Newbie with Questions

Status
Not open for further replies.
Wulfwin

Wulfwin

Member Since 2010
Hello all,

I'm a newbie on the board (although I've been reading for a couple of weeks now) and I had a couple of questions. This is a pretty long post, sorry!

First, the background on my diabetic kitty, Jason the Argonaut:
I work part-time in the vet clinic at a local animal shelter. Jason was brought to the shelter in early September as a stray. He was very underweight (only 6.2 lbs) and elderly (we estimate around 12 years old), but otherwise in good shape (although he did have a BB pellet under the skin of his chin which was removed easily). He put on weight quickly, but also came down with a URI. He went through several courses of antibiotics (Doxycycline and Orbax) but the URI kept coming back. In early October, we were hoping to make him available for adoption, but the vet wanted to check for diabetes first, given his age. Unfortunately, he was diabetic, but given that he was doing so well the vet decided to try to treat his diabetes. She first sent his blood and urine off for analysis, because she wanted to make sure his kidneys were in good shape. We got the lab results on 10/13. His kidneys were in great shape, but the lab work revealed anemia (HCT 24, cause unknown) and a systemic bacterial infection (neutrophils 23,440, dohle bodies 1+ and toxic neutrophils +2). Since we had no idea what was causing the anemia and the prognosis for an infection with toxic neutrophils was so poor, the vet recommended that Jason be put to sleep. I took him home to give him a few days in a loving home and ended up falling even further in love with him. I spoke to the vet the day that he was scheduled to be euthanized and we decided that I could try treating him at home. I picked up a bottle of Lantus that night, and our journey began!

I've had Jason for about a month now. His clinical symptoms have improved across the board: he doesn't drink/urinate nearly as much, his coat is much healthier, his hind leg weakness has improved (I don't know if this was actually neuropathy or if it was because he was so underweight and weak when he first came to us), his URI symptoms are gone (he's been on clavamox for 2 weeks; we did a C&S on him on 11/3 and upped his dose, and he'll be on it for a total of 3 weeks, then we'll recheck his blood work a week after stopping antibiotics), he's now a healthy 9.4 lbs, and his activity level is high. He does have pretty bad diarrhea, which he's had since I brought him home. He's been dewormed and been on a course of Metronidazole. His stools were improving, until he went on clavamox and they went back to liquid. He is getting probiotic powder with his evening wet food, but the diarrhea probably won't get better until he's off clavamox. His teeth were pretty gross, and he got a dental cleaning and two teeth removed on 10/30.

I started transitioning Jason (and my other two cats) to Wellness Core dry food this week, and changed his wet food to lower carb (I tried Wellness and Merrick, but he decided he wanted to be a Fancy Feast boy!).

I've finally got hometesting down pretty well, and I'm using the Walmart ReliOn Confirm, since so many here seemed to like it. I often can't test much past his AM shot, because I work 2 jobs, 7 days a week, and I usually have to be gone at least 12 hrs on Wednesday. Occasionally I am able to work from home, but I usually don't know when or how often in advance. On Saturdays and Sundays, I work at the shelter, and I actually bring Jason with me so I can run curves on him throughout the day.

The vet that I work with is excellent, and I can call her whenever I need her, even very late at night, but has never treated diabetes since she's a shelter vet. She does tons of research on it to learn as much as she can.

Jason's BG numbers have been all over lately, and the vet and I were wondering if maybe it was due to Somogyi rebound. His numbers on 11/9 went from 455 AMPS to a nadir of 318 at +6, then the next day his AMPS was 269 and had dropped down to 53 at only +3 (and that was a partial shot, since I felt some of the insulin on his fur). All of his BG readings and doses are on his spreadsheet. Does this look like Somogyi rebound to you all? Or any other ideas of what's going on? The only things that have changed in the last week is that I switched to a lower carb wet food and started transitioning to a lower carb dry food, both done after his crazy BG drop on 11/10.

Lately I've been having problems shooting right through the skin, so he's not getting full doses. Any tips on that? I'm used to giving Sub-Q 1 ml vaccines with 22 gauge needles, or sedatives IM, but I've never used such short or fine needles before, and I'm having trouble telling when I'm under or through the skin. I think maybe I'm pulling up on the skin too much (I just looked at http://felinediabetes.com/injections.htm).

