Newbie, just need some support please

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Putter

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Hi there, sorry this is long and probably all over the place. My wonderful kitty, Putter Pawz, was diagnosed with diabetes about 3 weeks ago, spent 5 days in hospital and is now on Lantus, 3 u twice a day, recently changed from 2 u. I am home testing without any problems and I prefer drawing from a rear leg vein (vet tech for over 15 yrs and can't hit the sweet spot in the ears, geez.) Putters numbers are consistantly high, sometimes as high as 655 (aggggghhhh) the lowest we have seen was 264, he is acting normal, at times he is pu/pd but not often, he is active, seems happy, grooming himself and his friend, Gator, his coat looks great, in fact if I did not know he was diabetic and I was not a tech, I would not have seen the little difference in his behavior. All other blood work is within normal limits.

The reason I am writing this is that Wow! it is so different when it is your own cat, the numbers will just not come down and he is getting really picky about what he is wanting to eat. He absolutely loves tuna, could be because of the smell,he wants it all the time and he is not going to have it all the time, he has and is only eating some of the best canned foods out there (Merrick, Evo, Natures Variety,Wellness) but all of a sudden he is so extremely picky about everything (except tune) I cannot tell you how many cans of food I end up giving to my dogs.

I work for the Vets who are treating Putter, so I am able to bounce things off of them daily, they are very progressive and tend to have a more holistic approach to foods which I find refreshing, they almost always use Lantus and are very open to owners home testing, but until now when I personally own a newly diagnosed cat with diabetes I never understood how completely frustrating and overwhelming this is. The high numbers are driving me nuts. I will not be testing him again until Monday, a promise I made to the vet I work with, as we both know that things take time and I am obscessed with the high numbers, Putter is acting normal so I am only to watch his trends and of course treat immediately if I see any hypoglycemic activity and give him his insulin as prescribed.

Thank You fin advance for any suggestions on how to relax about everything.
 
Hi and welcome to the FDMB.

Here's a link to a video that shows how to do ear testing. Watch it and see if it helps. http://www.youtube.com/watch?v=_zE12-4fVn8

Also, when using Lantus, it is possible that you started a little higher than Putter's ideal dose. When you can read over the Tilly's Diabetic cat site - to review the protocol for using Lantus (or Levemir). http://www.tillydiabetes.net/en_index.htm

I'm not sure I can help with the pickiness of your sweet kitty, but maybe try pouring some of the tuna juice over the other flavors.

Dr. Lisa likes Fortiflora (?) sprinkled on food as an appetite enhancer.

Sorry you are overwhelmed but we all are in the beginning. It gets better. Just breathe and hug your kitty. Read as many articles as you can, and get to know the Tilly's protocol - maybe using that you can get Putter into remission.

Best,
Pam & Layla
 
Hi same as Pam-welcome to FDMB :mrgreen:

I echo everything she has said.

I would also ask-do you test at times between +4-6 hours after shot?
To have got to 3u in such a short time, you may have missed ideal dose.
As Pam says, pop into Lantus isg and read the stickies.
Lantus buids a shed (like a petrol tank) and this takes time. If you haven't checked kitty's bg around nadir (+6) s/he could be going very low and then the numbers you are seeing are 'bounce'-body has released glucagon to compensate.

Also, do you test for keytones? Should always do this whilst trying to regulate FD kitty.
Your building up and looking for a breakthrough dose, then you start downwards-numbers are your guide.

The ethos of this board is start low, go slow. Usually at 1u and with Lantus you hold this initially for 5-7 days. Subsequent increase are in .25u increments and do this every 3-5 days depending on the numbers you see. Some peple are aggreesive (but still not more than every 3 days. When doses get higher they may be advised to increase in doses of .5u.These tend to end up being acro kittys)

I'm throwing a bit more at you as you say your a tech.
Cn't believe you can get blood from vein-ewww! My cat would have had my hand off! :lol:

You do ned to try and avoid the tuna, plus more you give they may get fussier.
Parmesan cheese can also work. Heating the food for 10 secs also (enhances strength of flavour)

Also if you have time, good to pop in tech forum and get a spread sheet set up.I find it very helpful for spotting patterns and people know exactly what your referring to.

