Newly Diagnosed / Introduction

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ChristaMJ

ChristaMJ

Member Since 2013
Hi All, I've been browsing this forum and it seems like a really good community and resource. My cat, Mister, was just diagnosed last Tuesday with diabetes and I'm trying to find as much information as possible to help her. Here's a little about our situation. Mister is a 12 year old long haired calico. She weighs about 12 lbs. and the reason that I took her in to the vet Tuesday was that she was very lethargic, wobbly legs when she did walk, she was drinking constantly and clearly didn't feel well. This seemed to happen all of a sudden, but I have come to understand that she has probably been suffering from hyperglycemia for a while.

The Diagnosis
When we took her in her blood glucose levels were over 400 and she also had an elevated white blood cell count. The vet informed me that she was most likely diabetic and, due to the hyperglycemia, had also developed a urinary tract infection. The tested her kidney function and tested for pancreatitus and both were normal. She was admitted to the vet that day and they began IV fluids, insulin and antibiotics. When I went to visit her the next day she still wasn't eating at all and was a very sick kitty. To try to stabilize her our Vet suggested that we insert a feeding tube along with the other treatments. The next day I definitely saw some improvement during our visit, but we kept her there for the rest of the week. Friday afternoon when I visited I begged to take her home and told them I would do whatever it took to take care of her.

Coming Home & Treatment
She came home with the feeding tube and lots of medication along with fluids to be administered daily. Here's everything we did on the first day home:
1 tablet Baytril
1 capsule Ampicillin
1/2 tablet of something that starts with a b (can't remember the name right now)

All of the medication along with some Omega 3 were crushed up with her food (Science Diet a/d) mixed with some liquid clinicare and given through her feeding tube. At night I administered 100 mL of fluid under her skin. I thought so far this was the worst part because the needle is huge. We also started 3 units of Lantus every 12 hours (9AM / 9PM)

By Sunday she was clearly feeling much better. On Monday morning I took her back to the Vet and they tested her blood sugar. It was 362. The set me up with a blood glucose meter (AlphaTrak 2) and showed me how to test. They also said to move her Lantus dose up to 4 units. I did that that evening and tested her glucose level in the morning. By this time she was eating on her own, but she still has the feeding tube in. (I'm using only one syringe of food through her feeding tube to basically make giving the medication easier.) Her blood glucose level tested at a 64, and just to be sure I didn't mess up my first test I tested again and it was 71. Called the Vet and they told me to not administer the insulin. I checked her glucose at about 7 PM and it was 101, so again no insulin.

So here we are this morning and I was hopeful that maybe she was going into remission, but I checked her glucose level this morning and it was a 403. Back to 3 units of lantus and I guess a lot more of testing.

I really hope my cat doesn't hate me after all of this. Between the feeding tube, fluids, insulin and testing it seems like every time I pick her up I'm poking her. So far she hates the ear prick to check the glucose the worst. I can tell that I'm hurting her and I hope to get better at it, but until we know the correct insulin dosage I think we are both going to have to get used to it.

So, if anyone has managed to read this long, thank you. This has been a long week and we still have a long way to go. If I wrote down something that seems wrong to do please let me know or if anyone has any suggestions on how best to take care of Mister I would really appreciate it.

By the way, I forgot to include what I had been feeding her: Friskies canned food and Iams dry weight management food. Now I have banished the dry cat food and she's only getting the low-carb Friskies.

Thanks again for reading.
 
Welcome to FDMB!

Wow! A lot to go through already!

Since you're already giving insulin, focus on testing until you feel really comfortable. It sounds like you are getting there. We have a really nice, auto-color-coding spreadsheet you can use to record the insulin doses, glucose tests, and other notes about your cat's health. Instructions are here

As the infection clears, and the Clinicare is reduced or eliminated, you are likely to see the glucose levels reduce, and the insulin will need adjusting too.

With an AlphaTrak, you want the lowest number between shots to be no lower than 80 mg/dL. Anything lower than that often signals a reduction in dose and may require intervention. As you've already encountered this, you may find it helpful to read and print How to Treat Hypos, and to have on hand some Karo syrup, plus a few cans of high carb, gravied foods (ex Fancy Feast Gravy Lovers will do) in case of going low again. An oral syringe may be helpful, plus extra testing strips for monitoring low numbers.
 
Hello and welcome to the board!

Mister is a girl? Is there a story there?

I am sorry to hear you have been having issues with Mister but your vet sounds like he has done some good things - the testing is great - and Lantus is a good insulin. Also a move to friskies is great ( the pates right?).