Does it look like there's anything else that I should be doing that I'm not? Any help would be appreciated!

Thanks!
 
Welcome to Lantus Land. How wonderful that you have been willing to adopt this boy and give him love...it sounds like he is really thriving under your care.

I've only been around about six weeks so I won't even attempt to answer your question about rebound but I will say that we encourage you to try and get him off dry food. Even the grain free dry food has alot of calories from carbs so that is usually the first thing that is recommended. Most of us use Janet and Binky's canned food charts to find canned foods with less than 10% of calories from carbs and many of us are feeding less than 5% but that depends totally on the cat. Here is the link

http://binkyspage.tripod.com/CanFoodNew.html

You might see some changes to his BG with eliminating the dry food. The other thing I do know is that Lantus likes consistency so it needs to be shot every 12 hours and you need to be consistent with the dose. If you read the stickys on the Lantus forum, there is a ton of info there...it would be informative until one of the advisors can come along and discuss with you his numbers and what might be happening.

As far as shooting through the skin, what size needles are you using? It's pretty much a personal preference as to whether you use the 1/2" or the 5/16". I like the short ones so I don't shoot through the skin or give fur shots but others like the longer ones. Are you using the 3/10cc syringes, half unit markings?

It's late and most everyone is probably asleep but I'm sure one of the experienced folks can look at this tomorrow morning and offer some advice on doses and what might be happening. Good luck!!
 
Thanks for the comments! I admit that I didn't really think Jason would last this long because of the infection, but he's apparently decided that he's found the good life and wants to enjoy it! He's been a wonderful addition to my home, and even my cats have accepted him (one is very wimpy and was even terrified by a 1 lb 3-legged kitten that I brought home one night because we'd almost lost him to hypo; she only took a week to decide that Jason was ok and not going to murder her if she came too close). Like my other cats, I think he was just meant to be mine.

I actually would like to get Jason on a pure wet food diet, but I my two other cats have never eaten wet food and still won't even try it, so the Wellness Core is a compromise to get them all on a lower carb higher protein diet until I can get the other two to eat wet. Right now, the majority of his diet is wet food (1 3 oz can of Fancy Feast, of the low carb wheat gluten free variety, in the morning and 1 in the evening), and he mostly just grazes on the dry in between.

I do try to be consistent as to when I give the Lantus, but I sometimes have to adjust by a half hour or so depending on my work schedule. Is that ok?

The needles that I've been using are 31 gauge, 5/16", 3/10 cc with half unit markings. They're actually donations to the shelter, but are too short for us to use (we use the 1/2" insulin needles for blood draws on small cats and kittens). I can probably get a couple of the 1/2" from the shelter to see if they work a little better for me.
 
He really is one lucky guy and that's fantastic he's fitting in with everyone so quickly!!

The advisors will need to weigh in on adjusting by 1/2 hour...I know you do occasionally have that latitude but it's not something you want to do all the time. Sometimes if numbers are low, they want you to stall and let the number come up before you shoot and that can get you off your normal 12 hour cycle but...again, consistency is best and the most you can vary it without having to mess with the dose is 1/2 hour. If you read the stickys they state that a late shot is a dose reduction and an early shot is a dose increase just meaning you want to give less if you're late and more if you're early in the hope you can get back on your 12 hour schedule. Perhaps you need to adjust your shot times so you shoot later in the morning so you can shoot later at night...that's what I had to do.

I'm not sure why you are shooting through the skin with a short needle....someone else will have to address that...it sounds like you know how to properly tent skin if you are giving cats squids. It's the same concept...where are you shooting him...scruff, side of chest, side of belly, flank?

It's awesome that you have Jason's SS up so quickly...that is a huge help to the advisors. Again, they will have to look at it for dosing recommendations but it looks to me like he's just doing a normal bounce; he had some low numbers in green and then the liver freaks out and dumps glycogen into the system and the BG goes up. This is different than a somogyi rebound but that is just my impression from what my kitty's SS looks like....the experts can let you know for sure. It can take easily 72 hours to clear a bounce....that's why I'm up late...Gracie is clearing a bounce from low numbers yesterday so I'm monitoring her. And if you haven't been getting all the juice in...well, that can certainly lead to higher numbers so...they will need to look at it and help you with it.

