New & Unique Situation for Smudge

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allicatmeow

allicatmeow

Member Since 2023
Hi everyone, my name is Alli. I am new here and just found this forum in my Google searches. I am very experienced in a multitude of animal medical situations, as I have had cats with everything from cancer to kidney disease to an operable brain tumor, but never diabetes, and I am learning a lot very quickly. I am in a bit of a unique situation with a kitty named Smudge who was diagnosed with diabetes yesterday and is currently hospitalized with DKA (but doing VERY well, to quote my vet, "responding faster and far better than average cats who come in with DKA").

Smudge is not mine. He was a neighborhood "stray" that my elderly, fixed/low income mother took in. I say "stray" because his owners live a mile away and just let him out and didn't want him anymore, so my mom's neighborhood took care of him, fed him, gave him places to sleep and cracked their garages open for him in rain and snow, and overall looked out for him. About 6 weeks ago, my mom had him inside and noticed he had a wound above his eye. She kept him inside and was treating it with some ointment that I gave her, but it eventually opened up and we realized it was a huge abscess from getting in a fight with another neighborhood cat. I rushed him to my vet who was able to flush it and give him antibiotics and sent him home with Animax to continue treating the wound.

The wound has taken an exceptionally long time to heal, to where I had been fighting with my mother to take him back to the vet for more antibiotics, and she finally caved because he stopped eating 3 days ago. I brought him to the vet 2 days ago where they cleaned the wound and did blood work to try to determine what was wrong with his healing process. I figured it would be one of three things; FIV, FeLV, or diabetes. When his results were in the next morning - his blood sugar was at 463, diabetes it is. He was not stressed during the test, in fact, he is the least stressed out cat I've ever met in my life and a huge sweetheart. They let him flush and clean the wounds both times without flinching, crying, or anything and he is just like that at home too. When he sees the Animax tube, he gets excited and jumps up on the bed, and waits for you to apply it. He is a remarkable 6ish year old boy.

He has been back at the vet since yesterday, where he stayed overnight and will stay overnight again tonight. He had two doses of the fast-acting insulin to stabilize him, where his number dropped to 283 quickly. I requested they use glargine insulin for him right off the bat (vs Vetsulin) and he had one dose of that last night - he stayed in the low 100s all night long! He is eating again, and they are trying to determine what food he likes best so we can continue with that and keep him eating through the process of getting him stabilized at home.

I am now in a position where Smudge will be under my care in my spare bedroom until we hopefully find a foster or a home for him, which is extremely difficult with a diabetic cat, I know. Unfortunately, I have my own 15 and a half year old kitty named Penny who has had chronic kidney disease now for a year and a half and I cannot keep Smudge. I will keep him as long as it takes to heal his wound as well as stabilize him, but this is a huge undertaking I was obviously not prepared for.

I have purchased the Alphatrak 3 for when he comes home either tomorrow or the next day, and I will purchase whatever food he likes best at the vet to transition him onto whatever will be best for him at home. I do see a lot of people using Fancy Feast chicken pate, which my vet did mention is shockingly good for diabetic cats, and I am open to that to cut down on costs for whoever will hopefully adopt him at some point. I did also look up on GoodRx where to get the cheapest glargine insulin and found it will be Walgreens near me.

I guess I am here looking for support and guidance on his food, feeding schedule, and to have the hope of getting him into remission because he is doing so well right now under hospitalization. I plan to create the spreadsheet that all of you use to keep track of his numbers as well.

So, hi everyone. Looking forward to learning more and hearing advice and experiences.
 
How wonderful of your mom and her neighbors and you to care for Smudge.

It's unusual for a cat to have such a quick response to glargine given the nature of its pharmacology. It may be the influence of the short acting insulin the vet is using. However, the presence of an infection raises blood glucose (BG) and you may end up seeing numbers coming down as the infection clears. Fingers crossed that the initially elevated BG was a result of the infection. Glargine has a great track record for getting cats into remission.

Also, make sure you ask for a prescription for syringes. You do not want to give insulin using the needle tip for a glargine pen. We adjust doses in smaller increments than the pens will permit. The pens dispense insulin in 1.0u doses. We adjust doses in 0.25u amounts. Glargine also comes in vials. You want syringes as follows:
  • U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars
  • BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
  • Syringes come in ½ inch or 5/16 inch needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
The first thing I'd suggest is to return the AlphaTrak 3. The strips are incredibly expensive. You do not need a pet-specific meter to effectively measure BG. Many of the members here opt for the Walmart Relion brand meter. The AT3 strips cost about $1/strip. The Relion strips are about $0.17/strip. All of the dosing methods we use are based on a human meter.

If you're going to make a supply trip, I'd suggest getting Ketostix (or the store brand equivalent). These are urine test strips so you can test for the presence of ketones. Ketones are very serious, potentially life threatening business and you want to do everything you can to prevent them from recurring. My cat was in DKA at diagnosis and never had a recurrence but you do not want to have them recur if at all possible given the costs of treatment and hospitalization.

You want to feed Smudge a low carbohydrate diet. We consider low carb to be under 10% carbs -- although most member feed their cat a diet that's in the neighborhood of 5%. Friskies and Fancy Feast pate style foods are popular and economical. This is a chart that was put together by a vet with an interest in feline nutrition that lists most of the canned foods available in the US along with nutritional info like carbohydrates. You have LOTS of choices. You may also want to pick up a few cans of medium carb (10 - 15%) and high carb (over 15%) food so you can steer numbers if necessary.

