Newly diagnosed - Simone

[juco]

Hello everyone! My cat Simone has chronic liver disease. When her appetite slowly tapered off last month, I thought she was having a feline herpes virus flare-up (all 3 of my kitties take L-lysine). When my husband took her to the vet, we were shocked to find out that she had a raging case of cholangiohepatitis that had quickly progressed into diabetic ketoacidosis. She had had a bad liver infection in the past, and I was so surprised that there weren't more prominent symptoms. Then I remembered all of the water that she was drinking and how full the litter box had been. Watch for these signs, folks!

We really thought we were going to lose Simone. The vet said that her best chance would be emergency care at a 24 hour vet, which would cost around $3000. They could keep her at the regular vet, but that would cost $1800. Even with vet care they said that she had a 50% chance of survival. We wanted to give her the best care, but couldn't shell out that kind of money. So they taught us how to give her subcutaneous fluids and insulin injections and sent us home with two different antibiotics, appetite stimulant, anti-nausea medicine, and liver support supplements. We sat at home with her, no knowing if she would survive. But at least we were there with her - we couldn't bear the thought of her passing away in a cold vet clinic. Amazingly she improved! She kept on eating and responded well to the insulin and antibiotics.

She finished up her two rounds of antibiotics this week and her bloodwork showed normal liver enzymes - thank goodness. But she's still diabetic. We had held off doing home testing hoping that she would go into remission once her infection subsided. We were disappointed and overwhelmed to think that this will be ongoing. Our vet (not sure how much longer I'll be going there, btw) only offered us the option of the Alpha Trak, which I'm sure many of you know is VERY expensive and not easy to buy in the first place. I actually had one ordered and found theFrugal Feline Diabetes page and CatInfo.org, which said that the AlphaTrak really isn't any better than drugstore meter. I cancelled my order and bought a Bayer Contour today. I'm going to experiment with testing on Simone tonight.

Simone has been a trouper through this whole ordeal, so I know that she'll be fine with home testing. She's on .5 units of Lantus twice a day, and she's eating Purina DM. I'm planning on making a diary of her blood glucose readings. Can anyone give me advice about adjusting insulin amounts? Can you guys also talk me through doing a blood glucose curve? Thanks everyone!

 

[BJM]

Welcome aboard, Simone and Juco.

Good for you for biting the bullet and getting started with testing. If you pop over to the Technical forum, there are instructions on how to set up a spreadsheet to record the tests, shots, and notes on Simone. A glucose curve is nothing more than testing evey 2 hours over the 12 hours between shots, from before the morning insulin shot (AMPS) to the before the evening shot (PMPS).

Since you are already giving insulin, hold off on diet changes until you are able to test successfully. That will ensure that you can monitor the results from any diet changes and know that it is safe to shoot (give insulin).

There are 2 Lantus forums with sticky posts at the top describing everything you need to know about Lantus and Levemir. Once you're testing and can do a curve, you'll be able to follow the protocol posted and get advice for dose changes.

Here's a spot of reading on nutrition to get you started: Cat Info. You'll note the emphasis is on low carbohydrate, all canned diets.

To see some information on various brands of cat food and the % of calories from carbs:
Binky's Page
Pet Food Nutrionional Values Comparison
Aim for under 10% of calories from carbohydrates. Notice that a lot of these foods are available over the counter and for much less than prescription veterinary diets.

 

[Brian]

Hi there!

When you have time, you might want to get a spreadsheet up setting up a SS, it will make it your data much easier to share if you need to ask for dosing advice.

The Purina DM-hopefully it's the wet food? There are much cheaper low carb options, you can search for Janet & Binkys food list to see what they are. Depending on what food Simone was on before, you might find a change to low carb wet food causes a big drop in blood glucose and insulin requirements, so ideally you'll get home testing down pretty quick. IMO the Purina wet is fine for a start, my cat did well on it and I could take some time finding other more affordable options.

Lantus is great, and you're on what should be a pretty safe starting dose. You should check out the stickies in the LANTUS (GLARGINE) - Tight Regulation Forum, and particularly STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL. There's also a link to the "Start Low Go Slow" version of the protocol in there.

If you're up to reading a journal article, here's a great one, the protocol on this site is a modified version of the one in this paper (and the one I followed). Particularly nice is this study is based on using human blood glucose monitors for home testing (most participants used the Contour) and it explains how your Contour will read lower than the vets tests or the AlphaTrak. This is no issue (almost everyone here uses a human meter) and the protocols take this into account, but it's something you and your vet should be aware of. This paper was also my main source of ammo to justify my choice of the Contour over the AlphaTrak to my vet.

