Newly diagnosed 6 year old, in South America

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shelly2893

Member Since 2013
Good evening everyone! Holly had been steadily losing weight, and I suspected diabetes right away. I was told by the people at Petsmart (where I adopted her) that torti's have a higher rate of diabetes than many other breeds. Unfortunately, they are not equipped here in Bogota for cats as well as they are dogs. Fancy Feast is not sold here, and I tried to bring two cases back recently. One case of 24 cans was taken at customs as I had brought back too much. I had someone else bring me another case that made it through. It's the diet she was on before we moved here last year, and I suspect she may have had controlled diabetes prior to our move. The good thing is that the diabetic supplies are much cheaper here than in the states. I have a Lantus pen, and just found out I should not be using it directly. The amount they have her on (which is not effective) is .01 of a unit. The pen isn't marked for it. I have to guess. I'll look for syringes tomorrow, but I doubt they have them marked for that either. Her sugars are still very high after nine days of insulin. All her labwork/notes are in Spanish. Doing the best I can, and am looking at options to get her the food she needs. I'm thinking .01 is WAY too low. When her nose is dry, I can't get blood no matter how warm her ear is. Any suggestions/comments would be appreciated. Thanks!
 
Hello and welcome to the FDMB, the best place in the universe to help your diabetic cat.

The three keys to diabetes treatment are

1. good, long duration insulin - Lantus is one of these so your set there.
2. food - low carb canned diet, <10% carbs
3. home testing - to keep your cat safe, to adjust the insulin dose, to have better control of the situation and more information to work with.

For food, look for foods without grains, no potatoes, no peas or vegetables or fruits. There is a topic that talks aboutFood for European and International buyers. I don't know if any of the foods mentioned there are available in Columbia. I don't think we have had many South American members.

Again, I do not know what glucometers may be available where you live. You want to find one with a low cost of test strips. That is where your major expense will occur.

The only South America info on food I could find was for Brazil.
FOOD/COMIDA

There are very few canned/wet food options in Brazil (Whiskas, Sabor & Vida, Topcat, Chanin, Three Cats). To make it worse, only one of the (national) brands currently found meet the criteria of <10% carbs, according to the label and that brand is "Three Cats premium wet food" in three flavors: chicken, meat and tuna, 300g/ Tem pouquíssimas opções no Brasil de ração úmida (aquelas de lata, não os sachezinhos), e a qualidade é muito inferior às estrangeiras. A única que segue o critério de taxas de carboidratos inferiores a 10% (aprox. 8%) é a "Three Cats Premium" - ração úmida (não confunda, pois há também uma versão seca, imprópria), que é brasileira e vem da região sul do país, é um patezinho que vem numa embalagem quadrada, meio dourada. Tem três sabores: frango, atum e carne, todas com 300g cada. Tem conservantes e corantes, infelizmente. Price Range/Faixa de preço: RS5,10 - 8,00.

Fabricated by/Fabricada por "Hercosul Alimentos" (http://www.hercosulalimentos.com.br/)

Supermarkets don't sell them, some petshops do. It's not impossible to find, but it's not so easy as well, like the other (poor quality and high carbs) brands/Supermercados não tem ração úmida dessa marca, mas alguns petshops sim. Não é super fácil de encontrar, mas também não é impossível, ao menos no Rio de Janeiro. Petshops que podem ter: "Petshop No Ar, Dog Landia, Cobasi, Pet World, American Pet.
Click to expand...
 
Hi and welcome to the group.

we typically suggest when starting on insulin to start at either 1/2 (0.50) unit or 1 unit twice a day.

It's great that you can easily get lantus and supplies, and you are right, using the pen needle is not ideal for dosing for a cat - check out the pharmacies to see if they sell U100 insulin syringes with 1/2 unit markings - you want the syringes to be 0.3 cc, I used 31 gauge 5/16 inch length

so it would read like this - 0.3 cc 31 gauge x 5/16"length

the length is a short needle (my personal preference) and 31 gauge is a very thin needle (you may find 30 or 29 gauge) and that's fine too. the important thing is that size be 0.3 cc ( which is 30 units or less) and the 1/2 unit markings will help you with micro dosing.


as far as food - what canned food options do you have available? check out Dr. Lisa's food comparison chart, to see if any of the available foods are on the list. The ideal is under 10% carbs. I typically use 0-7% carb foods. http://www.catinfo.org - look down the right side of the page for the chart.

if none of the foods that are sold in the US are available locally, then the next best thing is to read the ingredients - share them with us and we can do our best to see if they have any questionable ingredients.

questionable ingredients include - rice, wheat, grains, carrots, potatoes, peas, etc. Essential anything that is a carb - you want to avoid that as much as possible.

