsible owners (no leash while walking dogs, outside cats, etc) We have a handful of really good friends that we know will follow our instructions to the letter...but we don't want to over use them. (Our dogs have to be separated. The only animals that are together when we're not home are the cats.) I'm the kind of person that doesn't mind going out of my way for people (mostly friends, but people in general too). But I feel SO guilty asking others to do it for me. I thought...well, maybe we could bring him with us. (We're staying in a hotel) I could confine him to the bathroom area (we're bringing both our dogs too). Then I thought, no, that'd stress him out....maybe I'll just stay home (I'm not running the race....pffft-WAY too out of shape for that nonsense)...but then I was bummed out-cause I'm looking forward to it...then guilty because-sometimes responsible owners have to make sacrifices. I figured, I'll ask my girlfriend (she and I go to the gym together) and if she can't, I'll stay home.

Not only will she do this for us, she has experience doing it. One of her mom's cats (that has since passed away) used to take insulin. I cannot tell you how relieved I feel. She's on deck for next weekend, but we're planning on asking another friend (so we don't over use her).

My husband and I both work full time and go to school part time. Currently my classes are online, which allows me to be home for the majority of the work (have to take tests at the school) but they're still really time consuming. I was up till midnight last night...and have been for the last 3 nights.

One of our dogs-Trooper-is super itchy right now. (weather change maybe?) This is unusual for him. We've been putting a cone on him to prevent licking/chewing. We also give him Benadryl with each meal and have been rubbing him down with coconut oil. Our other dog-Bailey-(the one in the pictures) just had foot surgery to remove a mass between two toes (came back as non-cancerous, but poor margins), and she's still healing from that. We've been combating yeasty paws with her all of her life. She gets the cone of shame too, plus a sock on her foot when she's not in the house, fluconazole with breakfast, and gold bond powder (on the foot) as needed. Oh, and she has arthritis, so pain meds as needed. Both dogs get a glucosamine/chondroitin pill and a fish oil pill with dinner.

Can you imagine what my kitchen counter looks like? The only pet that isn't having any issues is Gus (the other cat) and that's saying a LOT! lol
 
Humulin / Novolin N or NPH lasts maybe 6-8 hours per shot, hits hard ,drops them fast, and wears off fast. It is not recommended because if you shoot only twice a day, it leaves 4-6 hours without glucose control.

Yes, Lantus is expensive. If you can purchase by the pen, that'll spread it out a bit. At 2 units, every 12 hours, one 3 mL pen containing 300 units will last 75 days. It can be less expensive ordered from a Canadian pharmacy, but then it must be shipped refrigerated and be able to get through Customs. If you've switched to low carb food, 1/2 to 1 unit twice a day is where you should be starting.

VERY IMPORTANT: Lantus doses are adjusted by the nadir, the lowest glucose level between shots. That should remain above 50 mg/dL on a human glucometer and 68 mg/dL on an AlphaTrak or other pet glucometer. Try to get a test somewhere between +5 to +7 hours after the shot as often as you can, especially when starting or changing a dose. Have on hand Karo syrup, some high carb food (ex Fancy Feast Gravy Lovers), an oral syringe, written instructions for dealing with a hypo and the symptoms, and directions to the nearest 24 hour emergency vet.
 
I must have misunderstood how the units, and the volume of the pens work because I thought it wasn't going to last that long. If that's the case I'd say it's not too expensive. I thought there were 100 units in the pen making it last only 25 days-with 2 unit doses twice a day. That makes me feel better.

I read up a little bit about the nadir...and found this when I went searching for how to read the test kit:
Beginners 200 mg/dL = no shot limit until midcycle data indicates reduction is safe
Intermediate: 150 mg/dL (no shot limit)
If your pretest is below your no shot limit-stall 30 minutes w/o feeding and retest
If not going above 150mg/dL-skip dose
Click to expand...

Am I finding good information?

I have the ReliOn Confirm meter. The numbers I should be looking for are?-At the vet he tested at 555 and we were told 159 is normal. I know there is a conversion on the human meters, but I'm having difficulty understanding it. (just add 17?)

I've printed the hypo symptoms and read them...husband has not yet.
 
Using a human glucometer, 50-120 mg/dL is normal for a cat.

See my signature link Glucometer Notes to understand more about how glucometers work.

Lantus is a U-100 concentration insulin; this means it has 100 units per mL.