In terms of dose, 3 units is a lot to start off with which is likely why you are having these lows and highs. We usually calculate starting dose as 0.25 unit per kg of the cat's ideal weight - which in your case is 1.36units. So I would recommend you drop to 1 unit and work your way up from there - we can advise more.

Also it would be a good idea to track your readings in a spreadsheet - that was both you your vet (and us!) can see whats going on and make recommendations - here are instructions but let us know if you have issues and we can help you set it up: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Let us know
Wendy
 
Hi Christa,

Welcome! I'm a Newbie, too (5/15) so I can't help you with the dosing, but I wanted to drop in & say 'hi' & let you know you've found a wonderful place with many experienced people who will be able to guide & support your efforts, your emotions, & your kitty every step of the way. :YMHUG:

You've been through alot already, & are doing great. The beginning has a huge learning curve, so keep breathing, have patience, read as many posts as you can, & don't give up!

Re. ear testing,it can be rough at first, but you & your kitty will get used to it & soon it will be much easier. It might help for you to try some practice tests - without the actual poke, but let kitty hear the sound of the lancet, & get used to the procedure. It also helps to offer a lc treat reward after every test - successful or not. Many people use freeze-dried chicken from a pet store or online. Another member recommends buying the dog size & breaking the pieces up - its much less expensive! Tigger's got to the point where all I need to do is shake the treat bag & he comes to his testing spot & plunks right down in my lap. We do the same with the insulin shot - Tigger goes right to his spot after dinner & waits for his treat.

The Spreadsheet is also really helpful for you & for other members to see your kitty's progress, patterns & history. You can also click on the link to other members spreadsheets & learn alot from them - they're a great resource.

Some others will be along to help you with the dosing & other items so keep checking back. Keep up the good work!
 
Thanks for all of the responses!

I do have the Karo syrup on hand now, but I'll be picking up some extra gravy emergency food too.

Thanks for the idea about the treats. I looked when I was at the grocery store because I thought it would be nice to reward her for being good during the testing, but when I read the ingredients they all seemed like they would be high in carbs. I'll look for the chicken - maybe I'll have some better luck at a pet store.

I'm not 100% positive but I think our vet came up with the 3 units over the week that she was in the hospital and I think they were testing her every day. She's a very good doctor, and the clinic is specialized for cats only, so I don't think she picked 3 units out of the blue. However, I do have a seed of doubt now, because when her sugar was high Monday she suggested going up to 4 units and after reading this board it seems like the dosage should have been changed in smaller increments. Would it be safe to go down to 1.25? I don't want her on a roller coaster.

Interesting comment about the clinicare too. I checked the carbs in the special canned food (hill's a/d) but I didn't even think about the clinicare. I had suspected that what I was pushing down the feeding tube might have had an effect, because on Monday the only thing she had was the pate friskies, no insulin, and the glucose readings were 71 and 101, then last night I did the feeding and now we are up to 403!

By the way, the spreadsheet is awesome, I love spreadsheets anyway so I will start recording everything from now on.

Oh, and I did know she was a girl. Our other cat at the time was named Miss, and as a joke when we first got her we called her Mister. She perked up right away and really liked it, so it stuck, but she is a cat of many names. She also goes by Biscuit, Biskie, and Mister No-Purr. I know we are both really awful at naming cats. Good thing we don't have kids ;)
 
Heres a shopping list in case you missed anything:

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

You can get the freeze dried treats in Walmart. Sometimes in the dog section in big bags... they say 100% pure chicken or something like that.

Would it be safe to go down to 1.25? I don't want her on a roller coaster.
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Yes but we should test her for ketones ( see shopping list above). Did the vet mention ketones at all?? We will move her up gradually every few days if its not enough. The 403 could be a reaction to her prior low of 64. Thats called a "bounce".

lol on the kids.

Wendy
 
Hi Wendy, so I just got home from work and took another reading - 88. I called our vet and she said to give half a unit of insulin tonight. Does that sound right to you all? I'm starting the spreadsheet, and I think that the smaller dose sounds like a good idea, but what is your opinion on this half unit tonight?

Also, do you have any links on what the 'bounce' means? I'd like to learn more about the entire insulin / BG curve, but I"m overwhelmed as to where to start.

Thanks again for all of your help, I really do appreciate it - so does Mister.
 
I didn't know W.M. carried the FD chicken - good to know - Thanks, Wendy! I got mine at Petsmart & online 4 oz for about $15. They last a long time.

I have a Relion Confirm & like it very much - the test strips are much less expensive than the type you already have. Also, you can order them through ADW (see icon above) as GLUCOCARD 01 Sensor test strips by Arkray are the generic form & cost less http:http://www.americandiabeteswholesal...or-test-strips-50bx-buy-4-get-1-free_4050.htm
 
I certainly agree with a lower dose....However we dont advise newbies shoot under 200 because you dont know he wont go too low.

