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Jeannee and Nuggie

Jeannee and Nuggie

Member Since 2011
I find this website a little overwhelming but I need to learn more about how to handle my cat's dosing. He is a high dose cat (12U). He also has Cushing's disease and pancreatitis. It seemed like he was always at the water bowl no matter what. His numbers for the longest time were always around 250. For about a week my vet suggested if glucose over 300 give 14 units, if under 180 give 12. Well, then he went down to 56 one evening ... then she said go back to giving 12 all the time. So last night his g was 65 - so I didn't give him a shot. This morning it was only 150 - I didn't know what to do. I now have a fear of him going too low. So I gave him 8 units - then 3 hours later he was 250. My very well educated friend said I should always give the same dose, so I hope I haven't messed him up.
 
HI !Welcome to LL! Although Lantus works best w/ consistent dosing, sometimes you need to make an exception. Unusually low BG at shot time is one of them. You didn't mess up, you kept your kitty safe!

It would help if we had a little more information about you and your cat. Names are good for a starter.
  • How have you been keeping track of the dosing? We use a SS here so others can look. Any advice given is based on the BG testing data. We can walk you through setting the SS up on Google Docs. Clink on the 2015 SS link in my signature to see an example. I'm a testaholic so don't freak, you don't need to test nearly that much.;)
  • How old is your cat?
  • When was Dx?
  • What does he weigh?
  • What is he eating?
  • Where are you? We have members all over the world, so a general location helps to keep time zones straight.
That would help for starters. The folks here are really knowledgable and we have several high dose cats, I'm not sure if any have Cushings though.
  • When was that DX made and what test?
:bighug: :bighug: Ann
 
I just wanted to say welcome. There are a lot of very knowledgeable people on here who will be able to offer great advise!
 
Hello and welcome. I too have a cat with a high dose condition, actually two of them. Neko has acromegaly and IAA. First a couple of questions. What insulin is Nuggie on? What food is he eating? The answers for dosing depend on the insulin. It sounds like you are also home testing, so good for you. We use a common spreadsheet to track our tests and it helps us suggest doses. Would it be possible for you to use our spreadsheet. The instructions are here.

We have a number of high dose kitties here, I hope we can help you.
 
Thank you everyone. My name is Jeannee - I don't know why I used an alias - I signed up a long time ago, but never used this site. My cat is Snuggles. I call him Nuggie-Nu. He will be 13 in March. He was first dx about 6 yrs ago, then went into remission for about 3 years. (I don't know what you mean about what test dx him.) He is on Lantus. I don't want to tell you this - but he is 19 lbs. We are in Cincinnati, Ohio. Food: right now Nutro Natural Choice which is less than 1% carbs and Wellness minced chicken (7% carbs?)

My vet wanted me to use the Royal Canin Diabetic. It is about the same price as the Nutro (except I usually get the Nutro on sale). She is so good to me I thought I would humor her and use it. My cat really likes it, but he got diarrhea. At the time we thought it was from the Clavamox. I didn't have any RC for several days and just got some more. After 2 consecutive cans he got diarrhea again.

I did get the spreadsheet but did not figure out how to do it the right way. I have it on my computer in my documents. I'll fool with it again. I wasn't able to upload a pic here either. Last week he had very labored breathing and looked awful. I was afraid he was dying. The vet I took him to said it was a virus, but his vet thinks it is something else he will have to deal with, so now we are using an inhaler.

Yesterday he felt better than he has in a long, long time .... now today something is bothering him again. I'm thinking maybe it's his pancreatitis. I gave him some Buprenorphine.
 
Welcome!

I think Ann was asking how the Cushings was diagnosed.

First, the amount of info here is overwhelming. We'll help you take it one step at a time. We have folks who are great at assisting with getting your spreadsheet up and running and that is a good first step. It's hard for us to help you sort out the dosing without being able to get the full picture of what you've been doing and how Snuggles has been responding.

I'd encourage you to read through the sticky notes at the top of the Board. They will help you to get the background for how we approach dosing. Some of what's there may need to be adjusted for a cat with Cushings -- much like it is for any high dose cat.

So, deep breath and let us know what questions you have an how we can help.
 