You may even want to consider a raw food diet. You can make raw food and freeze it and this way you will know exactly what is in it. of course that is assuming Holly will eat it. Maui will but my civvie Buster won't.

Are you home testing? It is the only way to know for sure if it is safe to give insulin and to know how the insulin/food is working for Holly. You can buy a meter, matching strips and lancets from a pharmacy. You should pick up ketostix to test for ketones in the urine.

And don't worry, we can help teach you how to test even from a distance.

so supplies you need:

glucometer - do not get any meter that has TRU in the name or freestyle meters with butterfly strips - several people have had issues with them. Relion , Bayer, OTU are good choices (if available)

strips - that match the meter

lancets - that either fit the lancet device if you want to use it and if not, then any lancets they have - just remember to get ones that are 28 or 29 gauge. the way the gauge is designed is the lower the number the thicker the needle.

neosporin - or any brand of antibiotic ointment with pain relief - to rub on ear after testing to help with bruising

ketostix or ketodiastix - to test uriine for ketones

you will also want to put a hypo kit together, just in case she ever drops too low, you will have this together so you don't panic or worry about what to do. here is the link for putting one together - viewtopic.php?f=14&t=2354

and here is the link on how to treat hypos - viewtopic.php?f=14&t=1122

so, how else can we help you?
 
If you wind up needing to make your own cat food, the Cat Info site has a recipe.

It also notes that about 1/6 of a canned food maybe replaced with plain, cooked, meat or poutry, wich may lower the carb calories too.
 
Thanks everyone! I am home testing with a one touch ultra mini. I should be able to find the correct syringes to use instead of the pen for injections. The only US food they have here (canned) is Friskies, and I did add chicken or fish to this food before I got a supply of Fancy Feast. I've been reading that the Lantus metabolizes much faster in cats than in humans and cats should get this twice daily, not just once. Her sugar levels were high before the insulin and are now even higher. (Mid-300's to now 450 and up.) It is a micro dose of insulin. (.01) The vet is having me test her this weekend right before the insulin and then two hours after. Last night it went down, tonight it went up. On Monday, I'll get these results to the vet to change her dosage. I have honey on hand in case of a hypo incident. I haven't found corn syrup yet.

I do have friends that go back and forth, and I come back every few months. I was actually supposed to be there now, but there are no caregivers here that provide the medical care Holly needs while I'm gone. I may have a vet student interested in helping out next time. It's just a matter of how to get the food here without them thinking I'm bringing it in to sell. I've looked at some home food recipes. The meat won't be a problem, but finding any needed supplements may be. Again, may have to bring them from the states.

I know she's not feeling well today. Our weather here ranges from the upper 40's to the 70's all year round, humidity is not a problem, so unlike the sweltering states, she's not reacting to the weather.

If only I spoke feline...
 
What is she doing? Is she licking her lips? Showing interest in food and then turning away?

If yes - that could be signs of nausea and if you can get regular pepcid 10 mg size and give her 1/4 tablet, that may help with the nausea feeling.

Do not use pepto bismol or immodium - those aren't good for cats.

What local brands of food are available? What are the ingredients? They may be ok to use depending on the ingredients.

So, I'm curious, what are doing in South America and which country are you in?
 
Hey there

Can you track your results on a spreadsheet so we can help advise better and see whats going on? http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
You really want to get 4 tests a day if you can:

- Always before you give every shot. As a newbie you dont want to shoot under 200 yet until you have enough data to know how Holly will behave when you do.
- Mid cycle - 5-7 hours after morning shot to see how low Holly is dropping
- Before bed - 2-3 hours after evening shot - to see what Holly's nighttime plans are.If this number is the same or lower than the preshot test you might want to set the alarm for another test mid night cycle as it usually means an active cycle.