Starting dose calculation:
What is your cat's current weight?
What is your cat's ideal weight?
Take the lower weight (aka lean weight).
Convert to kilograms if in pounds (pounds/2.2)
Multiply by 0.25
Round down to nearest 0.25 units.

This is not difficult math - do each step and jot down your answer for each step. The final result is the recommended starting dose.

There are 2 protocols we follow here for Lantus and Levemir. To read about the Lantus Tight Regulation protocol, go here. It includes a link to the Start Low, Go Slow protocol.
 
Hi Jamie,
So glad the follow-up vet visit went well. My grandkitty,Hank, is on Nonolin N and I would NOT recommend it either. I've been talking on this forum for awhile about switching but things have come up preventing me from doing so( learning how to home test, switching to a low carb dry for a transition food till I can get him on wet and now his diarrhea). BJM is right, it just doesn't last (take a look at Hank's SS) long enough. I started switching his food on 10/10/14 and Hank's numbers have really dropped! That's why testing is so important! Sure it's cheaper(Novolin N) but not worth it. I didn't know any better. My vet told me that he's never had anyone like me dedicated to helping the cat. He usually just offers the easiest way for his diabetic patients parents. So tomorrow I'm calling the vet to talk to him about switching Hank's insulin to probably Prozinc.

Lantus is a good insulin but be careful. What is that saying they use on this board, "start low and go slow"? My vet said that when we switch that we will start off at .5u's. Then work our way up slowly. I just had an episode on Monday night. I went out for the evening. When I got back I checked Hank's BG and it was 45 at +4 (after shot)!! I was in shock!!! I only gave him 2u. and I think less than the night before! I panicked! I gave him 12 "kitty candies" ( Purina Whisker Lickin"s-very high carb treats). He was acting fine before I gave them to him. I would've never guessed that he was that low. An hour later he was up to 86. Thank God! Using a human meter, I have read on here, that normal readings are 50-120. BJM has said many times, "high numbers are slow killing but low numbers can kill quickly"!

That being said, it is very important to learn how to home test. I am a "newbie". It was frustrating when I first started. The best tip I can give you is to warm the ear by either rubbing or a rice sock. I have made a rice sock and Hank loves the warmth! There are directions some place on here how to make it. Maybe someone can find it for you. I'll give you the short version: toddler tube sock, uncooked rice, fill 1/2-3/4 full, tie off with ponytail rubber band and heat in microwave for 25-30 sec. with a sm bowl of water in there too. After awhile the ear gets used to being pricked and you will get blood on the first try because the ear is making more capillaries. I switch ears too. Yes, I have seen little bruise marks in Hank's ears. That bothers me more than Hank. I believe the higher the number in the "pricker" (can't think of it's name), it doesn't go as deep. Mine is on 4 but only goes up to 5. Really, it's a bonding time for Hank and I. :smile: I start rubbing an ear and he starts purring. So cute! My husband thinks I test too much but Hey, I'm just trying to keep Hank safe. If you have any questions, don't hesitate to ask. That's how we learn. You're doing fine.

Take care,
Kimmie
 
Oh, one more thing. Since I have taken Hank into our house, we have taken Hank, 4 times now out to camp with us on the weekends. We have a permanent campsite that we go out to most every weekend from April 1-Nov 1. The most stressful part for Hank is the car ride in the carrier. It's a 45 min. ride there and he meows just about the entire time. We leave a litter box and box of litter there (covered when away). Hank has his own bag that we pack with food, "kitty candy", sharps container, syringes, sm. cooler with insulin, and little bl bag with meter and supplies in it. Oh, did I forget to say that he camps with our 3 dogs too. :smile: My husband and I decided that he had to go with us cause we didn't know of anyone to take care of him while we were gone. Hank loves camping! He's very comfortable there. He lays around looking out the windows or in our laps. His numbers are pretty good considering the insulin that he's on. So, no, I don't think it stresses him out being out there. Probably only the rides in the car to and from.

So, you see, if you had to take him sometime somewhere, it might not be too bad. But at least you have that friend who is familiar with giving shots and taking care of a diabetic cat. That's great! She probably wouldn't mind doing it whenever needed.

Just thought I'd tell you about Hank's travels. :smile:

Kimmie
 
Hello Jamie! It looks like you've gotten a lot of really great information already from everyone here. I just wanted to mention that if you're using Lantus insulin you should definitely check out the tight-regulation Lantus support group on the site... there are lots of good stickies with information and plenty of very experienced users willing to offer help and advice. (: Certainly worth poking around to read, at least!