Many vets will tell you to feed your diabetic cat only twice a day. We think otherwise. Many cats, especially outdoor cats, may graze or eat whenever they find food available. You definitely want to feed Smudge at shot time but feeding several small meals/snacks up until mid-cycle (usually around 6 hours after shot time) is fine. The one thing you don't want to do is to feed Smudge within 2 hours prior to shot time (unless his BG numbers are low). You want your pre-shot test to accurately reflect what his BG is and not give insulin if the numbers have been inflated by food.

The information for your spreadsheet and on setting up your signature is in this link on helping us to help you.

Please let us know if you have questions. The members here are very generous with their time and knowledge. We're here to help.
 
Thank you so much for such an in-depth response! I appreciate it.

The one thing I am unsure of is that my vet is pretty adamant that I stick with a pet specific blood glucose monitor and that the human versions are not accurate for pets. I am unsure why. (I'm not purchasing the monitor through them or anything like that.) I had just called her after I read your comment to question that to see if I could use the Relion and that was her response. Would you know why she'd feel that way?

I will get more in depth with the insulin prescription in person with her when I pick him up either tomorrow or the next day. I've screenshot what you wrote about all of that, including the monitor, so I can bring it up more clearly when she is not busy as the on-call emergency vet of the day.

I will be picking up food for him later today or tomorrow and we'll keep my eye out for the keto sticks. I am familiar with ketones in general (I actually used a keto diet to lose substantial weight), but understand the toxicity of them for cats. Do you have a specific cat litter you use so that testing the urine is easier if I cannot catch it while he's going?

I've set up the spreadsheet in my signature for when he comes home. I use these frequently to keep track of my Penny's kidney numbers throughout her testing over the last year and a half so members at the Tanya's forum could track her too. I love that you're all so helpful with this and will keep track with me if needed.

Thank you again!!!
 
Hi Alli and Smudge welcome ,you couldn't have found a better group to join
Thank you for taking care of him
Sienne is right there is no reason to use the pet meter
I used it in the beginning but it became to expensive and I told my vet I couldn't afford the strips any longer and I would be switching to a human meter.
She was fine with that
Tyler has been in remission since 1-24-21 and that's with the advice I received from the wonderful members here . He is now food controlled


Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up
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6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with
Here is a video one of our members made testing her kitty
She's using a pet meter that has to be coded ,with a human meter you don't have to code it.
I have always used a human meter
VIDEO: How to test your cat's blood sugar

The normal range for a cat on a human meter is 50-100
On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up if needed

Here's the link for lantus/glargine ,read all the yellow stickys especially the 2 dosing methods to follow ,they will tell you when an increase or decrease is needed
After you get all your supplies and start testing you can set up your signature
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/


For your Hypo kit
Med and High Carb food and some honey



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.

Just keep asking questions
 
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Thank you Diane! All of that is going to be so helpful when they do a demo for me at pickup. Im certain I will fudge it up here and there but the ear diagram will be a lifesaver.

Question on the meter so I understand: I won't have to code the Relion meter or use any type of mathematical formula to get the "correct" BG number? If this is the case, I cannot understand why a human meter is being frowned upon by my vet (she is not my usual vet, she was who was available in the same practice when Smudge went into DKA). I am not opposed to going against this kind of recommendation and my usual vet is used to that with me.
 
allicatmeow said:
Thank you Diane! All of that is going to be so helpful when they do a demo for me at pickup. Im certain I will fudge it up here and there but the ear diagram will be a lifesaver.

Question on the meter so I understand: I won't have to code the Relion meter or use any type of mathematical formula to get the "correct" BG number? If this is the case, I cannot understand why a human meter is being frowned upon by my vet (she is not my usual vet, she was who was available in the same practice when Smudge went into DKA). I am not opposed to going against this kind of recommendation and my usual vet is used to that with me.
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No coding with a human meter , from what I have been told when I joined before they came out with pet meters ,human meters were used .
You can take a look at Tyler's spreadsheet for each year , just tap in the years that's are at the top of my SS tap on where it says Tyler's Spreadsheet it's at the end of my signature that's in gray
 
Diane Tyler's Mom said:
No coding with a human meter , from what I have been told when I joined before they came out with pet meters ,human meters were used .
You can take a look at Tyler's spreadsheet for each year , just tap in the years that's are at the top of my SS tap on where it says Tyler's Spreadsheet it's at the end of my signature that's in gray
Click to expand...

Thank you Diane. Do you have to adjust your dosing units mathematically somehow because it's a human testing? I just worry with conversion, etc while stabilizing him.
 
allicatmeow said:
Thank you Diane. Do you have to adjust your dosing units mathematically somehow because it's a human testing? I just worry with conversion, etc while stabilizing him.
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If you read the link I gave you about lantus/glargine about the dosing methods and pick one when he comes home it will explain it, you can always post for advice though

We adjust the dose by how low our kitties drop not by the pre shots
Here's a little info
Just some info about it look at mine at the end of my signature it says Tyler's spreadsheet to get a look at it, you can look at anyone's spreadsheet

About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers
 
allicatmeow said:
Hi everyone, my name is Alli. I am new here and just found this forum in my Google searches. I am very experienced in a multitude of animal medical situations, as I have had cats with everything from cancer to kidney disease to an operable brain tumor, but never diabetes, and I am learning a lot very quickly. I am in a bit of a unique situation with a kitty named Smudge who was diagnosed with diabetes yesterday and is currently hospitalized with DKA (but doing VERY well, to quote my vet, "responding faster and far better than average cats who come in with DKA").