If you have honey then you dont need the corn syrup.

Sooner you get the syringes the better - more accurate for smaller dosing - you want ones with 1/2 unit markings if you can find them

Wendy
 
Hi Shelly,

Would you please provide us with some more information and put this in your user control panel? It helps us to help you better. This will take about 5 minutes of your time.

Think of this as having some very useful information at our finger tips for those that are replying to your posts. One reason we like to see this information in your signature is because if there is ever an emergency situation like a possible hypoglycemic episode, we don’t have to ask a lot of questions like what meter you are using to give you the best advice. Doing this signature update is totally optional, but it does help us to help you better.

If you are willing to do this, would you please do those updates when you get a chance? Thanks.

Go to the upper left corner of your screen and click on the words, User Control Panel
On the next screen, a row of tabs is presented. Select the Profile tab
On the next screen, there are a number of choices along the left hand side. Select Edit Profile.
Go down to the location field and enter your country, state/province, and city if you are willing to share that info.
Click on submit to save this change.

Still in the User Control Panel, Profile tab, this time select Edit Signature from the left hand list of options.
A free form text box appears.

We like to see information like your first name, your cats name age and sex, the diagnosis date for the diabetes like this (DX 4/30/13), what meter you are using for testing, what insulin you are using , what you are feeding (wet or dry, what brands/style of food), any complicating health issues your cat may have, any additional medications your cat is receiving. If you are using a pet specific meter like an Alphatrak or Ipet, please change the font size on that text from Normal to Large (using the drop down arrow list in the middle of the editing commands)

Click on submit to save this information. Now, this will appear at the end of every post you make. You can update the info when you need to.

There is an additional document you can create to provide even more information about your cat. This is also optional to create this google document and link it into your signature. The profile is in addition to the synopsis info in your signature. See this link on the how to's of profile creation. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=79123
Click to expand...
 
I moved to Colombia a year ago to teach English. I'm now taking some time off to learn Spanish.

It has been difficult to get blood from Holly's ears - she has a tendency towards dehydration. When her nose is dry, I know I can't get blood, but I try anyway. Trying to do a curve or get results more than three times a day right now is not possible. I've been keeping track of her injection times and blood sugars along with what type of food she's eating. I have a table I set up to keep track of everything. Looking at what I have from the eleventh, when we started insulin, she doesn't have any regular cycle. She can be high or low in the morning and the same after the insulin. I've tested her before and after eating, and again I get highs and lows as if what she's eating has no affect on her sugar level.

I have another older cat (Luna-12 years) who is healthy and prefers the dry food. I'm leaving very little of that out during the day and I do not leave it out at night. Holly doesn't like the dry stuff, so I'm lucky there.

For the insulin, I'm not even giving a half unit and it is only once a day. It's .01, less than the amount of blood I get from her ear for a test. She's still not feeling well today. I think she's constipated again. I have a laxatone-like product here I have to give her a few times a week. She turned down her food this morning - very unlike her. She has been drinking a little bit of water and her nose is wet. I just got a reading of 503, and she's eaten very little all day. Much less than usual.

She is licking her lips. I'm on my way out to get the syringes and I'll get some Pepcid. Do I just give her a few drops? I assume this may help with the constipation too?
 
We have some tips ( above) that might help. Do you freehand or use a tool? Key points from those tips include

- using a larger lancet ie 28 or 29g
- having something hard behind the ear to press against
- making sure the ear is really warm

Can you set up the spreadsheet? We have looked at hundreds of cats sheets and should be able to see a trend or whats going on, even if you cant. Now of course, if she regularly gets dry food that can well be keeping her high. You are sure she isnt eating any? The laxatone product doesnt have sugar in it does it?

Lantus is supposed to be dosed twice daily - every 12 hours for best effect.

503 is pretty high, are you testing for ketones?

1/4 pill of pepcid ad (one pill = 10mg famotidine) is enough. You can give it twice a day - make sure its the pepcid ac though as other ones have calcium etc in them.