Tomorrow morning if someone else hasn't done it, then you should reopen this condo and click on "post reply" and then either write "bump" in the space or ask another question....if I am up early and see it has worked its way down, I'll bump it up for you.
 
Welcome to LL! Jason sounds like a great guy, so glad you two found each other. I'm guessing you are another west coaster since you are posting so late. I can't give too many answers either, but the infection ca play havoc w/ BG numbers, as can changing his food. Is there anyway you can put the dry food where he can't get to it? That was apretty big drop so a bounce is a possibility. There are a number of strategies for evening out drops like that, but it takes a while.

We'll keep trying to bump you up to the top of the list to get more eyes on your questions.
 
Welcome to Lantus Land.

Jason is certainly very lucky to have found you. And it sounds like you are doing an excellent job w/him. I'm kinda new to this...3.5 months and typically don't give out alot of advice....I'm sure some more experienced folks will be around this morning.

Curry definitely loves her FF. I'm gonna try her on the Merrick this weekend....she if she'll eat that. My other cat was eating the EVO kibble....I too was just going to start the process of transitioning her to canned when she decided to do it herself. She's been seeing Curry's wet food and probably smelling it...then I found her this week chomping down on it....I'm slowly giving her the wet as I don't want to upset her GI system. So you could just leave the wet out....by your other cats dry food so they get use to the smell....they might decide they like it after a period of time.
 
Welcome to Lantus Land!

How lucky you and Jason are to have found each other.

I know that I've found I'm far more likely to mess up a shot if I shoot in the flank. Gabby gets her shot when she's got her face in her bowl. Scruff or side of the chest are the sites where I'm least likely to give a fur shot.

As far as Somogyi, with Lantus, it's highly unlikely. In fact, one of the more formal versions of the dosing protocol that we use, the Tilly Protocol, states,
Tilly Protocol said:
Be aware that experimental studies in human diabetics over the last 15-20 years have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists.
Click to expand...
I do think what you're seeing is a bounce. These can occur when BG values drop lower than what a cat's system has become acclimated to. The liver dumps glycogen and counterregulatory hormones to counterbalance the "low" BG level. It can take up to 72 hours for the cat's system to clear the hormones. In addition, with the dosing protocol that we use, dose changes are made in small increments -- typically in 0.25u amounts. Increasing in this way minimizes the potential a Somogyi-type situation.

I agree with Marjorie in that the sooner you can transition Jason off of dry food the more likely you'll be able to see a more stable BG. Dry food sticks around in a cat's system for quite some time.

I would also be attentive to Jason's numbers as he recovers from the infection. Often numbers can drop quickly as the infection clears.
 
Just wanted to say welcome and ditto on what has been posted already. I will get you bumped up and more experienced advisers will weigh in soon. Jason is a lucky kitty to have you as his bean cat_pet_icon My kitty is very bouncy and it can be very frustrating but keep heart you are in the right place for help, support and caring.
 
Boy this sweet Boy really lucked out by you finding & loving him!!
You really have great info, and are doing all the right things--As Sienne pointed out, dose increases & reductions are done here in 0.25 unit increments..
Really trial & error till you find the right dose...
I also feed fancy feast classic flavors only to both my cats--Check out the food lists we have here and you can see which he will like-
Two things that will drive up bg's-dry food and infection. I know you are working on that so hard!
You are doing ALL the right things, and now you have come to join us--Ask questions, read the stickys at the top of the lantus page, and test--Do what you are doing.
GREAT GREAT JOB for a "newbie" :-D -Lucky Jason! And lucky you to have such a sweet boy--
Welcome to Lantus Land!! :YMHUG:
 
welcome to Lantus Land!

I agree with the others that Jason is probably bouncing because he isn't used to the lower numbers he had the other day. Hopefully that will start to clear out tomorrow and we can get an idea of what this reduced dose is doing for him. You're doing a great job of collecting data, and now that Jason is starting to respond to the insulin that data will start coming in handy.
 
Thanks everyone for the welcome and help!

I'm actually a mid-westerner, but I'm a bit of a night-owl so I'm occasionally up quite late :smile:

So a bounce like this is not unusual? He scared me pretty good when his BG dropped to 53 so fast that one day - I was just lucky I happened to be working from home that day!