Smudge is not mine. He was a neighborhood "stray" that my elderly, fixed/low income mother took in. I say "stray" because his owners live a mile away and just let him out and didn't want him anymore, so my mom's neighborhood took care of him, fed him, gave him places to sleep and cracked their garages open for him in rain and snow, and overall looked out for him. About 6 weeks ago, my mom had him inside and noticed he had a wound above his eye. She kept him inside and was treating it with some ointment that I gave her, but it eventually opened up and we realized it was a huge abscess from getting in a fight with another neighborhood cat. I rushed him to my vet who was able to flush it and give him antibiotics and sent him home with Animax to continue treating the wound.

The wound has taken an exceptionally long time to heal, to where I had been fighting with my mother to take him back to the vet for more antibiotics, and she finally caved because he stopped eating 3 days ago. I brought him to the vet 2 days ago where they cleaned the wound and did blood work to try to determine what was wrong with his healing process. I figured it would be one of three things; FIV, FeLV, or diabetes. When his results were in the next morning - his blood sugar was at 463, diabetes it is. He was not stressed during the test, in fact, he is the least stressed out cat I've ever met in my life and a huge sweetheart. They let him flush and clean the wounds both times without flinching, crying, or anything and he is just like that at home too. When he sees the Animax tube, he gets excited and jumps up on the bed, and waits for you to apply it. He is a remarkable 6ish year old boy.

He has been back at the vet since yesterday, where he stayed overnight and will stay overnight again tonight. He had two doses of the fast-acting insulin to stabilize him, where his number dropped to 283 quickly. I requested they use glargine insulin for him right off the bat (vs Vetsulin) and he had one dose of that last night - he stayed in the low 100s all night long! He is eating again, and they are trying to determine what food he likes best so we can continue with that and keep him eating through the process of getting him stabilized at home.

I am now in a position where Smudge will be under my care in my spare bedroom until we hopefully find a foster or a home for him, which is extremely difficult with a diabetic cat, I know. Unfortunately, I have my own 15 and a half year old kitty named Penny who has had chronic kidney disease now for a year and a half and I cannot keep Smudge. I will keep him as long as it takes to heal his wound as well as stabilize him, but this is a huge undertaking I was obviously not prepared for.

I have purchased the Alphatrak 3 for when he comes home either tomorrow or the next day, and I will purchase whatever food he likes best at the vet to transition him onto whatever will be best for him at home. I do see a lot of people using Fancy Feast chicken pate, which my vet did mention is shockingly good for diabetic cats, and I am open to that to cut down on costs for whoever will hopefully adopt him at some point. I did also look up on GoodRx where to get the cheapest glargine insulin and found it will be Walgreens near me.

I guess I am here looking for support and guidance on his food, feeding schedule, and to have the hope of getting him into remission because he is doing so well right now under hospitalization. I plan to create the spreadsheet that all of you use to keep track of his numbers as well.

So, hi everyone. Looking forward to learning more and hearing advice and experiences.
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I'm going to tag Bron about the DKA she will probably give you some advice when he comes home. She will most likely be on later on tonight because she lives in Australia and it's 2:40 AM there
@Bron and Sheba (GA)
 
Thank you so much Diane. I am reading up in that forum as much as I can now. I am nervous to use the Relion, as I have two very close friends who are vet techs, who are explaining to me the calibration for human vs feline,. I am scared to get inaccurate readings while he is still so early on where it would result in me giving too much insulin. I am an over thinker by nature and just don't want to do wrong by him.
 
allicatmeow said:
Thank you so much Diane. I am reading up in that forum as much as I can now. I am nervous to use the Relion, as I have two very close friends who are vet techs, who are explaining to me the calibration for human vs feline,. I am scared to get inaccurate readings while he is still so early on where it would result in me giving too much insulin. I am an over thinker by nature and just don't want to do wrong by him.
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That's fine to continue with the Alpha Trak if you want to , I understand :bighug::cat:
 
If you are going to stay with the alpha Trak on your SS that you set up then the
last two color codings need to be changed
The dark green should be 68-99
And the lime green should be <68
The one you have set up is for a human meter
If you can't do it yourself I can tag a member for you to do it when you start testing
 
Sigh.... Ask the vet techs if they use a Freestyle Libre for some cats. The Libre is a continuous glucose monitor (CGM) that has a sensor that's attached to the skin. You get readings directly on your phone via the meter's app. If they tell you they use it, gently point out that it's a human meter.

Vets like pet specific meters because they are calibrated more closely with serum chemistry analyzers which is what most blood work/lab tests are run on. The range is slightly different on a human vs pet meter. There is no direct correlation as there is probably some highly technical mathematical function the might be able to allow us to cross reference the readings. I've been here for a very long time and no one has ever attempted to find the formula for making the human and pet meters equivalent. At the lower range, the difference is about 18 points but the difference gets larger as numbers increase.

Probably some of the issue lies with not all vets being big fans of home testing. If they figure you're testing only infrequently, cost may be less of a factor. The minimum number of tests per day that we recommend is 4. With an AT meter, that is a minimum of $4/day. Realistically, if your cat is in low numbers, you're going to test more. I just went back and briefly scanned Gabby's spreadsheet. There were days when I tested 15 times. Granted, I was a testaholic but Gabby was prone to fast, early drops in her numbers and testing was the best way to ensure she was safe. Even if you're having to test with that kind of frequency only a handful of times each month, the cost can become prohibitive. Vets typically have no clue what strips cost. Just as an exercise, testing x4/day for a month = 120 strips/month. Twice a month you're dealing with low numbers = 15 x 2 = 30. That's $150 dollars for AT strips provided every test is good. The cost with a Relion meter would be approximately $25.50.