Wendy
 
Thanks - I must have skipped over where you said you are in Bogota. Cool that you are teaching. A friend of mine went to South Korea to teach English. Personally, I'd prefer Colombia. ;-)

Since you are giving such a small amount of insulin and she is staying relatively high, I suggest two things:

1) dose her every 12 hours (2 times a day) or BID as we call it
2) give her 0.50 unit not 0.01 unit -

What you are giving is barely a drop and probably why it's not having much effect and only giving it once a day, means she goes 12 hours without insulin and that's not good.

I wouldn't get too concerned about doing a curve. Rather, I'd like to see you get set tests in even 3 each cycle is fine to start. And by cycle, I mean every 12 hours. So a total of 6 tests a day.

Pre shot
2 hours after shot
4-6 hours after shot

As you get used to testing and her ears start to bleed better, you can always test more, we will never tell you not to. :lol:
 
If you feed canned food, add some extra water. I add about 1 tablespoon per ounce of wet food. Think applesauce consistency. Or you can make it even soupier to get more water in her and keep her hydrated.

You can use canned plain pumpkin or squash or baby food squash to help with the constipation. It can help with diarrhea too. Start with 1 tablespoon added to the food.

Or get some Miralax (polyethylene glycol 3350 is the generic). Start with 1/8 teaspoon a day and work your way up until the poop is soft. Then work your way back down on the dose. Always add extra water to the wet food when giving the Miralax as it is an osmotic that draws water from the rest of the body. I simply mix the Miralax into Wink's food. He sometimes needs it 2x a day.

Pepcid is a pill. You want the plain, not the complete, 10 mg. Only give 1/4 of a pill (2.5 mg) 30 minutes before feeding.
 
Got the syringes - thanks for the info! I'm pretty sure she's not eating much dry food, if at all. She much prefers the canned. I pick up the dry during the night - neither cat has access to it. The vet gave me the laxatone. It's a combination of petroleum jelly and mineral oil. She wouldn't lick it off her paw this morning. :?: They don't have canned pumpkin here, but I'll check the baby food section. They have a LOT of fresh squash, maybe one of them will be similar. I'll ask around.

Just an FYI - they don't have canned or frozen foods like in the states. Everything is fresh - even the herbs and some spices are fresh and whole.

They don't have Pepcid. I have Gastrum, the only one they had with the same ingredient, Famotidine, 10 mg. It does warn about liver and kidney issues. Holly had high liver readings before the diabetes was diagnosed. They even thought she might have had FIP based on some marginal readings. Do you think it's safe to give her this medicine?

I gave her a teaspoon of milk (lactose-free) to aid in the constipation issue. Vet recommended it last time. Holly had to have an enema at the doctors a couple of weeks ago because nothing would work, even the milk.

The vets here do not know much about this. They called in an endocrinologist to help with the diagnosis and dosing. I guess the endocrinologist didn't know about the Lantus only working 12 hours either. Should I go ahead and start dosing twice daily? I'm hesitant to change anything - I am going to the vet tomorrow afternoon for the diabetes check. If she doesn't poop, I might try and go earlier. They might need to give her another enema.

My medical Spanish is improving faster than my basic...
 
I am not testing for ketones. I'm not sure the vet would know about that for the cat. This is seriously DOG country. :smile:
 
Ok so I would wait on twice daily dosing till you get the syringes (? Which will be when?) .

Normally pharmacies will carry urine ketone test strips but I have no idea about South American pharmacies so maybe get someone to ship you them from the US if you can't find them..

Wendy
 
I've got Holly's current table attached here. Sorry, but I don't use excel or google docs if I can help it. I prefer to make my own tables in word. Faster and easier for me to work with. If you think I need to add another column, let me know. the W and D are for wet and dry. If I see her eat a little dry food it's a small d. Mostly W's because she usually eats a LOT of canned food.

I just got the syringes. It will still be difficult to get the right amount - 0.01 of a unit.
 

Attachments

That's fine... but its not easy for us to work with... if you want us to help you. So if you won't use our standard format you will likely get less eyes and help than you otherwise would.