Unfortunately, now that Jason's legs are stronger, there's no where I can put the dry food that he can't get it. He showed me pretty quickly that my efforts to sequester it away from him on the counter were futile :roll: My other cats have sniffed his wet food on occasion, and there's often a little left over after he's done with it, but I have yet to see them eat it. I can try leaving some more out and seeing if they'll be interested in it, but I have a feeling they're going to be stubborn and it'll take a lot of time and patience to get them eating it. All three of them love plain boiled chicken as a treat, so I could try putting some of that on the wet food to see if that will make it more interesting. I've been feeding Jason Fancy Feast varieties that were on the wheat gluten-free and under 10% carb list that I saw posted. I had been feeding him the wet food right at shot time, but I recently started feeding him 30-45 minutes before the shot to see if that would help prevent sudden drops in his BG. Does that make sense?

The outward symptoms of his infection have been gone for probably 4 or 5 days now, but the vet wants to do a full 3 week course with the higher dose of clavamox (we upped it based on his C&S), so he'll be on that for another week and a half. He seems like he's hit a turning point in the last few days, as his activity level (and how demanding his is ;-) ) has greatly increased.

I do worry about the consistency at time. I usually try to shoot at 8:30 because I typically have to be at work by 9 (on Saturdays and Sundays I work at the shelter, so I just bring Jason with me and shoot at the shelter). On Wednesdays, however, I work both jobs, so I'm usually not home before 8:30 pm, and I'm often later (the shelter closes at 8, but we're often late because we're still doing adoptions). Should I just try to give a reduced dose on Wednesday nights when I'm late then?

I think my problem with shooting through the skin is two-fold. Jason's sudden BG drop scared me and I think was paranoid and over-compensating when trying to give the shots, and ended up going right through while trying to make sure I wasn't. It's really only been the last couple of days that I've been having a lot of problems with it, so I think part of it is just mental. I also think that I'm so used to working with longer needles and being able to see/feel where the needle is, that I'm having a hard time telling with the short needle when I'm in. I'm also used to being able to pull back on the plunger to check for vacuum to make sure I'm in. I tried using 1/2" needles today and it seemed to be easier for me, so I might just start using those. The 1/2" needles at the shelter didn't have half-unit marks though; is it possible to get those?

Should I be trying to shoot in somewhere other than where I have been? My vet suggested shooting under the skin at each limb (so right front shoulder, left back hip) in a rotating pattern to avoid any one area getting too sore/thickened. I tried shooting Jason while he was eating, but that was the one time that he did flinch at the shot so I'm not sure that will work.

Again, thanks for all the help and support!
 
What is your name???

Here's some info from the stickys on the injection sites. It varies where people shoot...I, personally, rotate around the scruff and back a little further and side of chest.
http://www.bd.com/us/diabetes/page.aspx ... 01&id=7374

You can get U-100, 3/10cc, 1/2" with 1/2 unit markings on Hocks.com or at Walmart (Relion). I'm not crazy about the Relion syringes but like everything else...it is personal preference. Alot of people use them and like them just fine.
 
My name is Sarah (I've used Wulfwin online for so long I don't even think about using my real name :lol: ). I updated my signature so it's there.

I've been using the 1/2" needles now and they seem to work much better for me. I'll have to see about getting some with half-unit markings.
 
Hi Sarah, welcome! A few things you asked that I don't think anyone else answered for you:

I had been feeding him the wet food right at shot time, but I recently started feeding him 30-45 minutes before the shot to see if that would help prevent sudden drops in his BG. Does that make sense?
Click to expand...
Are you testing when you shoot, after feeding? If so, your PS test is food-influenced, and it's best to get a "clean" preshot test. I test, feed and shoot all within a few minutes. Many of us split up the meals into mini meals, and feed at PS, +1, +2 and +3 in an effort to slow the drop in BG early in the cycle.