My guess is that vets are taught that the pet-specific meters are best. They are probably taught that by the manufacturers of the meters. It's similar to how they learn about animal nutrition. They get maybe an hour of lecture on nutrition and then the reps from the pet food companies tell them all about "prescription" food. (The pet food manufacturers lost a large, class action suit for calling their foods "prescription.") If the rep from Zoetis is telling vets how wonderful the AT3 meter is and, of course, giving them some free meters, there's a good chance vets will tell their clients to use the AT3. I suspect if you ask the Zoetis rep what's the statistical difference between the results on an AT3 and a human meter, you will not get an answer.
 
Wow. Thank you Sienne. All of what you said about the Freestyle Libre is what I was thinking, because she did okay that monitor. That's what made me so confused that I couldn't use a Relion. I've considered the FL because he will still have a cone on to heal the wound, so it would be convenient/easy.

I'm fortunate that my aunt has offered to pay for the AT3, so at least for the very beginning I can try to double test to compare numbers or at least appease the vet while we get him stable. $4 a day is absurd, never mind more than that. When you explained the $1 vs. 17¢, that pushed me to research even more and ask you all so many questions. I cannot thank you enough.
 
Just so you know in advance, we tell people to stick with one meter. If you compare the AT and Relion, there's a good chance you'll drive yourself crazy. @Marje and Gracie, one of the moderators, decided to compare meters. She does not encourage members to repeat the experience!!
 
That's very true. I don't want to start chasing numbers - it's easy to get caught up in doing that. I just picked up the Relion today and I will talk with my usual vet tomorrow at pickup. We have a strong 20yr relationship, so I think it may go just fine. Any tips on how to stay firm that I'm using the human monitor?

Smudge update: He's doing "great!!!" They are keeping for one more night to stabilize his numbers some more, but feels he's just about ready. He did have neuropathy in his hocks, but they feel that's improving greatly already. They said he is the "friendliest boy they've had in a long time" and he is getting tons of attention from everyone who goes back there. He picks his head right up as to say, "are you here to pet me?" and he takes his testing and insulin as if nothing is even happening.
 
If your vet has a sense of humor, ask if they'll pay for the AT3 strips because with Smudge's diabetes care and the cost of hospitalization, you are pinching pennies. If they don't want to pay for the strips, suggest they can pay for his hospitalization. All kidding aside, I'd point out the difference in cost. Your credit card is going to take a hit with Smudge being hospitalized and the vet should be sensitive to what good vet care costs.

If you want to treat the neuropathy, methycobalamin (methyl-B12) will help. You can find a formulation specifically for diabetic cats called Zobaline. It's available on Amazon. There are other places where you can find methyl-B12 (e.g., VitaCost or maybe GNC) just make sure the dose is the same as with Zobaline.
 
I'm fairly certain he will understand that I'm doing my best for Smudge (who isn't mine!) and my goal is to get him into remission, and if I can't, get him adopted with the lowest out of pocket for the new home. This is one way to do it for sure.

I've got Zobaline ready in my Amazon cart. I will ask about it for him tomorrow.

Got his spare room all ready for him. Crossing all paws over here.
 
Hello and welcome. Thank you to you and your family for rescuing Smudge.

Back when I started here, and that was after Sienne did, almost no one used pet meters, cause they weren't heavily marketed yet. All vets used human meters. My vet liked the Onetouch because she said it's results were very close to what she got back from the lab blood work. She and I used to compare notes on best places to buy test strips, and which meters needed the smallest blood drops and cheapest test strips. When the AT2 came out (precursor to the AT3) she told me she had one, but guessed (correctly) that I wasn't interested. :p A bit of news, the AT3 is a very recent addition to the market. Vets used to be all "the AT2 is the only way to go". Now, not so much, the AT3 is now the greatest thing and the AT2 is being phased out. I worked with marketing in a previous life - I'm impressed how good a job the company is doing.

The dosing methods we use were developed back before pet meters were created. They worked then, and still work now, using the numbers from human meters as the reference.
 
I actually said that to my vet tech friends, how human monitors were used for forever for this. Also that the AT2 was still considered "gold standard" by my vet and they didn't even know the AT3 was already widely available. The discontinuation of strips next month for the AT2 is so wrong and the price of all of the above feels like robbery.
 
@allicatmeow
Hi Alli I see you ordered the Zobaline as you can see it's pretty expensive
I used Vitacost brand that members told me about when I joined , I couldn't afford the Zobaline any longer
Even though the Zobaline is 3000 mcg and the Vitacost is 5000 mcg they will pee out what they don't need
Tyler had neuropathy and I used the Vitacost and saw an improvement almost every 2 weeks , he's totally back to running, jumping.
Just open up the capsule and mix it in with the wet food add a little water and mix it in
It's tasteless
Here's the link
14.49 for 100 capsules

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6?&CSRC=GPF-PA-835003001804-google_pla_gen_pro_vitacost brand-&network=g&keywordname=&device=m&adid=92700072586301669&matchtype=&gclick=Cj0KCQjw6KunBhDxARIsAKFUGs8PjStu_zPeweZxO8KP-7s5-gvQy2o5zNQSw8fe1Cgu2cDwe8hRCjsaAg0MEALw_wcB&ds_agid=58700007978637136&targetid=&gclid=Cj0KCQjw6KunBhDxARIsAKFUGs8PjStu_zPeweZxO8KP-7s5-gvQy2o5zNQSw8fe1Cgu2cDwe8hRCjsaAg0MEALw_wcB&gclsrc=aw.ds
 
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@Diane Tyler's Mom I have the Zobaline in my cart but haven't bought it yet. I forgot to ask on my call about it as well as the Vitacost option, but will this afternoon when I call back. I am hoping they gave him some kind of B12 shot (they likely did) to help him while in hospital as well.