The reason we have our sheet is it allows us to track trends and issues really quick.. Which is what you want if there is a problem. Our sheet is good in that it says how many hours after the shot the reading is without doing math all the time.did you look at our sheet? It's not hard. And given you could be tracking results for months, word will get unwieldy as it can run to many pages.

If you still insist in using word can you at least build a table and make it more like ours?
 
I have looked at the spread sheet in google docs. At some point, I'll see about starting a second table in google docs, but I have to keep this table I've started for the vet. Holly possibly has other undiagnosed health issues, or they could all be related to the diabetes. All I need to know right now is does the insulin get her sugar down. I think that's why they started so low, 0.01 units.

Right now, her blood sugar is 553, and she won't eat. I've called and left a message for the vet. My question now is, do I give her insulin? She didn't even want her treats after the ear stick. Constipation must be very bad. Should I give her the Pepcid equivalent I have even though it warns about liver and kidney issues? Her liver tests were high. Since her sugar is so high, should I give her a half unit? Even though she won't eat?

I have syringes now and can give her a more accurate dose. My gut says to give her the pepcid, crushed up in a feeding syringe of watery food then giving her a half unit of insulin and watching her carefully. The honey is ready if needed, but her sugar is so high...
 
Yep i would give her 1/4 pepcid and 0.5 units of insulin as Hilary suggested. On the 0.3cc syringes, that's a very small amount, the very first 1/2 unit mark. I will try to find a picture.

Then get a test at + 2 (2 hours after shot) and let us know where she is at.

Wendy
 
and don't give her any more milk - most cats are lactose intolerant and this could be contributing to the constipation.

If you can find baby food squash or fresh squash to puree - that would be good to add to her wet food daily and then you can back off the "pepcid" (or local name). You may also want to see if you can give her probiotics. While yogurt is a milk product, for now if you can get plain yogurt - without added flavors or sugar you could try mixing that in her food if you can't find the squash (pumpkin).

If you cannot get probiotics locally, you can order it online. Check to see if you can get Purina forti flora, or maybe you can find this or something similar locally - http://www.vitacost.com/jarrow-formulas ... lus-2-5-oz - and even being dog country, they may have something available for dogs that you can use.

It is important that we get her eating as not eating will cause other problems. If you need to syringe feed her. when you go to the vet - ask the vet to give you a feeding syringe - hopefully they will have it and be able to give you one - if they don't, you can always pull the needle out of an insulin syringe and use that as a feeding syringe.
 
Holly's blood sugar is now 527 after increasing the dose to .5 unit. I've spoken to the vet. We're going in first thing tomorrow morning. Should I dose her again in the morning? I did tell the vet about the twice a day dosing and the minimum starting dose.

I think the Pepcid helped a little bit. She's walking slowly, but she's still using her legs to climb.

The milk here is lactose free and processed a little differently. If I give her too much it will give her diarrhea. She only gets a teaspoonful or so. It's one of their remedies for cat constipation. Not so sure it works - I've only done it twice and it didn't work either time. :YMSIGH:

I do have a feeding syringe, thank goodness. I watered down some canned food earlier and stuck the crushed Pepcid in it. SInce so many people here can't have lactose, I have a LOT of lactose free products to choose from. I can even get lactose free yogurt! That is a great idea - I hadn't thought about the probiotics. Lots of health food stores here, I'm sure they've got something.

Everyone has been great, helping me out. I will try and do the spread sheet, but it is going to take some time.
 
Yes, she should get another 0.5U dose in the morning, 12 hours from the time of this evenings shot.

The type of squash we use here for the constipation are the winter type squashes like pumpkin, butternut, acorn. If you can find any of those similar orange or yellow fleshed winter squashes there in Bogata, you could cook it up and freeze it.
 
I've been trying to get the spreadsheet downloaded onto my computer. I don't have internet all the time, so I need to work with it on the computer and then upload it whenever necessary. There is no save option and the download won't work on google docs for some reason. I've tried copying it, renaming it and then trying to download it, and sending it to myself in an email, but nothing has worked. I can't think of another option. Any suggestions would be welcome! Thanks much!
 
It takes a couple of days to see the impact of a dose change because Lantus is a depot insulin and it builds up in their systems. I made a few changes to your word doc to make it better for us - see attached.
 

