Newbie Intro: Goldie

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FosterMomGoldie

FosterMomGoldie

Member Since 2013
Hello! Just wanted to introduce my foster cat, Goldie. He's a very sweet 9 year old orange and white boy, and super talkative! I've had him since the end of May; his previous family had him since he was a kitten, but when he was diagnosed in Dec 2011 they decided they couldn't be bothered to treat it at ALL, and never took him back to the vet and weren't even willing to change his diet to wet food. A friend of my rescue group (Halfway Home Cat Rescue) heard about him early this year and persuaded them to give him up to us. We took him straight to the vet and got him on insulin, and a day later he was a whole new cat!

He is very friendly, very talkative, and very adventurous-always eager to get on the other side of a closed door! Unfortunately my girl cats don't like him or I'd adopt him myself, but he's completely unfazed by them, and dogs as well. He is currently on two units of Lantus twice a day, and a wet food only diet (much to his chagrin!). I had some trouble home testing early on and his vet said not to bother with it, but after talking with the folks at DCiN I'm going to start testing before each shot-hopefully I can get some techniques off the forum!

Thanks in advance for any advice or encouragement, and please don't hesitate to send me a private message if you have room in your life for another sweet diabetic kitty!
 
Hello and welcome to the board!

What kind of wet food is he getting?

Do you need a shopping list for the meter etc? Once you have the meter we can give you lots of testing tips...

Wendy
 
Thanks! He's eating Friskies Pate, the vet recommended it as being high in protein. I have the testing equipment already, I'm not sure what brand as I've already left for work.
 
Welcome to FDMB.

Sounds like you've got diet down, and a good insulin.

What questions do you have?
 
My big question is, how will I be able to tell if his diabetes can be diet controlled? I know it has to do with testing and how long his BG stays low after insulin, but I don't know the specific numbers. Also, what is the safe range for giving insulin? I managed to test him this morning, and it was 34! I've never seen it that low (or even below triple digits), so I decided to play it safe and skip insulin, but he didn't seem particularly groggy or listless or anything that would suggest a potential crash. I've read that below 90 is 'normal' for cats, but beyond that I guess I don't have a very good concept of what different ranges indicate, or how low is too low.
 
FosterMomGoldie said:
I managed to test him this morning, and it was 34! I've never seen it that low (or even below triple digits), so I decided to play it safe and skip insulin..
Click to expand...

YIKES!!!! TOO LOW!!! Good decision not to shoot,
What is his Lantus dose?

Here are some glucose reference ranges used for decision making using a human glucometer. Numbers in parentheses are for non-US meters.

< 40 mg/dL (2.2)
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8)
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2)
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7); if not on insulin, this can be safe.

> 150 mg/dL (8.3)
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1)
- no shot level for beginners; may slowly reduce to 150 mg/dL ( 8.3) for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6)
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6), if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Wow, thanks! He's on 2 units twice a day, initially on one twice a day but after a few full-day BG curves at the vet she increased the dosage.
 
Welcome to Goldie and his foster mom. What is your first name?

I'm Deb and that tuxie over on the right is Wink, my diabetic foster. ;-)

BJM said:
FosterMomGoldie said:
I managed to test him this morning, and it was 34! I've never seen it that low (or even below triple digits), so I decided to play it safe and skip insulin..
Click to expand...

YIKES!!!! TOO LOW!!! Good decision not to shoot,
What is his Lantus dose?
Click to expand...

I second that YIKES!!!! Wow, good thing you decided not to shoot.

I see where you said the dose is 2U, B.I.D.

Looks like that may be too much insulin for Goldie. With that 34 BG(blood glucose) reading this morning, Goldie earned an automatic reduction. I'd drop the dose down to around 1U, maybe 1.5U but only shoot if you get a test first.

I think the diet is already starting to work for Goldie.

You should expect the numbers to bounce higher with that low number of 34 from this morning.

Do you have any other test data you can share with us?
 
We find it helpful to record any test data with a Google Spreadsheet/chart. Because it is online, it may be shared (selectively - you decide) with others for review, including your vet.
Instructions are here

AMPS - refers to morning (AM) pre-shot
PMPS - refers to evening (PM) pre-shot
+1 = any test 1 hour after giving insulin
+2 = any test 2 hours after giving insulin
+# = any test # hours after giving insulin

We reference the time this way due to the multiple time zones members are in. That way, no one has to figure out any time conversions.
 
