newly diagnosed, high #s

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julie & punkin (ga)

julie & punkin (ga)

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hi,
i've poked around this site a bit and am in need of some help/encouragement myself. my kitter, punkin, is 12 yrs old, weighs about 14 lbs, and was diagnosed with diabetes in December. we had started a major remodeling the week before and the vet said it's well-documented that stress can cause diabetes in cats. He put punkin on purina dm & prozinc. i bought both the canned and dry food from the vet. his blood sugar kept improving and he went off insulin about jan 1st. at that time i had him completely on canned dm, but when i ran out i bought only a bag of dry.

the next time i took him in for a glucose test it was up in the 350's. he started back on prozinc but the number stayed about the same. we spent about a month raising the levels of the prozinc (to 4 units), but the blood sugar stayed 350-415. he was getting Purina dm dry this entire time. two weeks ago the vet switched him to Lantus 2 units. Tuesday it was 513. I came home from the vets and read this site thoroughly.

My thought was that the control we got earlier was because we had him 100% on canned food. So Tuesday i went out and bought fancy feast canned food all on the list here & stopped giving him dry food. He was getting 3 units 2x/day of the Lantus. I took him in Thursday to have his glucose checked again and it was 250. vet said to raise it to 3.5 units 2x/day, but I didn't because i keep thinking it's the anxiety that's sending it high. He is a very anxious cat, won't be around if anyone strange is in the house, and this week he's begun trembling as soon as he figures out we're headed out the door to the vet.

As soon as he changed to canned food he stopped drinking a gallon of water, stopped peeing excessively, started looking like himself again. He stayed upstairs with us instead of downstairs with his water bowl. He was literally spending all day laying against his water bowl.

Took him in again to the vet's today and it was 315.

Read more on here and went and bought a FreeStyle Lite set-up to check his blood sugar. Tried to check his ear tonight and i couldn't get enough blood to sample. I gave up after sticking him 3 times and each just brought a tiny bit of blood - i tried to milk some out but didn't have any luck. He started getting wiggly so i gave up for this time.

I just gave him 3.5 units, but even though i don't know anything, i keep thinking it's too much. i keep thinking that based on his behavior it's dropped back down but his excessive anxiety at the vet's is sending it up. I do have the karo syrup ready and the instructions printed out. He's acting relatively normal at the moment.

Any thoughts?

btw, how do i put his picture in my profile?
 
Hi, Julie -

Welcome to FDMB! It sounds like you really have done a terrific job of researching.

A few thoughts:

FOOD - Sounds like you know the deal here and are familiar with the list, glad you got him on the wet food. That right there is one third the battle, good job.

HOMETESTING - This is the second third. I'm sure you saw the tips on the sticky. Just that you sat down and tried means you're well on your way. It doesn't always happen the first time. Some tips you may try if you haven't:

- warm the ear
- motivate with treat
- have a consistent testing spot, maybe sit him on your indian-style lap (i have success wih this and a good grip on him)
- talk in a low, relaxed voice with praise
- i have found a shallow, quick, slanted poke yields the most blood


INSULIN - There is a whole subforum on this board devoted to support for Lantus. Once you are hometesting, they will be happy to guide / support you through dosing decisions if you choose to let them help you. They generally begin treatment with Lantus on this board with the "start low, go slow" mentality. Meaning the dose starts low and you incrementally increase until you reach a dose that yields consistent cycles.

My knee-jerk reaction to your post is that your Lantus dose is very high for a starting dose.

My advice would be that you try the hometesting again as soon as you feel comfortable so that you can get a handle on what the insulin is doing, especially since you just also switched Punkin to wet food.

Profile Photo: Go to your Profile, go to "edit avatar" - you can upload your photo there.

:)
 
You are on the right track and are two steps ahead of most of the "newbies'. :-). If your cat has been on canned only for at least a week the BG has probably already dropped. For most people, changing the diet drops the average blood glucose at least 50-100 points. When I switched Nomad to wet food only, his BG went down about fifty points. The stress of going to the vet can raise BG and the vet bases dosage recommendations on the numbers in the office. This is how many cats end up on doses that are too high. If you go to the Lantus support group, you will notice most cats are on doses that are one and half units or below.