Attachments

Thank you so much! I'll get started on the spreadsheet.

After a scary two days of getting fluids at the vet, Holly is doing a little better and is eating and drinking. With the BID dosing and .5 unit, I've just recorded her lowest reading since this whole thing started - 360. I asked the vet about ketones - she doesn't know where to get strips. They only check ketones through the lab. She also didn't know how to use the glucometer. I think when these things happen down here they just put the animals down. :(

Sonogram tomorrow to make sure she does not have an obstruction somewhere. Antibiotic day two - Pepcid equivalent seems to be helping. (I don't dose these at the same time.) Just hoping Holly can hang on until the sugars get regulated.

Vet wants her to try Science Diet a/d canned. Says it's high protein. If I remember correctly, the dry ones were not good at all. I didn't check the cans. I'll go back and see what they are rated.
 
A/D is a medium carbohydrate food and only comes canned, I believe. Check the food chart at Cat Info. It is intended to get weight back on fast and get the cat eating again.
 
Glad to hear that Holly is getting better. We all get so scared and worried when our cats are sick and in the hospital. You must be so relieved to have her back home with you. Hope she continues to improve. Was it the lack of food or the dehydration that prompted you to take her to the vet? If she gets dehydrated again, I'd recommend that you ask your vet about getting the fluids and giving them yourself at home. It's easy. I've done it for several cats. We have youtube vidoes we can share on how to give fluids.

The Hill's Prescription Diet A/D canned is 12% carbs in calories, 15% carbs on a dry matter basis. Higher than we like to see. It's certainly going to be a bit of a challenge to find a lower carb food down there in Columbia. If she needs to gain the weight and she will eat this food, go ahead and give it to her. The insulin dose can be increased slightly to work around the food issue. It's more important that she eat something so don't worry or stress over the slightly higher carb content. Let's just get her to eat more.

Human diabetics get urine ketone testing strips at the drugstore or pharmacy or chemist. People trying to lose weight with a high protein diet will also buy urine ketone test strips to check their ketones. Two ideas to help you figure out where to buy them. We use the human ones for testing our cat's urine.

We have testing tips on how to use the glucometer. Here: top ear testing tips

Making it easier on Holly for the ear testing, AKA Ear Testing Psychology

Once you learn to home test Holly's ears with the glucometer, you can show your vet. It's so easy and a little education goes a long way. Maybe you can start a trend of home testing cats in Bogata. That would really uplift my spirits if I thought I could make an impact like that.

Please keep us posted. You're part of our FDMB family now and we worry about family when we haven't heard from them in a few days.

Remember to take some time to relax and do something fun and soothing for yourself. We want the mommabean (female human), to be relaxed, happy, contented, lower stress levels, and getting some restful sleep. Please, take good care of yourself, ok?
 
Thanks!

It's been a rough couple of days for Holly. (The internet is not as reliable here as it is in the states.) Two full days of fluids and she still had an impaction. I suspected this when she had no bowel movements for a few days. This is what prompted me to get her to the vet. Flushed her out again, just like a couple of weeks ago. She does not have an obstruction - they did a sonogram. Her sugar levels are now below 350 - the lowest since this started. She is eating some of the Fancy Feast now, with a little added water. I'm keeping her away from my other cat, separating them when I leave the apartment. Luna occasionally picks on Holly.

Holly is now on an antibiotic, day four, I believe the translation is for Baytril. She gets a half tab daily. Her urine output has decreased markedly and she is passing blood clots. She is not straining or crying. I've read up on UTIs, crystals, cystitis, etc. Holly is eating and drinking almost normally, so I'm not too worried about the blood clots or decreased urine at this point. I know to watch her and get her to the vet if any other symptoms on the lists show up. She won't lick the laxatone off her paw anymore. I got some tuna in oil and I'll give her a little every day to help. I'm also looking for mineral oil. The dry food is now with Luna, away from Holly. Luna hates the Fancy Feast I have. :YMSIGH: Don't want my other cat to develop diabetes.