Smudge update: He is doing well! His BG did spike this morning in the 400s so he was given 4U at 7:30am. My usual vet is now on his case, so I was able to talk through it a bit with him. He said the spiking is common during and after a DKA event, so he is not concerned, but wants to keep him an extra day to try to stabilize a bit more. He is enjoying the Purina DM most (he only likes pate) and we plan to continue that while stabilizing him, then he is fine with introducing the FF Classic pate that are LC. He said Smudge is such a good boy and he is being loved by everyone there. He is the best hospital patient and lets them do any and everything to him without a peep. He is also trying to keep my bill as low as possible for this and I am just so thankful.

I asked about the AT3 vs Relion. He said he understands why I want to use the Relion and is on board with it, he just sees human monitors be 20-30 points off for cats, so would like me to use the AT2 or AT3 for a month, just while stabilizing because of the DKA. I have a friend with an AT2, but she only has a few strips left. I will see what my vet has on hand. If they don't have strips for a reasonable cost, the AT3 starter kit includes them and is only $58. I feel this is a reasonable request and in Smudge's best interest, so I am fine with that.

I will call around 4pm for more updates!
 
Hi and welcome to the group! I got all misty-eyed reading about how you have taken in this poor stray. Are you maybe a clone of my wife? (we have 7 cats...including a neighborhood rescue with a similar story to yours)

Dammit where's that tissue box! @Diane Tyler's Mom ;)

When my boy Hendrick was diagnosed the vet said to buy an AlphaTrak and we did. Then we joined this group and found out using a human meter is fine as long as you understand the numbers are slightly different from a pet meter. Especially at the higher BG values. For example, using the AT we might get a 460 for Hendrick's BG, and using a human meter it might be 360. Both numbers are too high and indicate a non-regulated diabetic feline, that's it. There's no difference in how you would act upon the numbers.

Here's the thing: as long as you have context and understanding of what is a good, healthy range and what is a dangerously low number for whatever meter you're using, it really doesn't matter which one you use --- the AT is just a lot more expensive to use.
 
@Hendrick Cuddleclaw I might be a clone! When my husband and I moved in together, I had 5 cats all through working rescue and transport for a long time. For some reason, he let me move in and married me, even though he's allergic to cats! Now here we are with my 1 remaining from the 5 (Penny, my 15.5yo CKD cat) and now Smudge. Although I wouldn't say he's thrilled with the situation, he is supportive. ;)

Thank you for your experience and explanation with each monitor. My biggest fear, I think, is giving the wrong amount of insulin if the numbers are off by the 100 you mention. Of course, I am still learning what I would even give at specific BG numbers and I do not even have my vet's guidance on that yet either. I am an over-planner by nature and just trying to get an understanding ahead of having him back in my hands.
 
allicatmeow said:
My biggest fear, I think, is giving the wrong amount of insulin if the numbers are off by the 100 you mention.
Click to expand...

Yes I totally understand!

Whether you are using a human meter or a pet-specific meter, thankfully this site has decades of data and experience so that you can get the dose right. The dosing methods provide guidance and instruction and they take into account whether you are using a human meter or a pet meter. I followed a method called Tight Regulation because in some studies, this method produced remission in over 80% of the cats in the study. That was enough for me, all I needed to hear and I dove right in. Took a lot of time, energy and commitment but it was worth it for my boy.
 
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@Hendrick Cuddleclaw I have those pages from that thread printed out and ready to go! I work from home, so I should be able to achieve what it needs. We also think Smudge's diabetes is recent, so he has a good chance at remission. I am still trying to wrap my head around the dosing - it's like reading another language at first and my head is already spinning from how fast this has all happened. Did you have your vet fully on board? Did you do the small meals it says to do? My vet seems to be pushing the 2x/day meals while we are regulating him so we are sure he is eating. Smudge also has been having the fast-acting doses while in hospital, and I read that the starting dose needs to be adjusted for that, which is a bit confusing. (sorry for all the questions)
 
Yes my boy was also hospitalized for DKA and went from fast-acting to Lantus/Glargine. We started at 1 unit, they did not seem to account for switching from fast-acting to slow.

Regarding only feeding 2X/day. Everyone's vet says this as it is still taught in vet school but it is old and outdated thinking. Today, we know that it is actually easier on the little feline pancreas to eat multiple small meals throughout the day. 2 big meals with the insulin dose, yes, but also 2-3 other smaller meals are a good idea for a diabetic cat. And with a history of DKA, you want to be feeding EXTRA. about 150% of normal food volume, and lots of water to keep DKA at bay.

For sure this is like learning a new language there are terms and acronyms and at first it was all just a blur. Things will come into focus. I explained to my vet about Tight Regulation and my intention to follow it for dosing. I shared my spreadsheet with her and she had a lot of questions about how the dose is adjusted, why, and when. She was blown away, she said she had never seen anyone go to such lengths for a diabetic cat, that the vast majority of people just opt for euthanizing. She said she can't officially sign off on the dosing but she said he is my cat and it's my decision. And she was very impressed.


Six months later, my boy went into remission and is now a diet-controlled diabetic feline. And I have this site to thank -- the amazing people here with so much knowledge and experience. Willing to share with strangers. For nothing.