Thanks so much Sienne. I know - just when I think I have it figured out ... something else happens.

The Cushings: He had an ultra sound on Oct 15 which showed his adrenal glands are enlarged. His poor little belly is still bare.

I just remembered they did blood work too because she called me a couple days later to confirm the diagnosis.
 
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I see you've got the spreadsheet set up - that's great! Do you have data to the beginning of the year? The more we can see of recent data, the better. Could you put something in your signature saying that you use the AlphaTrak. most of us here use human meters, and follow a protocol that uses human meter numbers. But there are a few people here using Alphatrak - we just need to be reminded because decision points on the protocols are different depending on the type of meter.

Do you know if they have determined the cause of the Cushing's? Treatment options differ depending on whether the tumor is on the pituitary or the adrenal glands. If both adrenals were enlarged or just one? The blood tests could help determine which type. Do you have a list of the test run? Has your vet talked about next steps to treat the Cushings? There isn't a lot on this site on Cushings but there is some newer research material.

Dx - means diagnosis.

Using commercial wet foods that agrees with Snuggles is fine. Most of us here use commercial low carb canned or raw food.
 
Hi Wendy, I went back and added info back to Jan 1. It is a mess. We were back to vet tonight because he wasn't feeling well - I could just tell by his behavior and the look in his eyes. So she changed his insulin dosage to 10U. He is on Vetoryl for the Cushings. Both adrenal glands are enlarged. That's all I know. My "main" vet got whatever the "supervet" who did the Cushing's test supplied. I chose my "main" vet in part because she is a diabetic herself and can relate that maybe he didn't feel good today because his numbers were elevated. On the other hand his numbers could be elevated because he is in pain from the pancreatitis. So we have a new med plan for the next few days. She also kisses him and emails, so she is a saint.

About the AlphaTrak. I saw that some people use the Freestyle Lite strips, but when I researched, they are no cheaper than the AlphaTrak strips. I am going to have to cut down expense where I can without compromising his health.
 
If you shop at Target or Walmart they both have house branded meters whose strips are much less expensive. Taget has their Up & Up meter, actually an Agamatrix Presto and Walmart the Relion Confirm or the Micro, made by Glucocard. Both meters received the CR Best Buy rating From Consumer Reports. You can get strips for them at American Diabetes Wholesale for as low as 22¢ a strip if you buy several boxes. (There is a link on the Home page for "Shopping Partners". That will take you to a page of links. If you link from that page FDMB gets a commission, but it costs you nothing. It helps keep this site running.) ADW is also a great place to get syringes and other supplies.
 
Jeannee...I know you've heard this before, but there's really no need to keep using the expensive AlphaTrak meter

You could save a ton of money by using one of the human meters....the Relion meters a lot of us use have refill strips for as little as $9 for 50 (for the Prime) or $35.88 for 100 (Confirm or Micro)...the Confirm and Micro use the exact same sample size as the AlphaTrak too

Sending scritches for Nuggie!!
cat.gif
 
Hi again Jeanne - send some scritches and hugs to Nuggie. Poor guy on the pancreatitis. Pancreatitis pain can definitely impact the blood sugar. Have you seen our Primer on Pancreatitis?

Thanks so much for the spreadsheet updates. That's really helpful information. The protocols we use say to stick to one dose for at least 6 cycles to see how it's doing unless a reduction is earned. Both Levemir and Lantus work best with consistent dosing. The 10U you are doing tonight is probably a good place to stay for a while, unless you see him under 68. Anything below that on the Alphatrak means he needs a lower dose. Is it possible to get some tests in the night cycle, say before you go to bed? Often kitties will run lower at night than during the day. My Neko loves to do that. :rolleyes:

The Vetoryl (or trilostane) seems to be what is most commonly used for Cushings - good to hear he's getting that. As you probably know, Cushing's isn't very common in cats. We haven't seen many on this board. How is Nuggie's skin? Some Cushings cats have skin that tears easily. Which can make blood testing trickier.

Cushings can be caused by several things, such as overuse of steroids, or tumors on either the pituitary or the adrenals. Depending on the cause of the Cushings, the treatment can vary. Sounds like your vet thinks it's pituitary, which is the most common. Neko's acromegaly is also caused by a pituitary tumor.