Thanks, I'll set that up! I took another reading just now (still no insulin) and it was 128. He's eating less than usual today though, maybe because the testing is stressing him out?
 
Vets aren't used to doing this, but we recommend dose increases of only 0.25U at a time in most cases. Depends on the nadir or lowest number in the cycle.
 
FosterMomGoldie said:
T... He's eating less than usual today though, maybe because the testing is stressing him out?
Click to expand...

More likely, he doesn't have to eat for the excessive insulin. You're really lucky he's OK.
 
Just tried warming his ear with a microwaved rice-filled sock after reading the suggestion on here, it went SO much more smoothly!
 
Good job on the SS! We have read only access now, so that will help us to help you better and suggest tests at different times and see what is going on with Goldie.

Glad to hear the warmed rick sock did the trick for you, and made getting the blood easier.

How else may we help you?
 
Great job on the testing! Looking at todays numbers, 1.5 is also too much too!! I might reduce to 1 unit tonite and see how that goes.

Also if your PM test is under 200 I would skip the shot and start 1 unit tomorrow morning instead.

Wendy
 
Thanks for the advice! His numbers have been going very low since I got home from work, so I'm skipping the shot and I put a few pieces of dry food on top of the pâté to get him to eat some more. I'll test again before going to bed.
 
Ok but he is low, do you have any food with gravy in it? Or syrup? That 35 is too low and dry takes too long to kick in.

Give 2 tsp of high carb wet food with gravy or 2 tsp low carb wet food mixed with 1 big drop syrup. Retest in 30 minutes and let me know how it is.

We don't want him dropping any lower!!
 
I didn't see your suggestion for a few hours, but after I did I tried it with some syrup, and his BG went from 43 to 59 in about half an hour. Thanks!
 
Ok good because I was worried!

For future reference whenever he drops below 50 you decrease the dose 0.25iu and give him 1 drop syrup mixed with 2 tsp wet food. Retest in 30. Repeat syrup and food and tests every 30 minutes until he goes over 60. Then stop the syrup but test again at 30minute intervals until you get two rising numbers. Reason is that the syrup will wear off and he can drop back down again depending on where he is in the cycle.

If he does drop again like that just come on here though and ask for help (in a new post with 911 so we don't miss it)

EDited to add: remember tomorrow don't shoot if under 200. If over 200 give only 1 unit.

Wendy
 
My take on insulin therapy is that it is best that the dose be appropriately set so that the cat can get a shot twice (preferred) or once a day and not have big swings in its blood glucose (BG) numbers. And that the cat not be forced by exogenous (from outside the body) insulin to get below 50 mg/dl.

I am not a fan of simple sugars like karo or dry cat food to temporarily force up a low BG number, unless the cat is showing hypoglycemic symptoms like stumbling or seizures. If the cat's numbers are low but there are no symptoms, I prefer seeing people using small, frequent feedings of the cat's normal low-carb canned food to bring its BG levels up. Such small, frequent feedings of the cat's normal food results in a more gentle and long-lasting rise in BG levels. Simple sugars have potential to drive the cat into a sugar bounce--low from too much insulin, quick high from simple sugar, back low from sugar wearing off and insulin still on board, up again from the simple sugar...and maybe a sustained higher BG level from the combo of the simple sugar and the insulin wearing off

It appears to me that Goldie has amazing potential to go OTJ (off the juice or off insulin) from a gentle insulin therapy and continuing his low-carb canned food diet, without simple sugar add-ons. If he were with me, I would likely drop his dose to .25 to .5 units and only shoot when I found him over 150 mg/dl. I would be testing 3-4 times/day. After shots, I would be testing at +5 to +9 to see how how low he goes. In other words, I would do PRN (as needed) shots.
 
Wendy&Tiggy said:
I would shoot that 201 - give 1 unit and lets see where he goes.

Wendy
Click to expand...
Oh, I did, sorry, I've been very busy this weekend and haven't had a chance to update, didn't realize I forgot to put in the dose.
 
Venita and Ennis93 said:
My take on insulin therapy is that it is best that the dose be appropriately set so that the cat can get a shot twice (preferred) or once a day and not have big swings in its blood glucose (BG) numbers. And that the cat not be forced by exogenous (from outside the body) insulin to get below 50 mg/dl.