Take a deep breath, you can do this! It seems like a lot at first but after a while it becomes easier to deal with.

edit; Here's the link, definitely worth it for the info in the stickies alone. (: viewforum.php?f=9
 
Husband tested him prior to giving him his injection! He was at 195. That seems so drastically different from the vet, but I guess that first shot this morning could have brought him down. I tested him again later (only by 30 minutes) only because I was curious to see if there would be a change. It actually went up to 204. We didn't draw any blood on the first prick and I was a little nervous....maybe that rubbed off and stressed him out some. Husband said when he tested AND when he gave the injection-Charlie was happy as a clam. I'm already starting to feel better about this. I wish there was a day where we could do a curve. I feel like that's how you build a foundation.

Thanks for all of the links everyone has shared and is suggesting. Most of them I've read or looked at, but it's nice to have then here for reference. I've been reading so much I feel like my brain can't hold anymore. Some of the things/articles I've printed, some I've saved on the computer, and some I've done both to.

Also thank you for the continued support and encouragement. It really makes a world of difference. You guys have been both sympathetic and empathetic and it really means a lot to me.
 
It'll help if you add some details to your signature. These let us give you better feedback.

Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A text box displays.
This is where you paste the link for your spreadsheet.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter - put it in BOLD if it is an AlphaTrak
any other pertinent issues like food issues, allergies, IBD, etc.
 
Instructions are here for our spreadsheet grid.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Jamielvsaustin said:
Husband tested him prior to giving him his injection! He was at 195. That seems so drastically different from the vet, but I guess that first shot this morning could have brought him down. I tested him again later (only by 30 minutes) only because I was curious to see if there would be a change. It actually went up to 204. We didn't draw any blood on the first prick and I was a little nervous....maybe that rubbed off and stressed him out some. Husband said when he tested AND when he gave the injection-Charlie was happy as a clam. I'm already starting to feel better about this. I wish there was a day where we could do a curve. I feel like that's how you build a foundation.

Thanks for all of the links everyone has shared and is suggesting. Most of them I've read or looked at, but it's nice to have then here for reference. I've been reading so much I feel like my brain can't hold anymore. Some of the things/articles I've printed, some I've saved on the computer, and some I've done both to.

Also thank you for the continued support and encouragement. It really makes a world of difference. You guys have been both sympathetic and empathetic and it really means a lot to me.
Click to expand...

So the usual thing is for a blood glucose test, then food, then the Lantus. You will find that if you retest within the first hour or two the glucose level goes up because of the food intake. This doesn't mean that it isn't worth getting a test then as you need to build up a pattern to see how things are going. If you restest after a couple of hours you will usually start to see the drop.

This is what I do for my cat remi
Blood glucose reading-food-insulin
+2 another reading and feed again
+4 or +5 another blood glucose reading and then feed again.

I don't feed after +5 or +6 in order to make the most of the low blodd glucose (except if he is dropping too low ofcourse). Occasionally I try to get in a +10 and +11 reading as again this all begins to build up a picture.

I don't manage this each day but just whenever I can. As a minimum I always get in a shot time BG and then either a +1 or +2. There is an explanation of a typical Lantus curve (once regulated) I will go find the thread.
viewtopic.php?f=9&t=18139

NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:

+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. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number. Continue testing!
+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 (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
Updated my signature block! dancing_cat
Last night DH did things a little out of order (and I've been too) according to what you've suggested Philika. He tested him, injected him and then fed him. But-that makes sense as to why it was up a little bit when I tested him. Both times I've injected him I've done it while he was eating. Yesterday went really well...this morning not so much. I cut up some plain chicken breast for him to eat while I was testing. Of course I didn't get any blood on the first prick so I had to do it again...and I could see in him "is this chicken really worth it or should I take off?". I encouraged him to stay, had to hold him a bit...and he ended up eating all of the chicken afterwards. I then prepared the Friskies (this time a whole can between both cats) and brought him into his room. While he was eating I tried to inject him, but the second I pinched/pulled his skin up he tried to get away :( The room they're in is a spare bedroom, so I picked him up, put him on the bed and did it real quick and then put him back down in front of the food. He ran under the bed. Poor guy. I left and shut the door. Later I remembered that I hadn't given them any dry to go with the wet (trying to do a slow transition so we don't have any upset stomachs) so I went back in there...he ran under the bed again and peered out at me. I didn't try to coax him out, I just added the kibble, said my morning goodbyes and started to leave...he started to come back out, but when I stopped (thinking I'd give him a little scritch) he backed back up.