A rule of thumb is to start at one unit and maintain that for at least three to five days and moniter the BG to measure response to the insulin. Changes up or down are then made in small increments.

Everyone has some trouble getting blood the first few times. If you get on the board tomorrow, there will be more people who can give you links to videos on how to do the ear prick and home testing. Sorry I can't help you with getting a picture up-loaded. I haven't figured out how to get the picture out of my own cell phone yet.
I would be concerned about your cat remaining on such a high dose of lantus. Start getting some BG numbers and get back to this site so you can get some more feedback about the lantus dose.
 
thanks for your help. i REALLY appreciate it. it is a little overwhelming.

he's been on the wet food since Tuesday night - so 4.5 days. I said the wrong date on my 1st post - he's been on the Lantus only since last Saturday night, the 12th - so today is 7 days. He started at 2 units, the vet increased him to 3 on Tuesday and told me Thursday to increase it to 3.5. I didn't, because of what i'd read on here, but the vet tech scolded me today for not giving him what the vet had told me to. I did give him the 3.5 tonight.

i tried warming his ear, although he wasn't thrilled with it. he's tolerating being held. i did give him a piece of chicken afterwards and praise him a lot. then i had a glass of wine for me! He's slept all evening, but that's pretty standard. he's not acting unresponsive, dopey or anything unusual.
 
Many people feel reluctant to go against what their vet says. That is understandable but we get people on this siite every week that are on huge doses prescribed by vets that could overdose the cat. We did have several cats go hypo a few weeks ago and one even died. Your vet has almost doubled the dose in less than a week. That is not good.

Utimately you are the one who has to decide what is best for your cat. All I can say is I would not give my cat three and a half units of Lantus based on the information you have given so far. Some other readers will probably tell you the same thing. When you get your cat on the right dose of Lantus, which I am sure will be much lower than 3..5 , then you should go back and scold them!! LOL. :-)
 
Do you know what gauge lancet you are using to prick the ear? Are you using a pen or just freehanding it? If you are using a lancet that is gauge 30 or above I would recommend trying 28 or even 26 (the lower the number, the thicker the lancet), that may help you get a sample more easily. I used to use a pen but I never could see exactly where I was poking and it was quite unreliable, I have failed one test since switching to freehand (poking at a slight angle).

That dose does sound quite high. And since your kitty sounds like a big stresser at the vet, the numbers they're getting may be much higher than when he is relaxed at home. My cat Mali had a curve done at the vet about a month ago and they determined that his insulin should be reduced to 2 units twice a day (he was getting 3.5 units twice daily, we had switched his diet from dry to low-carb wet and his need for insulin immediately dropped). I still felt uneasy about the dose so I began home testing. His numbers were scary low, and long story short, he's been off insulin for 2 weeks now! He's a big stresser too, so the numbers he was getting at the vet said he needed a total of 4 units per day, but the numbers I got at home showed that he actually didn't need insulin at all. :)

If you'd like to reduce the amount of insulin right away (before you get comfortable with home testing), you may want to pick up some Ketostix or Dia-Ketostix (available at any drug store, I get mine at CVS). You can use these little strips to test their urine for glucose and ketones (excess glucose or ketones will tell you that his BG's are too high). It's nowhere near as accurate as home testing, but it will ease your mind from worrying about numbers getting too high.

And remember, once a cat has been diagnosed with diabetes they should never have even one piece of dry food, not even that expensive prescription stuff the vets try to sell you. ;-)
 
Hi Julie! Welcome and congrats on already getting some blood. You are on the right track. Have you tried dabbing a tiny bit of vaseline on the ear? This gets the blood to bead up, making it easier to see. It is very frustrating in the beginning, and sometimes you feel like you will never get it, but we have all been there ane you will. Keep us posted with your various attempts and we will respond with helpful tips!


edited to add---link to hometesting info viewtopic.php?f=14&t=287
 
YAY! i got it to bleed enough for a test. at 7:30am I fed him & gave him 3 units of lantis, at 9:30am his BG was 236.

any thoughts on that? how often should i try to test him?

i have been feeding him exactly the same amount (1 can) at 7am, noon, 5 and 11pm and giving him the insulin at 7am and 7pm.
 