The biggest thing I did wrong at the start of home testing was not heating the ear up enough. A pill bottle or a coffee mug filled with warm water or a small bag of rice heated in the microwave can be used. It made a huge difference for me.

Good luck!

 

[juco]

Thank you for all of your info - and Brian, thanks so much for that journal! That will be very valuable when I take in my monitor to compare it to my vet's. I just took my own blood glucose reading and then Simone's. It was good for me to stick my own finger first, that way I new how much force to use on her. She did great!

She wasn't eating very well last night and this morning, so my husband took her in to the vet this morning. I did a somewhat botched urine test and got a moderate ketone reading, and that scared me. They did a urinalysis, and sure enough - ketones. She's getting an increase to 1 unit of insulin twice a day and going back on antibiotics in the morning. I'm really happy for tools like the glucometer and the ketodiastix to alert me before it got too bad!

 

[Blue]

Hello everyone! My cat Simone has chronic liver disease. When her appetite slowly tapered off last month, I thought she was having a feline herpes virus flare-up (all 3 of my kitties take L-lysine). When my husband took her to the vet, we were shocked to find out that she had a raging case of cholangiohepatitis that had quickly progressed into diabetic ketoacidosis. She had had a bad liver infection in the past, and I was so surprised that there weren't more prominent symptoms. Then I remembered all of the water that she was drinking and how full the litter box had been. Watch for these signs, folks!

We really thought we were going to lose Simone. The vet said that her best chance would be emergency care at a 24 hour vet, which would cost around $3000. They could keep her at the regular vet, but that would cost $1800. Even with vet care they said that she had a 50% chance of survival. We wanted to give her the best care, but couldn't shell out that kind of money. So they taught us how to give her subcutaneous fluids and insulin injections and sent us home with two different antibiotics, appetite stimulant, anti-nausea medicine, and liver support supplements. We sat at home with her, no knowing if she would survive. But at least we were there with her - we couldn't bear the thought of her passing away in a cold vet clinic. Amazingly she improved! She kept on eating and responded well to the insulin and antibiotics.

She finished up her two rounds of antibiotics this week and her bloodwork showed normal liver enzymes - thank goodness. But she's still diabetic. We had held off doing home testing hoping that she would go into remission once her infection subsided. We were disappointed and overwhelmed to think that this will be ongoing. Our vet (not sure how much longer I'll be going there, btw) only offered us the option of the Alpha Trak, which I'm sure many of you know is VERY expensive and not easy to buy in the first place. I actually had one ordered and found theFrugal Feline Diabetes page and CatInfo.org, which said that the AlphaTrak really isn't any better than drugstore meter. I cancelled my order and bought a Bayer Contour today. I'm going to experiment with testing on Simone tonight.

Simone has been a trouper through this whole ordeal, so I know that she'll be fine with home testing. She's on .5 units of Lantus twice a day, and she's eating Purina DM. I'm planning on making a diary of her blood glucose readings. Can anyone give me advice about adjusting insulin amounts? Can you guys also talk me through doing a blood glucose curve? Thanks everyone!

Welcome to the site! It looks like you guys are off to a great start already, so I guess I'll just give you some links and you can ask whatever questions you have after looking at all the stuff has been given to you.

Food - you have the link to catinfo.org and there's a ton of great stuff there. For a diet, take back the vet food as it does not have great ingredients and you can get better ones of Binky's list that are under 10% carbs. Many people just feed Fancy Feast or Friskies pates no gravies or grilled .

For home testing, I also love the Bayer Contour the best, so just make sure you have extra battery for the meter and a good number of test strips.
Testing on cat’s ear

Because of Simone's history with DKA, be sure you have KETOSTIX and you are testing urine for ketones regularly.
List of Hypo symptoms
How to treat HYPOS-They can kill! Print this out!
Jojo’s HYPO TOOLKIT
Ketones
Pet Diabetes Wiki: Ketoacidosis

Fluids daily are going to help you with those ketones most definitely.
Good video of giving SubQ fluids
Saddle – locations for Squids/injections

The guys in the Lantus forum can help you with dosing decision.
Lantus & Levemir: Info, Proper Handling & Storage
I know that you have the main links for the protocol to help you with dosing, but here's the main guidelines so give you a quick look
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 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.


here's the link to set up a spreadsheet that will help you track your test results visually, and to allow others to see and help you as well.
Create your Spreadsheet

I am sure I have repeated some info and links but better twice than not at all.