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Kate and Grace

Member Since 2012
Hi - I'm Kate and I'd like to introduce Gracie (aka Grace, among "the many names of a well loved child") . She is 15 or older. She is blind, has arthritis, may have pinched a nerve (whatever happened was sudden and did not show up on X-ray) and now we've added a diagnosis of diabetes and her back legs are not in good shape (arthritis, pinched nerve, neuropathy... It gets complicated).

We've gotten Grace's pain under control with torbutrol and aspirin. I also give her glucosamine and fish oil. We started prozinc insulin, 1 unit BID and are working toward regulation. We are discussing xobaline.

Our vet is great, and I trust her. I'm told to give it a month. I'll admit I'm scared. Steady slow decline has turned into a free-fall. I can't keep her how she is (can't walk to food/water/box). I can't skip work to help her get where she needs to go. I can't let her go if she will get better. I can't keep her to avoid the loss I'll feel. I'm going through a month and I'll re-evaluate then.

I'm hopeful that this will just be another bump in Gracie's road (there have been far too many). But any advice on how to manage this new challenge, ways to get Grace through, how to manage... Will be much appreciated.

Kate (and Gracie)
 
Hi Kate and Grace - welcome! It sounds like Grace has a lot of issues and a Mom who is committed to help her with them!

Have you read about Methyl B12 for neuropathy? Lots of members have had success with it:
http://www.felinediabetes.com/weak-back-rear-legs.htm

What are feeding Grace? We feed wet low carb. A vet explains why here: www.catinfo.org

ProZinc is a good insulin. We would urge you to test Grace at home so you can be very active with her treatment. We think numbers gotten only at the vet can be higher than those at home because of vet stress and then doses can be too high.

We'd love to help you help Grace. Let us know what we can do.
 
Hi Sue and Oliver,

Thanks for the welcome! Grace is now eating only Fancy Feast Classic. Is Fancy Feast Classic an okay food choice? She's a bit picky, hates anything with chunks in it and has refused to eat in the past when I've tried other canned foods. The vet receptionist mention special prescribed diet but the vet did not broach the subject and I'm reluctant to change.

After self and vet research we are starting a methyl b12. A local pharmacy can compound a cat-friendly methly B12 for us (beef flavored liquid) and I should be able to get it tomorrow. The only noted side effect per pharmacy report is that it may stain her mouth red. Color of mouth - unimportant. Function of back legs - essential.

I'm not home testing BG at present but may down the line. At present I'm doing cat masage, warming cat feet, and doing range-of-motion exercises to increase circulation. We also have back-leg strength training exercise. I'm concerned if I start testing now I'll ruin my ability to accomplish anything else because she will decide she isn't dealing with me. We are using the start low and go slow approach, so chances of crashes should be minimal. Would you advise differently? Since she isn't moving much at present I could BG test without having to try to locate her and drag her out from under bed/in closet... but again if I create her wanting to avoid me it goes badly in many ways. I'm not sure how to balance the competing concerns/interests.

Another thing I worry about is insulin schedule... In a normal week it is no issue (AM and after work) but my work schedule shifts, we'll need to travel at Thanksgiving, I'm trying to adjust to as close to on a 12 hour schedule as possible but life is messy. I don't want to create any big drops when I'm away. Do you have suggestions on how to manage schedule changes? If I work 7-3 one day and 3-11 the next what is the best thing to do for her?

Thanks much for help and advice - we both appreciate it.

Kate and Grace
 
Our collective experience is that home testing is the most important thing you can do for Grace. Some many people come on and aren't testing and the cat is acting strangely. Then they try to guess whether it is too much or too little insulin. We figure we wouldn't give insulin to our 2 legged children without testing; we do the same for our 4 legged ones.

The fastest road to regulation and possible remission is to get a number before each shot (to make sure the amount of insulin you are planning to give is safe) and half way through the cycle to see how the insulin is working. Then you and your vet can adjust the dose as needed. Anytime you are worried about how she is acting, you can test and find out how she is doing. I can't tell you the peace of mind it will give you. This document is large and full of links but will give you great information on ProZinc and how it works:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

The Fancy Feast classics are a great choice. And the Methyl B12 should help. Neuropathy is helped by that but also lower, safer numbers so both are part of the process.

Many, many cats come to purr through the tests. I know it sounds impossible but it is common. The trick is to give the Grace something she loves after each test with lots of praise. It can be brushing or a special treat that is only given with the test - whatever she will associate positively with the test. I would start her out like this:

First pick a place where you want to test. Some people use the kitchen counter, a blanket on the floor, between your legs while sitting – whatever works for you. Take the kitty there and give her lots of praise while you play with her ears. Give a treat and release. Next time, add the rice sack (thin sock filled with raw rice, heated in the microwave until very warm but not hot) or a prescription pill bottle filled with very warm water. Lots of praise, treat and release. Finally add the lancet she will get used to the noise. The hope is that when you finally poke, they will be used to the process and know a treat is coming!

While she is fairly immobile is a good time to get her used to the test and the treat that comes with it.

My story about testing: We changed Oliver's food from dry to wet. We had been giving 2 units of insulin twice daily. The morning after the switch, we tested and he was 100 points lower than the day before. If we had just given the normal amount, he would have hypoed. It made believers out of us! Lots of things can change the numbers - eating less than usual, an infection, a change of food, being stressed about something at home, or just being a cat. The only way to know whether the shot will be safe for Grace is to test her before giving it. You just can't tell by observation.
 
Thanks for the help and advice, Grace and I appreciate it.