Yet another thought - sorry to be throwing a lot out there. Have you ever talked to your vet about the possibility of using Levemir? Lantus has an acid base, which can sting at higher doses. Not for all cats, Neko got up to 8.75U without it bothering her. I switched to Levemir after she went down to a lower dose. I just mention it because some Cushings cats have sensitive skin and Levemir might be easier on him.

Sorry for the long post. There is a lot to learn at first with diabetes and even more so when your can has a high dose condition. It does get easier. :bighug:
 
Hi Jeanne! You've gotten lots of good info - and boy can we all relate to it being overwhelming. Hang in there and as Sienne said, we'll help you find the right info that you need at the right time. I'm sorry your cute little Nuggie is having a bad time. My high dose cat, Punkin, had acromegaly (benign tumor on the pituitary gland). Punkin passed away a little over a year ago.

We love our little ones so much.

There have been cats here with Cushing's, although it is far less common than acromegaly or even iaa (insulin auto-antibodies.) If there is a question we don't know, there are folks with experience with Cushing's that we can get to help you. Linda/Bear Man is the most experienced, probably, and she just became a vet tech recently after all she learned with Bear Man. At the moment she's on vacation, but I'm sure she'll stop in to meet you as soon as she can. Wendy has also been doing a lot of recent research on the high dose conditions and has a wealth of knowledge on them.

The primer on pancreatitis that wendy gave you is a great resource to make sure everything possible is being done to help Nuggie's pancreatitis and to help you know what to ask your vet about.

Please keep asking questions. We're here to help you find answers, but we're also a great supportive community. You don't have to go this alone. :bighug:


Edited to add (because I always think of more to say):;)
by the way, I agree with Wendy about staying at 10u per shot right now. You're right that you'll see the best numbers and be able to figure out dosing if you stay at one dose for several cycles. Changing doses is a bit like rocking the boat - you've got to wait after you change to let things settle down so you can see what's going on.

I'd also switch away from the AT. In no time you'll have made up for the cost of getting a new meter with your savings. AT strips are the most expensive. Freestyle lites aren't good for cats - i used one - they measure the blood differently and you won't see the high numbers that are there. I'd stick with one of the ones that Ann & Chris are suggesting, but i don't think it matters much which. Human glucometers are completely fine and so much cheaper to use. For the cost of 1 AT test strip you can do 4 tests on the human glucometer.

Then I'd also try to get at least one test in the pm cycle because we do see many, many cats have their lowest numbers at night. Because Lantus dosing is based upon how LOW the dose takes the cat, not the high numbers, it becomes important to catch the lowest numbers.
 
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Hi Jeanne!

No advice from me, but I just wanted to welcome you and Nuggie to LL. We are a very friendly group and you will find lots of support here. Don't be afraid to ask questions. The only stupid question is the one you don't ask. We were all new to this once, and we know how overwhelming it is. I hope your kitty is feeling better tonight.
 
The nadir, or lowest point between shots, is often between +5 to +7 hours post-shot for Lantus. For Levemir, it can be later, even up to the next shot times.
 
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Thanks everyone. Nuggie is doing much better. I don't think I mentioned here that besides all his other problems, he had a twisty-tie in his tummy. When I took him to have it removed by endo-surgery last Tuesday, luckily it had passed. And he has been feeling much better since then. I know I shouldn't be a "fair weather" ... or "bad weather" participant, but what prompted me to come back here is I had upped him to 11U, now his g is 73 this am. I see someone said lower dose if under 68. I'll be home most of the day, so I'll be able to give him frequent checks. Wendy, thanks for the pancreatitis link.

His skin is ok. He's got some bald spots on his belly and arms from medical procedures done several months ago that has not grown back. I just took a pic of him feeling better. I'll see if I can put here.
 

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I agree - please get a +1 and +2 test. Any time you shoot a low number, you want to be sure to get early tests. Also, do you have a stockpile of strips and high carb food at home should you need it?
 