Good luck :mrgreen:
 
do persist with ear testing. it can take about a month for some cats' ears to bleed properly. initially there's no problem if you want to nick a capillary in the ear a bit in order to get more blood flow. you might want to consider using a thicker lancet (26 gauge or so), and to use it freehand rather than via a lancet pen. just apply slight pressure afterward to avoid bruising/scabbing. i poke the ear with a cotton ball on the other side to prevent poking thru my finger, then use part of the cotton ball to apply pressure. eventually i'd want to go to 30 gauge lancets. the BD brand is particularly well liked around here.

wondering if you'd get a discount trying the IGF-1 and IAA tests to see whether your cat might have acromegaly or insulin resistance? you've been giving insulin long enough to see a response from the lantus so i'd suspect that either your cat needs a lot more insulin to break thru resistance or the dose is too high and you're seeing classic rebound as your cat's system tries to protect against a big drop in blood glucose.

if you check the link in my signature or look at one of the stickies for newbies on the lantus insulin support group you'll be able to look at the tilly protocol for lantus/levemir. i might suggest going back to 2u BID and slowly raising dose by 0.25u every 3 days until you see better nadirs (around 5-7 hrs after shot for most kitties). [i'd prefer 1u BID if you don't mind, but be sure to check for ketones to make sure your cat isn't getting insufficient insulin.] wondering whether your cat spent 5 days in hospital because of diabetic ketoacidosis? if so, i'd be careful about reducing the dose too much and a lot more watchful about ketone testing.

concerned about why some vets discourage home testing. parents wouldn't avoid home testing if their children had diabetes, and it really gives a good indication of how our cats are doing. the natural tendency is to be a little overly numbers oriented at the beginning, but over time it becomes less of an issue and more routine. as you can't always tell whether numbers are high or incredibly low it's not super safe not to test blood glucose before giving insulin. around here we used to say it's like trying to drive with a paper bag on your head: not advisable.
 
First, welcome to the site!

I'll give you a bunch of links that I hope will be a help.
I have 2 FD kitties, one is acro and the one I adopted in March is acro and also IAA positive, so I have a couple higher dose kitties.

Testing is very important. I am no expert, so I don't aim for any vein, but rather I aim for along the edge of the ear and must be hitting something because I get a spot of blood that is enough to test. One thing to know is that ALL kitties' ears 'learn' to bleed. It is ok to experiment because it does not hurt (my Oliver sleeps through his ear pokes). I have found, Oliver has a fleshier ear and pokes on the under side work better for him, but for Shadoe, I poke on the outside of the ear. not sure why, but that's what works for the two of them. Below is a link that may help.
Testing on cat’s ear

It is quite important to test before each insulin shot because there may come a time when you get a BG that is TOO LOW to give a shot. I have had to skip shots on occasion, as have others, so always test before shots.
With Lantus, the protocol followed is based on the nadir, and not the ps BG values, so testing around mid-cycle is needed to know how the insulin is working. If you were to see high flat numbers all through the cycle, then it would be a safe bet that you need more insulin. On the other hand, if you see a high ps, then you see a crazy drop to the 50's or lower, and then a ps that is high again before the next shot, you can consider lowering that dose because it may be too much insulin and you are see a bounce, BIG bounce. Imagine taking a tennis ball or rubber ball, bounce it HARD into the ground from high up... what happens after bounce? It comes right back up high. Testing at the two high points does not show you that scary low, does it?
Yes, I admit it, I am a testaholic, but if you look at my spreadsheets linked in my signature, you will see a full story of how the insulin doses have been working and how we adjusted the dose.
Here are some links for Lantus/Levimir, and also the HYPO info links. Please DO print out the hypo sheets.
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

And the HYPO links:
List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

It's a good idea to fill out a profile so that you can put in info that everybody is going to ask you over and over; what's in this post won't be known to others in your next post, so the profiles are pretty handy to record info important to know before replying like any health issues or conditions, age, diet, insulin, dose etc.

