Newly diagnosed 6 year old, in South America

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Holly is doing much better! I've had the vet remove the port we had kept in for dehydration. The additional water in the food and the squash has kept her hydrated and regular. The dose is now 1.0 BID, and we even went under 200 at one point! It does seem her sugars go up quite a bit at night. It just registered HI again on the meter. Here is her updated chart. Her early morning readings seem to be okay, they are definitely decreasing! Any suggestions? I know she can't get into Luna's food during the day. Luna is in a separate room with the door closed, and I pick it up when I let her out.

Without everyone's help here online, she would not have made it, I have no doubt about that. I'll be speaking to the vet and the endocrinologist and I will pass along all this information as best I can (as they only speak Spanish). Thank you, from the bottom of my heart - I still have my little girl! :-D
 

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After several days of doing well, her blood sugar spiked again. Last night pre-shot was Hi, +3 it was 400, and this morning re-shot was HI again. After I gave her shot, she vomited up all her food. I noticed she had literally inhaled her food, and thought in the absence of any other symptoms that might have caused the problem. I'm skipping class again today to watch after her. I don't leave food down at night - I make sure she's eaten around 10 PM and she's fed again around 6 AM. Should I leave some food down for her during the night?

I'll check her sugars again in an hour. Hopefully I'll still have internet then.
 
Holly has now kept some food down. Her blood sugar at +3 is 597, coming down from HI. I'll check again in 3-4 hours.
 
I see your kitty has had some issues with constipation. You might find Feline Constipation a useful site to read over.

I suspect the reason you've not gotten much response is that your spreadsheet is attached as a document file. Here's a thought - take the document you use, and just upload it, with instruction to convert it to a google doc. Then, when you need to update it, do a copy and paste of the new info from your workd processor to the Google Docs version.
 
Thanks - I've been adding the squash (no pumpkin here) and it is working. Unfortunately, I can't use google docs as I don't have regular access to the internet. Long story, but cutting and pasting won't work in google docs on my computer. :YMSIGH: Someone here converted it for me to more closely resemble the spreadsheet. Holly is doing better now, keeping food down since this morning. Her sugar levels are still high, which I'm not surprised. I am still trying to find ketone strips. They only test for these in the outside lab - the vet doesn't know where to get them. I suspect it's bad, but again, I have to find out what the level is and then tell the vet what Holly needs. Even the endocrinologist doesn't know what to do.
 
Try a human hospital and suggest the vets consult with a human endocrinologist.
 
That's not a bad idea. I have a Colombian doctor friend, but he's on vacation. But I do have a dentist friend who's here - she might be able to find out something! Thanks! I don't speak Spanish well enough to explain the problem myself - I do have friends who can help. I'll also check with them and have them check with their docs! Great idea! Thank you so much!
 
Absolutely. I've used it before, I just have to be careful since it's "Spanish" spanish, and Colombian spanish uses different words sometimes. Between GT and my "Spanglish", it's usually okay. I've had friends come with me whenever possible too. The vet here didn't even know how to use the glucometer's strips; I had to show her how they worked. Even if I use Spanish, they are not experienced with this. I'm in dog country, and animals are put down when the going gets tough.
 
If you keep updating the word doc then that will work fine for us. excel would be better but we can live with word. Would help a bit more if you can color code the numbers. I have updated the word attached to get you started!

Anything under 100 = green
between 100-200 = blue
200-300 yellow
300-400 pink
400-500 red
500+ black

Also dont assume the nadir is +6, it does vary in cars so you might want to get some more spot checks esp when you see number under 200 when you might want to get another test in an hour to see if he drops further


Wendy
 

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Holly is improving greatly. She is gaining some of her weight back and is now playful and crying for food all the time. I feed her small meals 3-4 times a day. The other cat's food (wet and dry) is kept locked in another room. Holly has no way to get to it unless she can walk through walls. :)

We have another appointment with the endocrinologist tomorrow morning. Holly's levels seem to be much higher at night, and I was wondering if her morning shot should be increased to 1.5. She has hit a 184 once during the day, and close to 200 another time. I have color coded the numbers since it's a word document. (Thanks Wendy!) I did change from pink to purple for the 300's. On my computer, the red and the pink were too close to see the difference.

I test during the day when I'm home. I leave school for lunch so I can at least have one test during the +5/+7 timeframe. This weekend, I'll see if I can get a couple more in during the day to get a better idea. There have been a couple of times where Holly sees a bird or other distraction and pulls away - I'm not sure if the shot was completed or not. :/ Luna, my other cat, comes over to sit next to Holly when it's testing time. Very sweet.
 

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Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first (mg/dL). Numbers in parentheses are for non-US meters (mmol/L). Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- 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 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- 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 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- 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 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, 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.
 