Test him before giving him insulin tonight and try to also test six hours after the shot. The insulin brings the BG to the lowest point (nadir) usually about six hours after the injection. This is really important because you don't know how low his numbers are going. Having the blood glucose too low is more dangerious than it being too high.
 
ok, i tested him at 12:30 (so 5 hours after his morning shot, before giving him lunch) and his BG was 169. should i test him before giving him dinner at 5:30 too?

can someone give me a link to the empty chart that can be used to look at his blood sugar changes?

i think i have the hang of sticking his ear now. *whew* i put a lamp behind it so i could clearly see the vein. am i supposed to stick right on it or just near it?
 
i found the instructions on the spread sheet - you guys are really great at all of this. thank you for all your work for people like me who are trying to navigate all of this new stuff.
 
hmmm, the stick seems to be going clear through his ear and i was able to get the blood from the back side this time. is that ok?

i've updated his spread sheet - so today was
+2 236
+5 169
+10 133 he's eating now and i give him insulin in 2 more hours.

those seem like reasonable numbers - so i'm guessing i give him the same dose of 3u.
 
It's best to not go all the way through the ear, but their ears are so paper-thin sometimes it's hard not too. Just make sure you apply some pressure to the ear afterwards to stop the bleeding and prevent bruising. The most important thing is that you're getting those numbers - yea!

I'm no expert, and hopefully some other people will chime in, but those numbers look pretty darn good! I would recommend continuing with the same dose, and try to test before each shot and about 6 or so hours after the shot. Other than that, just keep your spreadsheet up-to-date and feel free to ask us to take a look any time - you're doing great! :-D
 
Once in a while I still go all the way thru to the other side....it gets better with practice. I have even pricked myself before, when my cat moves his head.. I guess that is Nomad's revenge!! If you are using a spring release lancet device, you might want to lower the number on it. The number on the device controls how deep the needle penetrates.

Once you have your spread sheet up and running, you can post on the lantus subgroup for more feedback. I still think that three units twice a day is too high a dose. My main concern is the BG could drop rapidly as the diet change and the higher dose kicks in.
 
ugh, this is hard! not to mention stressful.

took me 4 tries to get blood this morning. he was spitting mad because the normal routine is to feed him as soon as we get up, and i was trying to take blood instead. i've only managed to get blood from his right ear so far - is that normal? i tried 3 times on the left ear this morning before going to the right.

the spreadsheet is up to date - 396 this morning before feeding him.

Q: would him being so mad make it higher?

Q: if you don't get enough blood (and you get an error message) on one side of the test strip do you have to use a new test strip to try again or can you use the dot on the other side?

Q: am I aiming for straight on that little ear vein?
 
It is stressful at first. Believe it or not, it becomes routine. Always give him a treat whether you get blood or not.

You are aiming for the little capillaries that run off the vein toward the edge of the ear. (Get a flashlight and look at his ear to find the vein and the capillaries.). It won't hurt to poke the vein but do try to avoid it. It will give you more blood than you need.

You can also get a drop of blood on your fingernail and test it there.

Yes, often one ear bleeds better than the other.
 
Unfortunately, if you try to insert the strip again and use the other side you will get an error message. There are some meters that won't let you reuse the test strip even if you don't get any blood. I guess these companies have to make money LOL :-)

I know some other members have cats that bleed more easily on one ear than the other one. I don't have that problem with Nomad. His trick is to shake his head right before I press the button on the lancet device. If I poke myself he almost looks like he is laughing Even if you get close to the vein, it will increase your chances of getting blood.