How long is it till you are supposed to shoot? Also dont feed for two hours before the shot, and test first. That way the test number isnt influenced by food.

Also Lantus works best on consistency, not varying like this. We need to find a dose you can give every 12 hours... which is why I suggested 1 unit.

Wendy
 
She didn't tell me an exact time, just tonight. I have been doing the insulin every 12 hours, 9 AM and 9 PM, and I tested tonight at 4:30 before feeding.

I did feed her after the test, so should I test at 9 tonight before the shot? If the reading is under 100 should I skip the shot?

By the way, I picked up the freeze dried chicken and she looked at me like I was stupid. Its a no-go on those treats. I'll try a few of the other low carb treats I've found on here.

Also the vet hasn't mentioned anything about ketones. I'll pick up some testing strips tomorrow.
 
Typically, we test/feed/shoot all within the same 15 minutes for Lantus.

And please don't shoot under 200 mg/dL unless you have several weeks of test data showing it will be safe.

Here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir in long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- 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, especially if for most of the cycle between shots
- Uncontrolled diabetes and in danger of DKA and hepatic lipidosis
- Test for ketones; more than a trace, go to vet ASAP.
 
Hi Christa and Welcome!

ChristaMJ said:
Hi Wendy, so I just got home from work and took another reading - 88. I called our vet and she said to give half a unit of insulin tonight. Does that sound right to you all? I'm starting the spreadsheet, and I think that the smaller dose sounds like a good idea, but what is your opinion on this half unit tonight?

Also, do you have any links on what the 'bounce' means? I'd like to learn more about the entire insulin / BG curve, but I"m overwhelmed as to where to start.

Thanks again for all of your help, I really do appreciate it - so does Mister.
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If the 88 was at her shot time, I would recommend skipping tonight's shot solely because we don't have enough data on how she'll react just yet. We recommend for new users to not shoot under 200 but to hold off feeding and post here first.

What dose did the vet say to give her going forward? A few other things to take into consideration for the reduced dose Wendy recommended is that you've recently completely removed the dry food and she's getting better after being quite sick (which also spikes BGs).

"Bouncing" is what occurs when the body reacts to what it considers "low" numbers or when there's a sharp drop in numbers (i.e. 403 down to 88). Part of the pancreas's job is to help regulate glucose/insulin levels and when there's too much insulin, it spills out glucagon to trigger the liver into releasing glycogen (a form of stored glucose) to counteract the extra insulin. In a healthy system, this is a seamless process and there are no bounces or hypos to worry about. In a diabetic, however, the pancreas is not used to "normal" or even what "normal" should be. What happens is that the pancreas overreacts or "panics" and triggers the liver into releasing too much sugar. This causes the "bounce" from low numbers to high.

I would suggest you start here for more information on Lantus, the TR Protocol, and what a typical Lantus cycle looks like:
+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.
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To clarify: is she eating the Friskies on her own and then you're feeding her the clinicare through the tube? I had a cat with acute hepatic lipidosis that I had to tube feed for a few months until he could eat on his own again. cat_pet_icon Within the first week, he was purring in contentment as I tube-fed him, so don't worry; I don't think she minds the feeding tube as much as you think. ;-)

ChristaMJ said:
By the way, I picked up the freeze dried chicken and she looked at me like I was stupid. Its a no-go on those treats. I'll try a few of the other low carb treats I've found on here.
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You can try re-hydrating them with a little warm water to get them to smell. Some cats don't realize it's yummy chicken initially. :lol:
 
Sorry Mister didn't like the FD chicken to start, Christa,

KPassa wrote:
You can try re-hydrating them with a little warm water to get them to smell. Some cats don't realize it's yummy chicken initially. :lol:
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KPassa's suggestion should do the trick - I'll keep my fingers crossed!

You've got a lot of great information here - keep up the good work!
 
This morning's update:

I skipped last nights shot. I think 88 was just too low.

She is eating 100% on her own now - friskies canned pates, but the feeding tube is still in. Right now, my instructions are to basically use the feeding tube to give her the medications which are: 1 tablet Baytril, 1 capsule ampicilin, 1/2 tablet benazepril, 1 oz. omega 3, and 2 ml of Amino B-plex which I mix with some hill's prescription diet a/d and the clinicare. I think the only purpose of the clinicare is to water down the food so it will pass through the tube. There are also two other medications that were prescribed but I haven't been giving those - they were just prescribed on Monday. Metronidazole and Proviable. I haven't given those because I mentioned on Monday that she might have diarrhea but that has gone away since she has been eating on her own. I know that I should follow the doc's orders, but I just made the call on those.