Second, its time to bump up the dose for both shots. Your mid-cycle/nadir values are all above 150, so increase 0.25 units. You'll have to eyeball it on the syringe, there are no marks for 0.25.

After 3 days on the new dose, you'll need to recheck around the nadir, which you'll see on the preceding reference guide indicate a possible dose increase.

Depending on the time you have available, you may want to follow the Tight Regulation protocol or the Start Low Go Slow protocol

Since I know you internet is iffy, print or save the files to PC so that you can review them at your leisure.
 
I agree with BJM. It's definitely time to increase the dose for both the morning and evening shots. Holly's numbers are too high most of the time and went need to see more numbers under 200, preferably even lower.
 
Thanks everyone! The vet is pleased with Holly's improved appetite and appearance, but her sugars are of course way too high. Instead of increasing the dose, she wants to change the insulin to Novolin N, .2, q 12 hours. I've read this is not a good choice for cats. Is Levimir/Detemir a better choice if available here?

I'm not changing until I feel confident about what I'm changing to, and in the meantime, I'm increasing the Lantus dose, .25 as recommended here.

Do I still need to give her any squash with her meals? She's had such a bad problem with constipation, I'm giving her a tiny bit every day. Is it better to only give it every few days? Just when I notice she's having a problem?

They want to do a curve on her next Friday after she's been on the new insulin a few days. They've run a test for pancreatitis - we'll know Monday. They do have a silicon based non-absorbable litter, but I'm allergic to silicon. The aquarium rocks here are indeed treated with certain things for fish, and I'm afraid even after I wash them they could alter any ketone test. Looks like Holly will need to go in a locked area with an empty litter box, unless anyone has a better idea - and so many people here do! I know she would not be with me any longer if it were not for everyone here.

THANKS SO MUCH! (Weekend is coming, and it's a holiday on Monday. Cross your fingers for my internet!) :D
 
No, the Novolin N is a horrible insulin for cats. It's ok for dogs with their slow metabolism, but not for cats. Most cats only get 6-8 hours control with the Novolin N and it drops them like a rock very early in the cycle and then shoots them up high as the insulin peters out.

I think you have not found a high enough dose of the Lantus yet. We need to have you hold the increased dose for 3-5 days ( 6-10) cycles and then we reevaluate. If Holly's nadirs are still not below 200, we need to increase again. We like to see the cats nadir's down in the 50-120 range. Many cats can be diet controlled with the right food and the right dose, gradually changing the dose up or down as needed. Right now, Holly needs those increases. I think we need more frequent increases before you consider a different insulin.

Levimir/Detimir would be much, much better than the Novolin N or Vetsulin or Humulin N for your cat Holly. But first, I'd give the Lantus more of a chance, increasing the dose more frequently than you have been.

I wish you would post daily, so we could help you more. But your internet access does not permit that, I'm sure.

If she is still constipated, giving the squash daily is a good idea. I give my sweet kitty Wink and one of my civies Delta, Miralax daily, 1/8 teaspoon to help with there harder poops. I increase it to twice a day if the poops are getting harder. The squash/pumpkin is serving the same purpose so I would continue to give that to your cat Holly. The squash adds more fiber, helping Holly to poop better. I'd keep it up indefinitely.
 
Absolutely not

He is not familiar with Lantus. It does not work the same as Novolin. It will not drop him like a rock he way novolin does. It has an onset around 2 hours, a nadir around 6 hours and lasts 12 hours. Novolin lasts 6-8 hours in the cat.

You should increase the Lantus, as we noted previously.See my signature link Secondary Monitoring Tools for tips on urine testing.
 
NONONONONONO. You dont want novolin - its a horrible insulin for cats - its very harsh, very fast acting and wears off fast and very hard to regulate a cat on. Plus its unlikely for remission. Its better for dogs. Stick to the lantus.

What weight is she now? How much fancy feast does she get a day? What would you say her ideal weight is? I want to work out if she is getting enough calories but while she is unregulated I would feed her as much as she wants to keep her weight up.

Other ideas to collect pee:
- use lentils instead of gravel
- stick a ladle under her butt - or a little tray made out of foil
- cover the litter in cling wrap so she pees on it. Sprinkle a little litter on top
- buy a non clumping litter - you can test 1 tablespoon of it mixed with plain water. If the strips show nothing, then do the same for 1 tablespoon of peed on litter. And double the results.