The testing will become part of the routine after a while. Anytime you make a change with a pet or a kid there is always the battle of the wills for a while. The stress of testing an uncooperative cat might raise his BG but I am sure it is less stressful than when it is done at the vet.

When I first started I probably wasted two or three test strips for every sample I got. Walgreens and Abbott labs must have made a lot of money off from me.
 
ok, thanks for all the answers. i'm not going to try to test him today til my husband is home to help keep him still. we're not quite to the point of him leaping up onto my lap and sitting quietly yet! hahahahahaha
 
Here's my trick with Mali: I drain the water from a can of tuna into a bowl. Get everything set up next to the bowl and bring him in. While he's slurping down the tuna juice I test him - easy as pie!

When I first started trying to test him he was all squirmy and wouldn't sit still, so I had to get creative. But as long as he has that bowl of tuna juice I can do pretty much anything to him! Once I drain out the water I add a little more to the can and pop it in the fridge, so it marinates for a while and the water gets fishy again for the next test (much more economical than open a new can each time). Oh, and I let the can warm up on the stove before each test, when stuff is warm it smells stronger.

You could also try this "distract with a treat" method with any low-carb treat your kitty really likes - salmon, chicken, etc...
 
wow those are great ideas, thanks! it's like raising kids and finding more experienced moms than you have all the tricks figured out to make life easier.

i have this funny image all of a sudden with my semi-catatonic fluffy orange long-haired cat with clothespins running like a mohawk down his back slurping up tuna juice while i'm stabbing his ear. :shock: :lol:

i'll give it a try!
 
not sure which one of us is having a worse time on all of this. tried the clothespins last night, and at first he did seem calm, but then he kinda went nuts, screaming and clawing & all. i gave up after 3 pokes. tried again this morning, tuna water at hand, vaseline on the ear, didn't get enough blood on the first ear but made it on the second when i flipped him over onto his back, held his paws in both my hands and my husband did the deed.

so this morning pre-shot, pre food was 256. i had read a little on the lantus board last night before going to bed and when i woke up i was thinking he had died during the night from his BG getting too low. i went ahead and gave him the same 3 units, but am wondering how would i know to start reducing the dosage? i was reading the whole storage shed post and thinking maybe he's now gotten a build-up of the insulin. i don't see how i can check it during the day when my husband is at work to know what it's doing +6 hours when it peaks.

the good news is that he's grooming at the moment. since he got sick his hair has been grossly oily.
 
I am sorry you are having a hard time testing, but am glad you got it done. We wrapped Oliver in a kitty burrito. We put a towel down on the couch next to the arm. Then we wrapped him up with only his head showing. I could lightly press him into the arm to keep him there.

We will keep giving you ideas that worked for us and one of them is bound to work for you. One of the most vital parts is to be sure you give a treat and praise every attempt, successful or not.

If you would like some hands-on-help, give us your city and state. Maybe someone lives nearby.

Your 256 is a good number but your 3 units is a high dose. I would cut back until you get testing down.

You will figure out what works for you and you will be amazed at the sense of control testing gives you.
 
In the beginning testing mocha was easier for my husband then it was for me. But soon we each had a rhythm going .. now we both set mocha on the counter and lean over her, almost where our right side of the ribs rub against her left side and our right arm drapes over her left side .. then we have a folded piece of toilet paper and we stick that behind her ear (inside) We will rub with our index finger the outside of her ear for a few seconds somewhat fast .. just enough to get the blood going .. then we take our lancet and poke .. we use the wal mart brand relion micro meter and thankfully we can have the strip already in the meter ready and waiting while we are poking and getting the blood out .. once we see the drip we sip it up and instantly fold the toilet paper over the outside of her ear and apply pressure. When it is very cold outside we warm up a sock with rice in in for about 20 seconds in the microwave and hold that on the outside of her ear, just long enough to get it good and warm for us ... Not sure if any of this is helpful to you but I thought I would post just in case .. oh, and in the very beginning I couldn't juggle the toilet paper and try to poke so instead I wrapped a band aid around my finger. The cushion on the bandaid protected my finger from getting poked and it was one less thing to juggle ...
 