The only payment the knowledge that another cat out there was helped. Dammit where's that tissue box
 
allicatmeow said:
@Diane Tyler's Mom I have the Zobaline in my cart but haven't bought it yet. I forgot to ask on my call about it as well as the Vitacost option, but will this afternoon when I call back. I am hoping they gave him some kind of B12 shot (they likely did) to help him while in hospital as well.
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Believe me the Vitacost brand is fine and safe to give . Maybe some vets have never heard of it .
 
allicatmeow said:
Hi everyone, my name is Alli. I am new here and just found this forum in my Google searches. I am very experienced in a multitude of animal medical situations, as I have had cats with everything from cancer to kidney disease to an operable brain tumor, but never diabetes, and I am learning a lot very quickly. I am in a bit of a unique situation with a kitty named Smudge who was diagnosed with diabetes yesterday and is currently hospitalized with DKA (but doing VERY well, to quote my vet, "responding faster and far better than average cats who come in with DKA").

Smudge is not mine. He was a neighborhood "stray" that my elderly, fixed/low income mother took in. I say "stray" because his owners live a mile away and just let him out and didn't want him anymore, so my mom's neighborhood took care of him, fed him, gave him places to sleep and cracked their garages open for him in rain and snow, and overall looked out for him. About 6 weeks ago, my mom had him inside and noticed he had a wound above his eye. She kept him inside and was treating it with some ointment that I gave her, but it eventually opened up and we realized it was a huge abscess from getting in a fight with another neighborhood cat. I rushed him to my vet who was able to flush it and give him antibiotics and sent him home with Animax to continue treating the wound.

The wound has taken an exceptionally long time to heal, to where I had been fighting with my mother to take him back to the vet for more antibiotics, and she finally caved because he stopped eating 3 days ago. I brought him to the vet 2 days ago where they cleaned the wound and did blood work to try to determine what was wrong with his healing process. I figured it would be one of three things; FIV, FeLV, or diabetes. When his results were in the next morning - his blood sugar was at 463, diabetes it is. He was not stressed during the test, in fact, he is the least stressed out cat I've ever met in my life and a huge sweetheart. They let him flush and clean the wounds both times without flinching, crying, or anything and he is just like that at home too. When he sees the Animax tube, he gets excited and jumps up on the bed, and waits for you to apply it. He is a remarkable 6ish year old boy.

He has been back at the vet since yesterday, where he stayed overnight and will stay overnight again tonight. He had two doses of the fast-acting insulin to stabilize him, where his number dropped to 283 quickly. I requested they use glargine insulin for him right off the bat (vs Vetsulin) and he had one dose of that last night - he stayed in the low 100s all night long! He is eating again, and they are trying to determine what food he likes best so we can continue with that and keep him eating through the process of getting him stabilized at home.

I am now in a position where Smudge will be under my care in my spare bedroom until we hopefully find a foster or a home for him, which is extremely difficult with a diabetic cat, I know. Unfortunately, I have my own 15 and a half year old kitty named Penny who has had chronic kidney disease now for a year and a half and I cannot keep Smudge. I will keep him as long as it takes to heal his wound as well as stabilize him, but this is a huge undertaking I was obviously not prepared for.

I have purchased the Alphatrak 3 for when he comes home either tomorrow or the next day, and I will purchase whatever food he likes best at the vet to transition him onto whatever will be best for him at home. I do see a lot of people using Fancy Feast chicken pate, which my vet did mention is shockingly good for diabetic cats, and I am open to that to cut down on costs for whoever will hopefully adopt him at some point. I did also look up on GoodRx where to get the cheapest glargine insulin and found it will be Walgreens near me.

I guess I am here looking for support and guidance on his food, feeding schedule, and to have the hope of getting him into remission because he is doing so well right now under hospitalization. I plan to create the spreadsheet that all of you use to keep track of his numbers as well.

So, hi everyone. Looking forward to learning more and hearing advice and experiences.
Click to expand...
I'm going to tag Bron again for you about the DKA she will probably give you some advice when he comes home. She will most likely be on later on tonight because she lives in Australia and it's 2:40 AM there
@Bron and Sheba (GA)
 
allicatmeow said:
Smudge update: He is doing well! His BG did spike this morning in the 400s so he was given 4U at 7:30am. My usual vet is now on his case, so I was able to talk through it a bit with him. He said the spiking is common during and after a DKA event, so he is not concerned, but wants to keep him an extra day to try to stabilize a bit more. He is enjoying the Purina DM most (he only likes pate) and we plan to continue that while stabilizing him, then he is fine with introducing the FF Classic pate that are LC. He said Smudge is such a good boy and he is being loved by everyone there. He is the best hospital patient and lets them do any and everything to him without a peep. He is also trying to keep my bill as low as possible for this and I am just so thankful.

I asked about the AT3 vs Relion. He said he understands why I want to use the Relion and is on board with it, he just sees human monitors be 20-30 points off for cats, so would like me to use the AT2 or AT3 for a month, just while stabilizing because of the DKA. I have a friend with an AT2, but she only has a few strips left. I will see what my vet has on hand. If they don't have strips for a reasonable cost, the AT3 starter kit includes them and is only $58. I feel this is a reasonable request and in Smudge's best interest, so I am fine with that.