Jeannee, did you give the 11 units? It is not filled in on your spreadsheet, yet.
I agree to start the cycle with a +1 test, and you will probably need to test frequently today, so I hope you have lots of test strips and high carb food or syrup, if needed.
Please let us know what his next test number is.
 
Yes, I did. Ok. I'll check. He had shot about 50 minutes ago. Yes, I have plenty strips - and I'm going to go get a Relion meter after while. Funny thing is the highest carb food I have, I believe, is the DM with gravy. I ordered some on a whim to make my vet happy without reading the ingredients. When I got it, I read on the label that it has corn starch and wheat gluton and I wrote the company and asked about the carbs - over 11%! So no, I haven't used it.
 
11% is more like a medium carb food. Do you have some karo syrup or maple syrup or honey?
If you need to, you can make some high carb by adding a of couple drops of syrup to his regular food.
I would try not to get him too full (so feed smallish meals), as if you need him to eat to get his numbers up later, you want him to be hungry enough to eat.
 
Ok +1 it is 97. (I have corn syrup.) Looks ok, though, huh? I'll check again in an hour.

[Also since I first posted here he had another problem - he had a spell of very labored breathing - I was afraid he was dying. I rushed him to the vet and that vet said it was a virus. I took him to HIS vet the next day and she thought it was something more permanent that is a result of his other health issues, so now he also has an inhaler. He hasn't needed it for awhile though.]
 
The 97 is a safe number, although it could be from a food spike. (I'm guessing he ate when you gave him his shot this morning.) Still get a +2. Lantus often doesn't "kick in" until around that time, and we want to make sure he stays safe today.

So sorry to hear about the breathing problems; I can't imagine how terrifying that was for you. What type of inhaler did the vet give you?
 
Thanks for the info.
Let us know what the +2 is.

If you have a grocery store real close by you, maybe you could run out and pick up a few cans of high carb?
I always try to keep a few cans on hand.
 
I would get another test in an hour.
That window when he was 97 at +1 is past now. I would post pone any appointments or errand running until he is rising without food for a couple of hours. When was the last time you fed Snuggles?
 
If he'll eat, I would give him two or three teaspoons of food now, to try to get him surfing along at these numbers. Maybe even add a drop of syrup to get him to rise up a bit.
 
Checked g at 8:30. He ate between 8:30-9:00. Then I gave shot.

What should I do in the future? A time or two in the past when I did not give shot or gave lower dose he just shot back up.
 
I just read your last comment Dyana. I'm glad you said that because my other cat wants another bite to eat and I can't give to one without giving to the other.
 
What should I do in the future? A time or two in the past when I did not give shot or gave lower dose he just shot back up.
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Post here first, and ask, if you are unsure about whether to give insulin or not. You can add something to the Subject Line like "Need Help on deciding whether to give insulin or not" or something like that.

All of these tests today, and all of the future test information you get, will help you and anyone helping you to make decisions, by looking at the past data and his history.

Cats will often bounce (or have higher numbers) after going down to a number they are not used to. Whether you give insulin or not.

Let us know if you gave a drop of syrup and what the next test number is. Sorry, for all the pokies, Nuggie, just trying to keep you safe.
 
I did not give syrup. I gave him Wellness minced with a couple Temptations. He was highly suspicious of me (thinking I was going to take him to the vet) and hid in the closet, but then he came out and ate.

I just read under "tight regulation" that if g is <80 to reduce dosage by .25-.50 IU.
 
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You might want to close the closet door and the bedroom door (so he can't hide under the bed).
 
I'm going to call this +3.5 61! I'm so glad you urged me to keep testing.

I rubbed some corn syrup on his gums and gave him some more Temptations.
 
I'm glad you read my post, and didn't leave.

I think that 61 using an Alpha Trak meter earns him a dose reduction. I would go to 10.5 starting with tonight's dose. Let's see if any others suggest that it only be a 0.25 reduction to 10.75. Are you able to test more during mid cycles, during the days and nights?

Next test should be in 30 minutes, now.
Come on up, Nuggie. I'd like to see you up in the 110s.
 
You can put that 61 in the +3 column and write 61 @3.5 and then you'll have to manually change the color of that box. I would like to see the +4 please. We want him rising. See if he'll eat a little bit of regular food with a drop of the corn syrup mixed in. The corn syrup you rubbed on his gums will wear off pretty fast and the food will help to keep his numbers up longer.
 