Holly is not out of the woods yet. She went from 14 pounds (two or three pounds over weight) down to 8 on a good day. It was the weight loss that I noticed a couple of months ago that got me to the vet. She did have a minor case of dandruff on her backside which I attributed to the dryer climate here. Now I know better. It was probably the first sign, back in March or April probably. :YMSIGH: If only I had known...
 
Those blood levels, are they preshot or nadir?

The dandruff could be the diabetes.. They don't feel as well and don't clean as well..
 
Both these levels are preshot, with little or no food. I make sure she eats before I give her insulin and retest two hours later. I'm not able to test two hours after the morning shot because I'm in class Monday through Friday. I do wait about 30 minutes to check for reactions before I leave. I'm getting ready to test after the last injection - 341 preshot. Her poor ears are so small, and they've been stuck so much. She is starting to rebel a little.
 
Can you get neosporin pain relief there? Apply a little to her ears to ease them. And always with the treats after.

Maybe vary your midday tests, like mid cycle instead of two hours after. Check to see how low she is dropping during the day.. Lantus usually hits its max action 5-7hours after shot and you need to know where she is then.

Wendy
 
Well, her two hour post shot is 516. The last two nights, the sugar levels went down two hours after. Now it's much higher. I did wonder when I gave her tonight's shot if it all went in. I wish I could be here tomorrow morning to test her after the insulin. I will check it Saturday and Sunday.

I tried to get her midday after class today. Unsuccessful - she always comes running when she hears the treat bag. I hadn't thought about the Neosporin. I brought some from the states. Not something they have readily available here.

I didn't know that about the Lantus, five to seven hours later. That makes the midday tests more important, doesn't it? I do have a few midday readings - they range from 365 - 534. Since she's been up and down with the fluids, impaction, and likely infection, I'm not surprised the readings are all over the place. Hopefully, things will settle down and we'll see a difference with the insulin response.
 
I'm surprised that you are only giving AB's once a day. I've always been told to give twice a day. Maybe it's that dog thing in Colombia where they give dogs once a day and are transferring the same to cats..... confused_cat confused_cat

Might be worth discussing with the vet and maybe it will help her to feel better sooner.

Have you had any success in sourcing "pumpkin" like products to mix with her food? Do you have Miralax or anything similar available? You may want to get some and add that to her food 1/4 teaspoon once a day with lots of added water may help with the constipation.
 
Holly looks better today. Her eyes are big and bright, she's been eating and drinking. I've added a teaspoon or two of water to the food every time I feed her. I found a squash-like substitute I'll try tomorrow. She won't eat the tuna in oil. Still looking for mineral oil just in case. I did find plain yogurt, no sugar added, pro-biotic, and lactose free. (One of the advantages of living in a lactose-intolerant culture.) I tried mixing some with just a few drops of lactose-free milk to thin it out. She wouldn't eat it.

However, both readings this evening were "HI", pre and (3 hours) post shot. I'm kind of at a loss as to what to do now. If it's still "HI" in the morning, and since her sugars are so high to start with, should I increase to 1 unit instead of .5? This is also before I give her the antibiotic, just in case it might affect the reading.

The anti-biotic, Baytril equivalent, is for both dogs and cats, once daily. It does seem to be helping. Her eyes don't have the runny goop anymore. Do you think it's better to give her a 1/4 BID?

I try to make sure her ears are "clean" and my hands are too before I test her. Would trace amount of neosporin cause readings to go off the charts?
 
The neosporin doesn't affect the readings. I think she is higher because of the infection and/or not being regulated. How many days have you been on the 0.5 dose?

Have you been able to put together a google spreadsheet yet? It will be helpful for others to see it and be better able to give you specific guidance.

You also may want to start posting on the lantus forum to get more dose specific advice. Please note they are numbers driven there and will ask that your spreadsheet be attached to your signature in order to really help.

Here is the link to set up the spreadsheet (ss) and link it to your signature: viewtopic.php?f=6&t=18207


In the meantime, here is information from the lantus forum, that may help you decide if it's time to increase the dose:


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

- Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

- Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

- Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

- After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

- After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:

- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

- If an attempted reduction fails, go right back up to the last good dose.

- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.



You can give the baytril as you are or if you prefer to divide into two doses daily, you can do that too. Up to you, whatever is easier and working.
 