hmm, i'll try the bandaid on the finger thing. one of the problems is that i've got a lamp behind his ear so i can see the vein, but then when i put the paper towel up behind his ear to hold it still and be ready then i can't see the vein anymore. i've only hit the actual vein once. i am using the rice sock, which he hates, and rubbing his ear. equally hated. i haven't tried the kitty burrito yet, but that's next. i may try him on the counter too. that's an interesting idea. so far we've been doing it on the sofa with my husband holding and me doing the rest, but it worked well today with me holding and him doing it.

i know i need to get to the point of being able to do it alone, so i'll keep working on it.

if i decrease the dose, is it by .5 unit - so i would go to 2.5? unfortunately i just bought a box of 100 needles and they only mark whole units, but i can guess in between.

i really appreciate everyone's suggestions! feel free to keep sending them. i won't be offended - i'm still at the point of needing all the help i can get!
 
Welcome Julie!

Sue asked me to stop by since I tend to hang out over on the Lantus board more than here. To answer your question about whether this is too much insulin, the only way you will know is by testing. Lantus dosing is based on the lowest number (the nadir) of the cycle -- not on the pre-shot numbers. What that means is you need to get spot checks during the day and evening. Generally, we encourage people whose cats are starting Lantus to get tests at +3, +6 and +9 or a regular basis in order to see how their cat is adjusting to Lantus. (And no, you don't need to do this throughout the night.) Also, we change doses in small increments -- in 0.25u amounts. (You'll need to get syringes that are marked in 0.5u increments otherwise you'll have a hard time approximating the dose consistently.) The amount that your vet is suggesting could easily cause you to miss a "good" dose for Punkin and cause his numbers to drop low. With the switch back to canned food, especially since it sounds like you have switched to a fairly low carb food, I would be very cautious about the dose until you are more comfortable with home testing. In other words, don't increase the dose regardless of what the vet says. It's your cat. Unless the vet tech that was chastising you is planning on stopping by to do the testing in order to make sure Punkin is safe, politely ignore her. (All of the info on the approach we use to dosing is in the Tight Regulation Protocol sticky on the Lantus board.)

For most cats, the initial dose is based on weight providing the cat hasn't been on another insulin. If this is the case, the dose of the previous insulin is factored in as would any medical condition(s). Has Punkin had any problems with diabetic ketoacidosis, been on steroids, etc?

Another trick with testing -- if the first poke doesn't draw blood, try to poke in the same spot or very close by. If you get 2 spots that are side-by-side, the small drops may combine to give you enough blood to fill the strip. My kitty is also one who has one ear that bleeds better than the other. If's not uncommon in the least. Also, as you poke more often, the ear will "learn" to bleed.
 
I have never used a lamp.

I sit on the floor, Squeak between my legs. I'd brush him while warming his ear. Grab my stuff that I've set beside me, keep the rice sock in his ear for support, poke with my softclix lancet device. grab my meter, get my sample and voila. I don't restrain him because he'd fight me...

Jen
 
thanks again - i've been watching videos on youtube on ear sticking and am thinking that part of my problem is i'm trying to go from the underside of the ear because there is so much hair on the outside. he's seeing me coming at him and maybe if i try the floor position, doing it from the outside with vaseline it would work better.

i'm a little reluctant to try the burrito thing, although i watched youtube videos on how to do that too, only because i am afraid if we go that direction that's what i'll always have to do. i'll try the between the knees position first.

sienne, thanks for the info specifically on the lantus - as i've been reading around on that board, i'm gathering that we could be approaching an insulin-overload problem as he adjusts to the lantus. today is day 10 of being on lantus - and no, he hasn't had any other significant health problems except recurrent annual bladder infections. although after reading all the info on cat diets, i'm thinking the dry food was probably a factor in those infections.