I am not a fan of simple sugars like karo or dry cat food to temporarily force up a low BG number, unless the cat is showing hypoglycemic symptoms like stumbling or seizures. If the cat's numbers are low but there are no symptoms, I prefer seeing people using small, frequent feedings of the cat's normal low-carb canned food to bring its BG levels up. Such small, frequent feedings of the cat's normal food results in a more gentle and long-lasting rise in BG levels. Simple sugars have potential to drive the cat into a sugar bounce--low from too much insulin, quick high from simple sugar, back low from sugar wearing off and insulin still on board, up again from the simple sugar...and maybe a sustained higher BG level from the combo of the simple sugar and the insulin wearing off

It appears to me that Goldie has amazing potential to go OTJ (off the juice or off insulin) from a gentle insulin therapy and continuing his low-carb canned food diet, without simple sugar add-ons. If he were with me, I would likely drop his dose to .25 to .5 units and only shoot when I found him over 150 mg/dl. I would be testing 3-4 times/day. After shots, I would be testing at +5 to +9 to see how how low he goes. In other words, I would do PRN (as needed) shots.
Click to expand...
Wow, this is very interesting! What level does Goldie's BG have to remain at for him to go off permanently, below 150?

(Still busy today, so I probably won't be back on until tonight, but I'm very interested!)
 
Venita - I am not sure how you can tell this early ( less than a week of insulin) that Goldie looks like she has a good chance of remission - any more than any other cat anyway. to my eyes, it could be the dose is just too high at 2units, and forcing her too low. Especially when we usually recommend most cats start at 1 unit.

I always understood the key to lantus was consistency and we are looking for a starting dose we can give twice a day and build up the lantus depot. 1 unit may well be that dose. Obviously as a newbie I wouldnt be shooting over 200 (or 150 as Venita said) for now, but over time you may find that you have to shoot low in order to keep him low.

Wendy
 
New question: I tested Goldie three times in a row, and the numbers were very different! 136, 100 and 150, in that order. I usually don't double check, but they've never been more than 5 apart when I have. Is this typical? Should I replace the meter? It's a Bayer Contour USB from DCIN.
 
Wendy&Tiggy said:
Venita - I am not sure how you can tell this early ( less than a week of insulin) that Goldie looks like she has a good chance of remission - any more than any other cat anyway. to my eyes, it could be the dose is just too high at 2units, and forcing her too low. Especially when we usually recommend most cats start at 1 unit.
Click to expand...

Goldie has been on insulin since mid-May and started on 1U. After 3 weeks and an at-vet curve in the mid 400s, the dose was raised to 2U BID. (I have this information because DCIN is helping with Goldie and has his vet records.)

I said what I said about remission because I see Goldie being very responsive to the Lantus. Especially after being diagnosed and untreated for 16 months by his former owner. Goldie seems like a very resilient diabetic, and I do get "good vibes" from what I see on his spreadsheet.

Okay, should I be taking three readings and averaging every testing?
Click to expand...

I would say no to that, Goldie's Mom. Maybe on occasion you would want to double check the meter on the same drop of Goldie's blood or test it on yourself or with control solution. But taking three samples for every test and averaging unnecessarily triples the cost of home testing. Those readings were within variance, and unless they were taken on the same sample of blood, it is reasonable for blood glucose to quickly change.
 
Re: Newbie Intro: Goldie for adoption.

Goldie is still available for adoption. Goldie's Bio: Goldie is going to be 9 in June. He is a recently diagnosed Diabetic. Neutered up to date on Rabies and is a real sweet cat. He is doing well on low doses of insulin and had a full glucose curve in June. We have been told that his numbers are so good, that he is a good candidate for remission! Please contact Robin at 413-237-6271 or email at Robin at ivorykbkb@yahoo.com NEXT ADOPTION CLINIC 8/25/2013 AT PETCO IN ENFIELD FROM 10-1.
 
I've been testing a few times a day this week and only giving half a unit when he gets up to 150. I think it's going well, he's only needed one shot every other day for almost a week now. I'm going to try testing very frequently when I'm home during the day this weekend to see how his BG behaves on average.
 
You might take it down to 0.25 units by eyeballing it on the syringe.

Or, see how many equal sized drops you can reliably get out of 0.5 units (use colored water to see it better), then dose by drops.
 
Once you can get the same number of drops per half unit, You draw up insulin as usual, then squirt out the number of drops your don't want to give.
So 0.5 - 1 drop
So 0.5 - 2 drops
So 0.5 - 3 drops
Etc.
Discharge the excess insulin into the sink.
 
Thanks!

Didn't get to do a full curve after all, was incapacitated with a migraine most of the weekend :(. Did get more readings than usual, though, will post tomorrow.
 
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