No, I haven't had the time to do a spreadsheet yet. Lots of things going on down here, unfortunately. Trying to get to it this weekend.

She's been on this dose for five days. According to some information, (I had to look up nadir - I still don't understand that one and there is no way the vet here can explain it) I should increase her dose another .5 and give her a full unit. This is based on how high her blood sugars have been running, if I read it correctly.

I'm still not sure what the abbreviations are across the top of the spreadsheet. I assume the "+numbers" are the hours after the shot? AM and PM PS look like the insulin dose I give her. Thanks for filling in the numbers I had already posted - it helps figure out what I'm doing, if I'm reading it correctly. The early doses say 1, and it should be .01. Does that matter? I'll see if I can get the numbers in before her two hour post-test.

Her reading this morning was 492. She had no dry food at all last night, I made sure of that. She's been eating well, begging for food, and finally pooped. She wouldn't lick the laxatone off her paw, so I took a pea sized amount and stuck it in her mouth last night. Holly is grooming herself again. I know she's feeling better, but that is probably the antibiotic working.

Another question I had was for pancreatitis, if that could be causing problems. There is a special blood test for this in the states and Canada, and I've emailed the lab to see if they know if this test is available down here.
 
AM PS = morning pre-shot test

PM PS = evening pre-shot test

Turquoise column is units of insulin given

+# = number of hours since the shot
 
Can you update the excel document I provided above instead? Lets take a better look at her numbers to see what she is doing before a dose increase.

Nadir is the lowest blood sugar of the day... Lantus lasts 12 hours so the highest blood sugar is often just before the shot. Then after the shot the lantus kicks in and brings the blood down to the low (nadir). Then the lantus wears off and the blood sugar goes back up again. its like a curve.. but of course not every cat follows this curve:

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Now, you dont want to increase the dose unless you know what the nadir is, because when you increase its the nadir that will be impacted.and you dont want that too low.

I assume the "+numbers" are the hours after the shot? yes
AM and PM PS look like the insulin dose I give her. AMPS and PMPS are the preshot readings. U is the dose.
if I'm reading it correctly. The early doses say 1, and it should be .01. Does that matter? I'll see if I can get the numbers in before her two hour post-test. Werent you giving 1 unit?

Wendy
 
I've attached a spreadsheet for Holly's levels. Her sugars are all over the place, and an insulin injection may or may not bring them down. It seems like she is not reacting to them at all.

The laxatone equivalent I'm using down here does not list any kind of sugar in the ingredients.

No, I was not giving one unit. It was .01 of a unit, extremely low. The endocrinologist based her dosage on a variety of things. She did some calculations and showed me the numeric value and demonstrated how much, so the .01 was correct based on what she showed me. Seriously, like a drop off a pin, it was so tiny.

Holly does have an infection of some kind, and is on antibiotics once again. I've been in touch with a lab in the states that developed a blood test for pancreatitis, just to see if it is available here.

I'm getting ready to do another pre-test. It's almost time for her shot.

I did find a yellow type squash. I cooked it down and pureed it. Both cats were very interested in it. I added a small amount to the wet food with added water. Both girls ate it! The only baby food I've found here are fruits. No vegetables or meats - everything is cooked and served fresh, mashed up as needed. I was hoping at least to find some meats. I'm still looking though.
 

Attachments

Holly's latest reading is 549. I did not hit save this morning when I updated her chart - her +2 reading was 450.
 
In my opinion, Holly needs more insulin, sooner than later. I would increase the dose to 1U with the next shot.

Her numbers are way too high and we need to get them lower. That means more juice (insulin).
 
Thanks again everyone! I thought I had read somewhere to increase every four days as needed, which is now overdue. I will give her one unit tomorrow morning. She's already had her dose tonight. Other than her sugar readings, she's doing much better. Grooming, eating, drinking - a week ago I thought I was going to lose her. How much squash should she get? Should it be a little every day? A teaspoon? She's about 7.5 pounds right now. I froze the batch in an ice cube tray so I can use what I need.
 
An infection will spike her blood sugar for sure. Might come down when the infection is cleared.

Lets hope the 1IU works better.

Wendy
 
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