he was on prozinc for the month of december - then he went off insulin for about 3 weeks, and unfortunately i had bought dry food not knowing any better, and then he went back on prozinc (still eating dry food) for 3 weeks without any drop in BG. last dose of prozinc was 4 units BID, numbers not decreasing in the vet visits. So the vet switched him to lantus 10 days ago and i switched him to the fancy feast canned classics food at the same time. the vet started the lantus at 2 units for Saturday night, Sunday & Monday BID, Tuesday morning, then Tuesday +2hours the vet checked his BG and it was over 300, i don't remember exactly. He went up to 3 units BID and on Thursday the vet wanted me to raise it to 3.5. I gave one dose at that and all the rest since have been at 3 BID. i'll pop over and read that tight regulation info. actually i think i printed it off a few days ago, but wasn't sure about it.
 
i'm going to try again today at +6 - i'm thinking he's getting so worked up because we're restraining him, not so much because of the poke. he doesn't seem to mind the poke, although when it got to 3 or 4 pokes he did. so questions:

1. i usually am giving him lunch at +5, should i test him before i feed him or delay his lunch to +6?

2. is it ok if he's eating while i poke him? i'm seeing videos of them eating pieces of meat as treats while they're being tested. is that ok, or is the regular cat food ok?
 
I used a thin sheen of vaseline to make the blood bead up. I poke the thicker edge of the ear rather than the thinner outer edge. I poke about 2/3 of the way down the ear, and in a few milimeters....Squeak HATES being restrained and yet I've never had issues testing him (I no longer have to because he's off of insulin).

Test prior to shots and get spotchecks at different times when you can, and try to make it a no fuss kind of thing....test him when he's eating or whatever works easiest for you. There are tons of variations on successful testing techniques :)

This WILL get easier

Jen
 
haha, you mean i shouldn't freak out quite so easily!? :lol: i guess it's because i have the image that death is just around the corner if i don't do this right! ;-)

but i got it by myself while i'm home alone, so am feeling better.

burrito-ed him and had him face down & away from me on my lap. rice sock, rubbed, then added the vaseline on the whole area so if i had to poke more than once it was all covered. I went through the back of his ear - had to do it twice, but had a nice little drop on the second try. the first try it went through and there was a spot of blood on the inside, but not so i could get it.

BG was 169 at about +5.5 hrs. he yowled slightly when he got one leg free and thought he had a little hope of a break-out, but i managed to recapture the leg and we all survived.
 
You are making progress with the testing, Julie---keep it up! Even though it is hard to believe, one day it will be so routine it will be hard to remember it was ever such a struggle. :smile:
 
Hi Julie and welcome!
I love the rice sock but my Payne doesn't ..... so we compromised! I got some baby
socks about 4-5 inches long, filled with rice and warm the same. The beauty is the sock
only fits over the ear and half the time she has this quizzical look on her face. :lol:
Good luck, it will get easier!
Nancy
 
Another trick I've heard about for cats with hairy ears: you can shave some of the hair off with nose-hair trimmers.

As for light, I have one of those LED headlights with an elastic strap that goes around your head. I look like a miner when I wear it, but it's really bright and keeps both hands free. I got it at Walmart, I think in the camping section. I don't remember the exact price, but it was less than $10.

And I'm not sure if I mentioned this to you before, but you may want to pick up some ketostix (available at most drug stores). These little strips will test urine for ketones, they also have ones called dia-ketostix that also test for excess glucose. All you have to do is put something non-absorbant in a litter box (non-clumping litter, fish gravel, I've heard that lentils will work too), then as soon as kitty does his business just tilt the box a bit and dip the strip. Or you can try laying plastic over the regular box so the urine will pool up (my cat won't go near his box with plastic on it though). There's a color chart on the bottle that will tell you if/how much ketones/glucose are in the body since the last time kitty peed. This may help ease your mind if you decide to lower the dose before you've gotten the testing down completely. It's nowhere near as accurate as testing blood, but it will tell you if the numbers are getting to a dangerously high point.
 
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