I skipped the clinicare last night, just water, and this morning I tested her BG and its 136.

The Vet first prescribed 3 units twice a day, then one day she told me to skip when her blood sugar was normal, then the next day it was really high (following a clinicare tube feeding), and she said to up it to 4 units, and then last night when I had the BG of 88 she said give a half unit (which I skipped).

So, my question today is insulin or no insulin? confused_cat
 
I'd skip.

Next time you give insulin, I'd drop the dose. The idea is to have a dose you can give safely every 12 hours, which doesn't take the glucose below 50 mg/dL on a human glucometer or 80 mg/dL on an AlphaTrak meter.

How much does you cat weigh?
How much should your cat weigh?
 
Again, dont shoot under 200. But lets see where she goes today. and then 0.5 unit tonite if she is over 200. We can work our way back up from there in a few days if its not enough.

Also can you update your spreadsheet with these readings? Put "skip" in the dose column too

thanks
 
I just updated the spreadsheet with the new BG readings. Hopefully I have it filled out right, please let me know if it looks messed up.

Mister weighs 12.2 lbs, but I'm not sure what her ideal weight is. This is her weight history:

11/06 - 11.4 LBS
6/09 - 13.2 LBS
6/11 - 13.2 LBS
12/11 - 14.4 LBS
7/12 - 13.6 LBS
7/13 - 12.2 LBS

Thanks!
 
Is she currently underweight?

I'm asking, because her lean weight - the lower of her current or ideal weight - may be used to determine a starting Lantus dose.
 
Wendy&Tiggy said:
How are you weighing her? Thats a lot of weight loss for one day between Jul 12 and 13..

SS looks better thanks!

Wendy
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Ha! I should have clarified :smile: - these are months/years - she's getting weighed at the vets office.

The vet is concerned about her most recent weight loss, but didn't specify if she is overweight or underweight.
 
She lost a pound in a year? Doesnt tell us much - she could have done it slow over the year or in the last month. I would weigh her on your scale every few weeks (weigh yourself with and without cat and do math). Add it to the comments field of the SS>\.

Wendy
 
Hi again, I feel like I'm really going to wear out my welcome, but any dosage advice would really be appreciated. I just checked her sugar again and now its at 309. I'd really like to find a consistent dose to give every 12 hours. 1/2 a unit ? 1.25 units? I've read about the lantus 'reservoir' and I really would like to find the magic dose to keep her steady rather than skipping doses.

Not sure what is best??? Any thoughts? confused_cat
 
Don't even think that!! You are not wearing out your welcome. We are here because we want to help and enjoy helping!! So keep asking..

However dont make me repeat myself.lol.! Give 0.5 units tonite as per my post above and lets do that for a few days to see how she does.

Actually you might want to read back through everything thats been said cos its easy to miss stuff with all the posting and getting set up .. and sometimes you dont understand it at first but it makes more sense later!
 
The Clinicare is 25% carbs by calories. So if you have completely stopped giving that because she is eating better on her own, then that should help to bring the BG's down over time.

Hi again, I feel like I'm really going to wear out my welcome, but any dosage advice would really be appreciated.
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No, welcome mat is always out here on the FDMB. ;-)

Dose of 0.5U BID for a few days, monitoring to see that she does not still drop too low would be my recommendation. If Mister drops below 50, we reduce.
 
Update

So, on Thursday night I gave Mister the 1/2 unit of Lantus. Testing BG on Friday morning and she was at 114. My vet, who is super awesome by the way, has been advising me on dosage everyday via email, said skip the dose. Tested her again Friday night and she was at 119 - again skipped the insulin. This morning I took her into the vet's office and had her feeding tube removed because she is eating normally on her own. I didn't test her because she was super stressed and I didn't want to make it worse, but I did test her in the evening and she tested at 78.

Is it too early to hope for remission? So far, I"m really happy with how happy she seems. Its been a complete turnaround from two weeks ago when I thought I might lose her. :-D
 
If Mister's BG numbers continue to creep up, he may need a little bit of insulin to support the pancreas with more healing.

I suggest you keep a close eye on him, test every day in the morning and evening and keep us in the loop. Keep the SS updated as well if you would please.

Remission is a distinct possibility, but it's too early to tell. We want 14 days in these low numbers, 40-120, with most of the numbers below 100.

We are in waiting mode. Put on your patience pants please.

Pick your favorite color!
 

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Paws crossed but if he starts to creep up then maybe you want to try 0.25units. Usually we recommend a slow tapering of the insulin from 0.5 to 0.25 to 0.1 before going off entirely.
 
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