I do worry about the consistency at time. I usually try to shoot at 8:30 because I typically have to be at work by 9 (on Saturdays and Sundays I work at the shelter, so I just bring Jason with me and shoot at the shelter). On Wednesdays, however, I work both jobs, so I'm usually not home before 8:30 pm, and I'm often later (the shelter closes at 8, but we're often late because we're still doing adoptions). Should I just try to give a reduced dose on Wednesday nights when I'm late then?
Click to expand...
How late are you giving the shot? If it's a half hour or less, there's no need to change the dose. If it's more, we can help you figure out how to adjust for it. You can adjust the time by up to 1/2 hour a day without it having too much of an impact.
 
Hi Laurie, and thanks for the answers!

Laurie and Mr Tinkles said:
Hi Sarah, welcome! A few things you asked that I don't think anyone else answered for you:

I had been feeding him the wet food right at shot time, but I recently started feeding him 30-45 minutes before the shot to see if that would help prevent sudden drops in his BG. Does that make sense?
Click to expand...
Are you testing when you shoot, after feeding? If so, your PS test is food-influenced, and it's best to get a "clean" preshot test. I test, feed and shoot all within a few minutes. Many of us split up the meals into mini meals, and feed at PS, +1, +2 and +3 in an effort to slow the drop in BG early in the cycle.
Click to expand...

I typically test before feeding, since I assume that the number will only go up by shot time, not down. I started feeding him earlier to see if having the food in his system a little longer might help prevent any sudden drops in his BG. Tonight I actually tested him at shot time, post feeding, just because I wanted to see what the spike in his BG was from the food (334 half an hour before feeding, 477 half an hour after feeding). I usually can't feed him mini meals after the shot because of my work schedule (at least in the morning), but he typically eats 1/2 to 2/3 of a 3 oz can when I feed him, and then finishes the rest over the next few hours (so by +2 or +3).

Laurie and Mr Tinkles said:
I do worry about the consistency at time. I usually try to shoot at 8:30 because I typically have to be at work by 9 (on Saturdays and Sundays I work at the shelter, so I just bring Jason with me and shoot at the shelter). On Wednesdays, however, I work both jobs, so I'm usually not home before 8:30 pm, and I'm often later (the shelter closes at 8, but we're often late because we're still doing adoptions). Should I just try to give a reduced dose on Wednesday nights when I'm late then?
Click to expand...
How late are you giving the shot? If it's a half hour or less, there's no need to change the dose. If it's more, we can help you figure out how to adjust for it. You can adjust the time by up to 1/2 hour a day without it having too much of an impact.
Click to expand...

Most of the time I only have to adjust the dose by half an hour or less. On Wednesdays, I could be as much as an hour to an hour and a half off. It's rare for me to be that late, but it has happened.
 
A couple quick things to say for you...
For testing, at the end of cycles, sometimes the number zoom up fast so try to test and then give a shot within 15min, no longer of a time after testing. Also, no food for 2hrs prior to ps testing and shooting.... if possible for you.

About the dry food .... I have one civvie who refuses, absolutely refuses to eat anything other than ff oceanfish dry food. Only the ONE kind and flavor. I have tried to switch her to wet of some kind, any kind, but nope. She went without food for 2 days as she refused all efforts. So here's what I do when I am out - I remove the dry food.
That's it. There is plenty of wet food and water for the other 3, 2 who are diabetic.

I used to feel bad, that she would starve and die before I got home, but it's not like there is no food. The refusal is HER choice, and so could eating wet food be HER choice.

When I get up in the morn, she is the very first one greeted and fed, and she knows too! She goes scooting off to her bowl and I put out her tiny bit of biscuits. All through the time I am home, I give her handfuls of food because my civvie kitten, Apple, eats everything and I have to keep chasing her back to the wet food. I adopted her at 5mo and all she had been fed was dry, but she does love all wet foods and even loves raw chicken chunks.

I cannot leave dry because it is harmful to the diabetics. Oliver never touches it, but Shadoe ate mostly dry for 6yrs until her dx, so she needed to be broken. When she eats only a few pieces, her BG goes into the 400s, so I have to remove the dry if I am not around for her health. She has now, after a year, decided that the wet's pretty good and so are the yummy steamed chicken chunks she gets often.

I am sure the lots of cats prefer the dry kitty crack, but maybe one day or two when you are around, try putting just the wet food and give the others a chance to try it out, or try some of the methods to switch over from dry to wet.
 
Status
Not open for further replies.
Back
Top