The spreadsheet is handy to see too because over time you will see patterns, and others may even make suggestions like if you are getting big drops in the first few hours, some people give tiny snacks at +1, +2,and +3 to slow down the drop. Your kitty's nadir is unknown till you test and do a few curves. I found that my Shadoe has nadir around normal +5 or so, but Oliver has quite a late nadir near +10 or so and that is close to ps, so his low point is often just before his shot!

Since someone mentioned the acro and IAA testing, just in case you want the info on the two tests, here are the links to where I had mine done. The acro must be done at msu, but the IAA are done at other places as well. I could have had the IAA done at a Canadian location, but I decided to have them both done at msu so the results would be consistent and I'd get them at the same time.
IAA Test
IGF-1 (Acro) Test

I know it's alot, and I am sure you already know alot of it, but I figure some other newbie may come along and read your post and see the info in this reply.

Sorry for being so wordy, and welcome again.
 
Meters are geared to read capillary blood, not venous, so I don't know if that would make a difference. Please keep trying the ear or do a paw pad stick. I remember years ago a vet came on board and was having a lot of trouble home testing. She eventually did it and if not mistaken, she taught at Seneca College in CA, and was going to be teaching new vet techs how to home test.
 
Actually I would like to know more about whether a meter 'prefers' capillary or venous blood. I would think that blood is blood regardless; but would love a confirmation on this. I find that when I hit a capillary on the ear, my cat doesn't even feel it. If I hit the vein, he twitches and tries to get away. Anyone?

Hope + (((Baby)))GA said:
Meters are geared to read capillary blood, not venous, so I don't know if that would make a difference. Please keep trying the ear or do a paw pad stick. I remember years ago a vet came on board and was having a lot of trouble home testing. She eventually did it and if not mistaken, she taught at Seneca College in CA, and was going to be teaching new vet techs how to home test.
Click to expand...
 
Welcome!!!

Sorry to hear about the diabetes diagnosis for Putter and the frustrating high numbers. Sounds like Putter is in the "best" hands right now with you looking after her. I agree w/you that its a huge change in our routines and lifestyle. Its almost like another full-time job.

Curry was dx 3 weeks ago as well. I switched her to the canned food and she seemed to love it. Now it takes her a long time to eat the food and won't finish it until I put either freeze dried bonita flakes or freeze dried chicken on it. Before the switch to canned, I feed her the high carb low-fat stuff twice a day as she was overweight. Now she is going to have to learn to go the kitchen to get her food during the day when she is hungry. She won't do it on her own....I have to entice (bonita flakes) or carry her to the kitchen to show her where the food is.....So I try to get as much of her meal into her before work w/the help of the bonita flakes and other tasty freeze dried protein treats....

So maybe sprinkling the freeze dried stuff on the food will help Putter. You can always try.

Freeze dried chicken - Stella and Chewy's carnivore kisses....got them on Amazon as my local pet store ran out of them.
Bonita Flakes - Bellyrubs all natural bonita tuna flakes....got them at my local pet store.
 
Edit: How rude of me! I didn't even say "Welcome aboard"! Well, I'll say it now, I'm glad you're here for the sake of Putter Pawz; he needs a good human and he's lucky to have one. From one freshly minted member to another, welcome! :-D

(And don't worry about the relaxation - I'm still working on it, but we've made great strides since Rufus and I showed up on the 5th. I think it comes once those mysterious high numbers start turning into trends and not just alarming you!)

SaraJaye said:
Actually I would like to know more about whether a meter 'prefers' capillary or venous blood. I would think that blood is blood regardless; but would love a confirmation on this. I find that when I hit a capillary on the ear, my cat doesn't even feel it. If I hit the vein, he twitches and tries to get away. Anyone?

Hope + (((Baby)))GA said:
Meters are geared to read capillary blood, not venous, so I don't know if that would make a difference. Please keep trying the ear or do a paw pad stick. I remember years ago a vet came on board and was having a lot of trouble home testing. She eventually did it and if not mistaken, she taught at Seneca College in CA, and was going to be teaching new vet techs how to home test.
Click to expand...
Click to expand...

I looked this up and was getting ready to cut + paste the link to the source when... my finger slipped on the touch pad and I exited out of the window. :roll: Go Bee!