I will call around 4pm for more updates!
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@Bron and Sheba (GA)
 
@Hendrick Cuddleclaw I am glad my vet gave him the 4U of glargine this morning then, seems they are at least accounting for fast acting vs long acting. The 2x/day meal thing I questioned from the start solely from knowing that human diabetics need multiple snacks between meals to keep a constant. I figured cats would be the same and/or similar, but then the difference in BG numbers on the monitors, etc got me questioning myself and trying to research further (and that's how I ended up here really). I have a water fountain for Smudge all ready to go and I figured I'd be doing 2 main meals and some snacks sprinkled in. Maybe even an auto-feeder with just a little in it would work for throughout the night. Did you print out the spreadsheet template from here to show them? I also noticed in your video you gave Hendrick some treats, what ones were they? (again sorry for all the questions! I hope to be as successful as you and Hendrick!)

@Diane Tyler's Mom Thank you for the tag again :) I will order those Vitacost ones now!
 
Just an FYI about dosing with glargine...

Dose is not based on how high the number is. Glargine dosing is predicated on how low the dose takes blood glucose. Just as an example, my kitty was known to start a cycle in the 400s. Her numbers could plummet into the 40s and she'd be back in the 400s at the next shot time. I did not raise her dose because she was in the 400s. Rather, the drop into the 40s indicated that a dose reduction was warranted.

Glargine is a long acting insulin and you get weird results if you change the dose from shot to shot. Rather, doses are held so the insulin depot can stabilize.

This may not make a lot of sense yet. It will eventually.
 
@Sienne and Gabby (GA) THANK YOU. I have been reading that part of the TR thread over and over and over, trying to understand it, but your explanation made it click. I could not understand why you wouldn't move the dose up if they were hitting the 400s regularly (which Smudge is doing). I suppose it's a "trust the process" situation? A drop into the 40s is so scary to me. So is calculating what Smudge needs as a starter dose. He was 15lbs when he first had the abscess, but dropped to 12.9 as of last week - he could afford to lose what he did, but he is a big boy and I need to find out what his ideal weight should be. However, being prone to ketones now with the DKA...... aaaaaahhhhhhhh! Feels so overwhelming.
 
allicatmeow said:
The more I'm reading, the more I agree with you. This is so stressful.
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I mean, Smudge *did* go into DKA and getting insulin is super-important in terms of keeping him in recovery from that and not regressing. But in terms of insulin therapy the more common starting dose is good for a number of reasons. Most importantly, it allows you to gather data on how the insulin is acting on Smudge because every cat is different. And as you gather data, you adjust the dose accordingly. But the proven method is to do so in small increments, ideally .25U at a time.

The danger with starting at 4.0 is if it is too much, a hypoglycemic episode can result which could be life-threatening. While it is good to treat the Feline Diabetes, too much insulin is much more dangerous than too little.
 
Hendrick Cuddleclaw said:
I mean, Smudge *did* go into DKA and getting insulin is super-important in terms of keeping him in recovery from that and not regressing. But in terms of insulin therapy the more common starting dose is good for a number of reasons. Most importantly, it allows you to gather data on how the insulin is acting on Smudge because every cat is different. And as you gather data, you adjust the dose accordingly. But the proven method is to do so in small increments, ideally .25U at a time.

The danger with starting at 4.0 is if it is too much, a hypoglycemic episode can result which could be life-threatening. While it is good to treat the Feline Diabetes, too much insulin is much more dangerous than too little.
Click to expand...
It's hard because I am not seeing his curve myself and I have to trust them through the process of getting him past the DKA. I know for certain they would never continue at that dose if he was dipping too low and they are checking his BG every 2 hours.

I don't even know where or how I would start with the TR if his coming home dose is 4U. :(
 
Hi Smudge and Alli and welcome. I'm sorry I am just seeing the tag now. I don't think it worked.
You have been getting great advice and support. This is really a fantastic community isn't it?
I am so glad your boy Smudge is doing so well.
Here is what I would recommend you do for Smudge once you get him home.
  • you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Smudge won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, don't feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
  • Give antinausea medication if needed. Ask the vet for some cerenia and /or ondansetron to have at home.
  • Give appetite stimulant if needed after the antinausea medication if needed
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently...I see you have the SS set up...great!!
  • Post daily with updates and ask for help as often as needed.
 
Bron and Sheba (GA) said:
Hi Smudge and Alli and welcome. I'm sorry I am just seeing the tag now. I don't think it worked.
You have been getting great advice and support. This is really a fantastic community isn't it?
I am so glad your boy Smudge is doing so well.
Here is what I would recommend you do for Smudge once you get him home.
  • you need to give one and a half times as many calories as he normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Smudge won’t eat the low carb food, feed him whatever he will eat as eating any food is better than not eating,
  • Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, don't feed and test again in 20 minutes and post and ask for help.
  • Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.
  • Give antinausea medication if needed. Ask the vet for some cerenia and /or ondansetron to have at home.
  • Give appetite stimulant if needed after the antinausea medication if needed
  • Give extra fluids. If kitty will tolerate warm water in the food, put a teaspoon into each snack..
  • Ask the vet about subQ fluids
  • Set up a spreadsheet and test the BG frequently...I see you have the SS set up...great!!
  • Post daily with updates and ask for help as often as needed.
Click to expand...

Hi @Bron and Sheba (GA)! Thank you!! I hope you don't mind if I ask questions to your bullets?