It gets better right?
 
Yes, it gets better. Spitzer would come right into the half bathroom to get his test and shot.
 
When I test remi I show him the treats (thrive dried chicken breast), let him sniff the tube but I don't let him have any until I have taken the test. I then just give him a tiny bit. I then go get his normal food, let him eat and then inject. If I try to inject whilst he eats he just try's to run off so I wait until after. Let him finish cleaning himself and then get him back on the sofa sat down. If my partner is there he strokes him whilst I give the injection but if not I try to relax him and then give the shot. The best place for the shots are not the scruff of the neck but down the side more. I can't remember where I read that. You also should vary the injection site. So I do left in the morning and right at night.

Great job with the spreadsheet. If you are home today try to get a few more readings. Ideally every two hours from one dose to another. But what ever you can manage is great. :smile:
 
I hate it. :( We tried testing around 4pm today soon after we got home, but we couldn't draw any blood. And then he ran and hid. We coaxed him out with some food and he was fine after that but we decided to leave it alone. We just tested, fed him, and now I'm trying to update the spreadsheet. When I go in through google docs it shows as updated. When I click the link here to look at it, it doesn't appear updated. Is there a delay?
 
The link in your signature is a read only document that no one can change. It has today's numbers on it. The only one you can add data to is the one on google docs that you have saved to your computer.

Sorry that testing is so hard. It will get easier, promise. Just keep offering treats. Are you really heating his ear till it's nice and warm? Are you using a larger lancet (25-27 gauge)?
 
I'm not sure what the lancet size is-it came with the glucometer. I'm almost out though, so what size do you guys recommend? The syringes we were prescribed are 29 gauge, he seems fine with them. But for the lancets I'm open to changing them if you think it'll help.
 
Get the 26 to 28 gauge lancets, intended for alternate site testing. They are a bit thicker and improve your chances of getting blood when starting out.
 
You are doing really well. Trust me by next week it will be easier. When I first started my hands would shake and I could barely get any blood out of his ear. I resorted to using a sterile needle and ended up lancing his vein over and over. :shock:

In the beginning it is best to try to come at them with a false confidence and just pretended that this is the best thing ever and what a lovely cat they are,etc,etc.
 
Thank you all for the hand holding. It really is making a world of difference to me. Last night when we tested him my palms were sweating and I had cat hair stuck to them...and I was getting hot and frustrated. I'm sure that added to his discomfort :(

It's weird-how I feel about needles. I have tattoos, so obviously they don't bother me too much. But if I'm at the Dr. and they have to draw blood, or I'm donating blood I have to look the other way. It was the same way when my dogs donated blood. So long as the needle was in, and the tube was full of blood (and I didn't see it moving) I was okay. And I think with Charlie, when I give the medicine I can't really see it go in his skin (too much fur) so it doesn't bother me as much...and he doesn't really react too much. But with the testing, the needle is right there and I see where it's going into his ear.

When I know he has to be tested and I feel like giving up-I just remind myself-he needs this. He may not understand but I do, and this could be the difference between life or death.

We don't inject up near his shoulders, always behind his ribs-on either side. Our vet told us it would be better this way too, phlika. I think she said it had to do with circulation.

I think the problem I was having with the spreadsheet is that I never closed my browser. After I did that and clicked the link from here on the forum, it appeared updated.

I'm considering changing his testing site to his paw. But I'm up in the air because he already doesn't like to have his feet touched. We weren't really concerned about touching them until recently when he started getting "pee foot" and the litter was getting stuck to the bottom.

My husband really wants to quit testing him. I think part of it was that the vet wasn't really concerned with it, and the other part is how hard it is. And he thought I was crazy when I told him-really-we should be testing him 4 times a day.
 
Ask your husband if he had diabetes, would he want someone giving him insulin not knowing if it was safe or an effective dose. Or if he would want to drive a car with a blindfold on.

Diabetes is a chronic condition that has to be managed. It doesn't go away, though in some cases, it may be possible to get it diet-controlled. To do that, you need to know how the cat is doing and you get that info from testing.
 
Why don't you show your husband my remi spreadsheet, it shows that right at he beginning I got a very low number that was unexpected and then when he switched to lantus how he went from the reds, into the yellow and now the green. If I wasn't testing I wouldn't be aware on when to increase the dose and when to watch him as he is getting close to the hypo range.
 
Well, after our scare this morning. The husband is no longer fighting testing. He still hates doing it (and so do I), but he gets it now.
 
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