Anyway, there are all sorts of technical answers on the subject, but the flat answer I saw was this: the values of the blood in veins vs. capillaries are different. It may or may not have anything to do with the calibration of the meter. Venous blood can read... great, ( ohmygod_smile )I may have forgotten, but I think it was 10-20% higher than capillary blood. I hope that's the right answer!
 
Glucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as "whole blood equivalent" or "plasma equivalent."

What meter are you using? Not many read over 500/600......they just say "Hi"
 
Hope + (((Baby)))GA said:
Glucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as "whole blood equivalent" or "plasma equivalent."
Click to expand...

Thank you for correcting! Misinformation never goes over well. I read several technical variations of an explanation as to why the results would differ and they kind of went over my head - until I saw a conversation being had by EMTs. Obviously not the same kind of answer as one you would get from an actual doctor or scientist. I'm glad an actual explanation was given. Sorry about the confusion it may have started. @-)
 
OK, I'm not sure this necessarily computes for me... does this mean I need to puncture the long vein travelling up the ear, rather than the margin towards the outside of the vein? I know it's less painful for my cat when I do the margin - but what technique gives accurate readings (using an ipet meter). Sorry to have hijacked this thread.

RuBee said:
Hope + (((Baby)))GA said:
Glucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as "whole blood equivalent" or "plasma equivalent."
Click to expand...

Thank you for correcting! Misinformation never goes over well. I read several technical variations of an explanation as to why the results would differ and they kind of went over my head - until I saw a conversation being had by EMTs. Obviously not the same kind of answer as one you would get from an actual doctor or scientist. I'm glad an actual explanation was given. Sorry about the confusion it may have started. @-)
Click to expand...
 
Yeah, I am the same as Hope; no way I can hit a vein and no matter where the lancet device hits, I get a drop of blood good enough to measure.
 
Hey all, thank you for all the great info and support. I am using an Alpha-TRAk bg monitoring system, the same one we use at the clinic. We have some docs and techs who draw from the ears and some that prefer the tiny veins on the rear legs, easy stick and Putter seems to care less. In fact he seems to prefer the tiny pinch of drawing it from the leg over the ear stick, whenever we would draw it from his ear he would jump, the leg vein he just stays still, drawing from the vein is a piece of cake for me, Putter is a doll and a very good patient. My other cat, Gator, would be a huge pill about the whole thing.

I did take some advice about the foods and mixed some raw (rad cat) with some Fancy Feast (eeewwwwww!!!! meat by-products, NOOOOOO!!!) but I have to admit, he chowed it down. I am a cat and dog food snob and since I saw first hand at the clinic the destruction caused by the whole pet food recalls a few years ago, I have refused to feed anything outsourced, or containing something such as "meat by-products" or anything I don't fully reconize. I think I read every and all labels pertaining to any food my cats and dogs eat, much more than I read labels for myself and husband. :-D

The raise in Lantus from 2u to 3u has just been in the last few days, I will be testing him tonight pre-insulin, just really for my own knowledge. I have not tested him since Friday per my agreement with his personal vet, both because we know Lantus takes time and Putter seems pretty good.
The numbers were/are driving me nuts. I do have his hypo-supplies just in case and thank goodness I have not noticed any signs of hypo problems.

Thank you all once again from helping me not loose my mind completely, everyone at work is surprised how well I am handling having the home testing job and .When we are at the clinic we only have the cats for a short period of time before they go home and the owners are always encouraged to home test and switch foods from dry to raw or canned. I have personally taken calls from frantic owners over high numbers, most of the time though, the calls are because of low #'s.

I will be testing at about 7:30, so please wish me luck.

Thanyou all again.
 
Shannon, if you ever get a client that cannot afford that AT meter, please encourage them to just buy a Walmart Reli-On meter or a One Touch Ultra. The AT is expensive to clients, vet markup, and test strips also are expensive. Majority of us on FDMB use human meters......they work just fine.......and were testing long before Abbot Labs wised up to people testing their cats and came out with the animal meter. We try to convince people not only to home test but to try and cut costs so they can keep and treat their diabetic kitty. Majority of vets around here use the One Touch, not the AT. Also, people do not realize, if they run out of test strips, they just can't run to their local pharmacy and get AT test strips.

A lot of us also buy our supplies from Hocks.com.
 
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