  • What snacks do you recommend? Of course more wet, but I'd like to treat reward him for all the pokes periodically too.
  • The dosing with TR is a bit confusing to me... My vet has explained the 2x/day 12hrs apart dosing, but TR does not seem that way?
  • How does everyone here test for ketones? I have the strips, but I'm not sure how to even go about it. I've only ever had to catch urine once in the past for a cat with stones and not sure he will tolerate that. He is very particular with his litter box and I don't want to cause him any issues that will make him hold it.
  • I have both on hand - Cerenia for Penny my CKD cat and leftover Ondansetron from my brain tumor boy, so no problem there.
  • Mirataz also on hand for Penny, so no problem!
  • I like to mix water into wet food for Penny, so easy peasy. He will have his own water fountain too to encourage.
  • I'm a fluids master with Penny, I think they will likely have me do them when he comes home for a short time, as he's on a drip there now. Will definitely be asking.
Thank you, I will be posting plenty I am sure. You guys are just amazing. I'm already so thankful.
 
allicatmeow said:
The dosing with TR is a bit confusing to me... My vet has explained the 2x/day 12hrs apart dosing, but TR does not seem that way?
Click to expand...
Found this for you that one of our members posted ,hope it helps ,if not Bron can explain it better
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50. The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

You could try TR if you are feeding LC wet (and no dry) and if you think that's more testing than you can manage, you can switch to SLGS.


On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up
 
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@allicatmeow
Some members use ketone meters
I know the test strips are kind of expensive
Here is one I see that some members use
https://www.adwdiabetes.com/product...MIxPXp7uGAgQMV7vbjBx2QRguXEAQYAiABEgLKJPD_BwE

Here is one that doesn't come with the glucose test strips like the one above
https://www.adwdiabetes.com/product/3400/nova-max-plus-glucose-ketone-meter-kit

Test strips
https://www.adwdiabetes.com/product/3398/nova-max-plus-ketone-test-strips
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Here is another one , have to buy the test strips separate
https://www.amazon.com/DSS-Precision-Glucose-Results-Included/dp/B00JIK6CIW/ref=sr_1_2?hvadid=177788502361&hvdev=t&hvlocphy=9003521&hvnetw=g&hvqmt=b&hvrand=4219662392123758501&hvtargid=kwd-477427537592&hydadcr=21691_9710897&keywords=blood ketone meter precision xtra&qid=1693276389&sr=8-2

Test strips I see they offer you different amounts to buy
https://www.amazon.com/dp/B00XIBK8HS/ref=twister_B0C9PQWPVK?_encoding=UTF8&psc=1
 
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allicatmeow said:
What snacks do you recommend? Of course more wet, but I'd like to treat reward him for all the pokes periodically too.
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Yes snacks are low carb wet food if possible, but remember eating anything is most important when recovering from DKA. For treats try and keep to low carb if you can. If you are unsure just ask.
allicatmeow said:
The dosing with TR is a bit confusing to me... My vet has explained the 2x/day 12hrs apart dosing, but TR does not seem that way?
Click to expand...
Yes, TR dosing is 12 hours apart dosing. TR just means you can increase the dose more quickly than with SLGS, which is important with DKA. And the reduction BG is lower with TR (50) for a human meter and 68 for a pet meter, where SLGS reduction BG is 90 for both the human and pet meters. We will help you with it.
You can read about TR and SLGS HERE
allicatmeow said:
ow does everyone here test for ketones? I have the strips, but I'm not sure how to even go about it. I've only ever had to catch urine once in the past for a cat with stones and not sure he will tolerate that. He is very particular with his litter box and I don't want to cause him any issues that will make him hold it.
Click to expand...
Most use the urine test strips but some buy a meter that tests for ketones in the blood. They are more expensive than urine test strips. Let us know how you go with the urine testing. If it doesn't work out you can have a look at the blood ketone meter.
Her is a link to COLLECTING URINE FOR TESTING
allicatmeow said:
I have both on hand - Cerenia for Penny my CKD cat and leftover Ondansetron from my brain tumor boy, so no problem there.
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Excellent
allicatmeow said:
Mirataz also on hand for Penny, so no problem!
Click to expand...
Perfect!
allicatmeow said:
I like to mix water into wet food for Penny, so easy peasy. He will have his own water fountain too to encourage.
Click to expand...
You are well organised! Great!
allicatmeow said:
'm a fluids master with Penny, I think they will likely have me do them when he comes home for a short time, as he's on a drip there now. Will definitely be asking.
Click to expand...
That's really good you know about sub Q fluids. They can be really useful when recovering from DKA. Not always needed but really good to have if needed.
 
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Hi Alli, I think it’s already been stated, but I just want to (re)emphasize that the BG numbers stated as “normal,” and what’s considered “too low” or warranting dose reductions, are based on a human meter (AT and other pet meters would have higher values).

For example, 50’s on a human meter are considered in the normal range but would warrant immediate intervention with food/syrup on a pet meter (as well as a dose reduction).

The dosing methods/protocols on this site are premised on BG values from a human meter. Although that’s emphasized in the dosing explanations, it’s easy for that detail to slip through the cracks for newbies (and worth re-emphasizing as a precaution IMHO, including for lurkers…).
 
JL and Chip said:
Hi Alli, I think it’s already been stated, but I just want to (re)emphasize that the BG numbers stated as “normal,” and what’s considered “too low” or warranting dose reductions, are based on a human meter (AT and other pet meters would have higher values).

For example, 50’s on a human meter are considered in the normal range but would warrant immediate intervention with food/syrup on a pet meter (as well as a dose reduction).

The dosing methods/protocols on this site are premised on BG values from a human meter. Although that’s emphasized in the dosing explanations, it’s easy for that detail to slip through the cracks for newbies (and worth re-emphasizing as a precaution IMHO, including for lurkers…).
Click to expand...
True. An oversight on my part. I’ll amend my post. Thanks
 
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