Lastly I just think your vet needs to be patient - I agree your dose needs to increase. Lets try 1.25 for 3-5 days to see how that goes but also get a before bed test 2-3 hours after evening shot - we want to be sure she isnt dropping low at night like many cats do.
Wendy
 
Thanks again, everyone. This is from the endocrinologist - she's nice, but this is really new territory for them. I have found several guides for vets in dealing with feline diabetes. Which one would be the best one (most recent?) to print up and get translated for them? I went to the vet and told them about the Novolin N and about increasing the Lantus. I'm going to stick with the Lantus for now and increase the dosage.

Lentils! Great idea! Or the saran wrap! Also good! We have LOTS of different kinds of dried beans here.

I'll increase the dose tonight and stay up to watch her and get another test after her nighttime shot. It's a three-day weekend here so I can spend more time watching her on this new dose.

I need to change my signature to reflect no fancy feast right now. It's souped-up Friskies (now called Felix down here) pate style only, with lots of extra protein. Chicken or fish, no pork or beef.
 
you asked about leaving food out overnight for her and YES that is perfectly fine to do. You may discover that she eats more overnight and it may help with the bg levels as well.

Did you look in the pharmacies and look at the diabetes section to see if you can find the ketostix there?

Maybe you can translate it into spanish and ask the pharmacist for the container.

The box should look like this: http://www.amazon.com/Ketostix-Reagent- ... B0000532GJ

Or they may have it out of the box and then it should look like this:
http://isearch.shopathome.com/?user_id={09264f5b-4105-48ff-973b-99ec5c903ff4}&q=ketostix+image

If you can't get it locally or at the hospital, are you able to order online and have it shipped? Or have someone in the US buy and ship it to you?

Just some more thoughts. Glad to see that she is doing better and you are sticking with Lantus. Remember it's an excellent insulin, you just need to find the right dose.
 
I do have the test strips. Thanks. I found a pharmacy about ten blocks away that has a lot of specialty items. I got their last box.

Getting things sent here is unfortunately expensive and time consuming. Most people who can afford it fly to the states every few months, go shopping, and bring things back in their luggage. Tried to bring FF back from the states and half was confiscated and tossed. (I had bought two boxes of 24 and some single cans.Total.) I now have a letter from the vet and I might have to go to the customs people and get their permission. That could take a long time. And some money under the table. :/ However, if anyone wants to come and visit....;)
 
This is from the endocrinologist - she's nice, but this is really new territory for them. I have found several guides for vets in dealing with feline diabetes. Which one would be the best one (most recent?) to print up and get translated for them?
Click to expand...

The AAHA Diabetes Management Guidelines for Dogs and Cats might be a good place to start with educational material for your vet on diabetes. Vet journal published in June 2010.

The Merck Veterinary Manual has a short article on diabetes.

This article by Rand and Marshall, Understanding Feline Diabetes Mellitus: pathogenesis and management is from top diabetes researchers. Published in 2009.

This one, with the original Roomp and Rand Lantus protocol, may already have a Spanish language version. It's from the College of Veterinary Sciences in Santa Fe, Argentina website. Original published in Journal of Feline Medicine and Surgery in April 2009.

I hope those help you.
 
I haven't had a chance to update her file yet - but I had a big surprise today! Her +6 reading today was 157! The lowest it's been since this all started!

I upped her insulin a week ago to 1.25, but sugar was still doing the roller coaster. Two days ago I started 1.5. Her pre-shot reading was 172 tonight! Two low ones in a row.

WOW! I'm hesitant to give her 1.5 again with such a low reading, even though I know it's still high. I have honey if I need it. Based on what I've read, it is still okay to give her the shot, but I'm tempted to lower the dose given her propensity for the roller coaster sugars.

Any advice?
 
Maybe stall 30minutes to see what she is doing(going up or down).. So don't shoot or feed and retest in 30. Then if she is going up I would shoot but definately get another test at +2 as that will tell you her plans for the night.. If its lower than preshot you might want to set the alarm for anther test later on..
 
Thanks! She's already eaten - her food is ready as soon as the test is done. Holly is begging for food all the time and I have her on a schedule now. I'll test again in a bit and see what's going on. I still can't believe today's readings. Still a long way to go, but definite progress!
 
Ok well you should be ok to shoot her normal dose or a reduced dose if you aren't comfortable.. but definately get a +2..

Do you have syrup and strips just in case?
 
Back over 400. Sigh. Also turns out the ketone strips I bought are for blood ketones. I'm going to see tomorrow if one of the pharmacies can order the product available in Argentina, Keto-Diastix. I have the supplier and their phone number. Thanks for your help!
 
Could be a bounce -

Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
The insulin depot - what it is and why it effects your cat’s BG numbers
 
157!!!!! Congratulations on that blue number! Now, how about showing us some green? :mrgreen:

Way to go Holly! :RAHCAT

As you gather data, you can lower your shoot/no-shoot number. Over in the Lantus TR forum, the threshold is 150.
 

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