Hi Jeanne - looks like Nuggie want your attention today. I agree with Dyana on the 0.5U reduction down to 10.5U. You had gone up to 10.5U earlier, but you need to give a dose 6 consecutive cycles to see how it's doing, and the reduced dose for his endosurgery mixed that up.

And thanks for posting the pic and update on Nuggie's skin. A lot of Cushing's cats have sensitive skin that tears easily, but not all do. For those that do, we suggest a bit more conservative dose so the caregivers don't have to poke them as much. Nuggie's numbers are looking pretty good. I think the meds to help his Cushings may be starting to work. Once that happens, it's easier to get the diabetes aspect under control and you may need to reduce the dose again.
 
He's eating the food with corn syrup right now. Should I give it a little while longer so it has time to get into his system?
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I would test again when he's done eating. I would like to make sure that corn syrup is helping him to rise.
If you wish, give him 10 to 15 minutes, and then test.
 
Please take a look at the Shooting & Handling Low Numbers sticky. There's a section on managing low numbers. It's useful information to print out.

Temptations or any dried food/treat can take a while to be metabolized an get into the blood stream. The gravy part of high carb (HC) food hits the blood stream far more quickly as does any kind of syrup. (The dry stuff also takes a long time to be processed through your cat's system.) FWIW, I use Karo to manage Gabby's numbers since she is sensitive to the gluten in HC food. The point is that using any kind of HC food to boost numbers is a temporary fix. You have to keep an eye on the numbers and make sure your cat is staying in a safe range since as the HC wears off, numbers drop back down.
 
So when the Temptations kick in he'll prob be 400! (I'm exaggerating - I hope.) I feel so bad I did this to him.
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Don't feel bad, you're learning and learning is a good thing. You only gave him a few, right?

He's 86 now.
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Good. Is that his +4? I would test again in 45 to 60 minutes.
 
I called it +4, but it's closer to +5 since I waiting a little longer than an hour each time.

(I gave him a few a few times.) I was in a panic to get his numbers up.

I have a really hard time getting blood from his right ear. Would there be any reason for that ... or it's just him ... or me.
 
Sometimes the one ear may bleed easier than the other. Have you tried the left one?

When you have a chance to, write in the Remarks section of the spreadsheet what you fed and gave and when.
It may help you in the future.
 
We don't have to address this right now - you must have other things to do today but if I understand correctly if my AlphaTrak says 80 the human meter (for the same blood sample) would say 50. So that google spreadsheet - is it assuming the human meter? Do people just automatically add 30 to their human meter reading?

About the food - yes, I will record. Thanks. I remember what he ate yesterday so I'll put that in.
 
It could be scarring. Do you apply pressure after you poke to staunch the bleeding? Make sure you're using a new lancet with every poke, too. I've seen photos of a lancet after even 2 pokes, and they fray out like crazy. That can increase damage and scarring. Some people alternate ears - we learned on punkin's left ear and scarred it, then switched to his right ear for the next 2.5 years. I put neosporin ointment with pain relief on it every single night and his ears looked perfect. They would heal overnight. Vets always commented about how good his ears looked and how you'd never know we tested him often.

I don't want to mess things up with Dyana helping you, but i wanted to say 2 things: I agree with decreasing by 0.5u, and i'd also encourage you to always get some sort of mid-cycle test in every cycle. Because Lantus dosing is based upon how low the dose takes the cat, it's important to know that for dosing, but also so if he goes low like today you can keep him safe. Insulin is a powerful hormone and you want to take it seriously. Gotta protect these precious little kitters!

You can vary the time of a mid-cycle test to whatever works with your life - when you head out to work or when you come in from work during the day cycle. In the pm cycle the right-before-bed test is really important.

Just put in the numbers you get from tests and make sure it says loud and clear on your ss that you're using an AT. We look at it with those eyes. You'd save a ton of money if you switched to a human meter - 4 strips in a human meter = cost of 1 strip AT.
 
See my signature link Glucometer Notes for some feline reference ranges using a variety of meter types and measurement systems.
 
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