I'm still a litle worried about testing. I think I'll start prepping her for it as you suggested and cross that bridge when we get closer to it. Earlier in her history trying to get a single pill in once a day was a disaster. She hid, didn't like it, and would then refuse to speak to me after I succeeded. Since I'm her primary relationship, she was awfully alone, increasingly unhappily and acting increasingly poorly. Note posession of multiple carpet cleaners during this period. Once a day prozac crushed into food saved the relationship (and reduced carpet cleaning). My vet suggests we go slow, and she tests in the beginning, and I take over when we are approaching regulated. Does that sound reasonable? She doesn't plan to manage tight control at this point, and sees high numbers as safer than hypo episodes. What are your experiences with this?

Thanks again from Kate and Grace
 
Hi Kate,

My vet suggests we go slow, and she tests in the beginning, and I take over when we are approaching regulated. Does that sound reasonable? She doesn't plan to manage tight control at this point, and sees high numbers as safer than hypo episodes. What are your experiences with this?
Click to expand...

Hmmm, tough to answer. As Sue said above, the absolute safest way is to home test and test especially before giving any shots. A lot of this, if you aren't going to be testing from the start, will have to do with what sort of BG numbers the vet is seeing, and what sort of dose she prescribes. I understand her not wanting to manage "tight control" but it also matters what her definition of that is. Higher numbers are safer than hypo episodes, sure. Hypo numbers are dangerous and can be harmful or deadly quickly. High numbers, however, are not a good thing either. Numbers that are higher than the mid-200 range cause damage to a cat over a period of time. They can cause glucose toxicity and insulin resistance when they remain above that level for a long time. So yeah, you're sort of between a rock and a hard place.

If you can give us an idea of the BG numbers and the dose once you get to that point, we'll be able to help advise if the numbers are logical.
I totally agree with the "go slow" approach. We advocate that strongly. And we tend to be "slower" than many vets actually. We put her safety above all else, and when we adjust dosage, we do so in much smaller increments than most vets recommend. We also tend to advise starting doses that are lower than most vets prescribe.

Home testing is nowhere near as traumatic for cats as pilling a cat that doesn't like to be pilled. It sounds scary, like "you want me to poke my cat and make her bleed????" But it isn't really that bad. My cat, Bob, wasn't a big fan of me when he was diagnosed. He was my wife's cat, definitely a Momma's boy, and didn't really pay much attention to me, or want any attention from me. I, however, was the one who decided to go the "treatment" route instead of having him put to sleep like "Mom" was ready to do.
On that day, I took over 100% of his care. The first few ear pokes weren't all that much fun. But we got through it. Each time I got blood was easier, took less time, and caused less stress. A week later, it was a one minute process, tops. Eventually, Bob would come to me at test time, especially the tests just before his meals. Purring. Every time I poked his ear, he got a fresh shrimp as a treat. Bob lives for shrimp! He would chew through your foot if you were standing on top of a fresh shrimp :lol: Anyway, Bob was on PZI for 10 weeks last year and ended up going "off the juice". And now, as far as he's concerned, I am now "The Momma". ;-) He hasn't had a shot in 15 months. But if I go get the meter out right now, and he heard or saw me do it, he would run to me, lay down, purr, and wait for me to poke his ear. Your cat will associate the shots and the ear pokes with treats, and with feeling better. There will come a day when you forget it's time for a test or a shot, and Grace will remind you.

Your dear girl has had a pretty tough time of it. Being blind, arthritic, nerve problems....and every step of the way, it's been you who has loved and helped her to deal with it. Compared to all of what has come before, diabetes is NOTHING. Sure, it needs to be treated, but compared to all the other things she's dealt with and all the other things that can go wrong with a cat, it's really not that huge a deal. Gracie knows, by this point in her life, that you are the one who loves and cares for her and makes her feel better. She'd not going to feel any differently about you when you get her past "this".

You've found probably the best place in the universe to get help with dealing with and learning about feline diabetes. We would all be happy to help you and Grace with this.

Carl
 
Grace was BG 485 Thursday and 386 Saturday before starting insulin. One of my concerns is that these numbers are following a second round of steriod treatment for a pinched nerve - possibly steroid induced diabetes and possible reversal coming? I noticed increased food consumption and increased and diluted urine only in the week before the Thursday appointment. I'm wondering if I really ought to be testing just in case we get the miraculous recovery - I'd hate to kill her trying to fix her. Grace has had her many challenges but she has had plenty of amazing rebounds - it's why we keep trying even when I think I've lost my mind to be doing this next thing. From the advice I'm getting it sounds like a trip to walmart for a glucometer will be my next adventure after the trip for the B12.

Do you have a sliding scale you use based on the BG you get or do you just not give if the number is below a certain point? Or is this a question better directed at my vet (who I doubt knows about sliding scale insulin but is always willing to research and learn)?

Grace is not objecting to the insulin shots yet, is eating and drinking less, and has stopped calling for me in the middle of the night. I'd like to think we're making progress but it is early still. We remain scared but hopeful. And we appreciate the support, help, and advice!
 
Kate,

Here's a shopping list for hometesting:


A human glucometer. Any one that sips and takes a tiny sample is fine. Some members stay away from any meter with True in the name and the Freestyle meters. Some people think they are unreliable and read lower than other meters. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water. It provides a good surface to poke against.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats


I think the best way to approach dosing is to start with .5 or one unit twice daily. Test before every shot and midcycle to see how the insulin is working. Hold the dose for several days, collect the data and then evaluate, here and with your vet. One of the annoying sayings here is that this is a marathon, not a sprint. So we start at the low dose, test and then reevaluate.
 
You asked about having a number that is too low to give a shot? We usually recommend that people just starting home testing not shoot if the preshot test shows a number below 200. At least not until you've gathered enough data on preshot and nadir BG values to know what the current dose is doing over the course of a 12 hour cycle. Eventually you may feel comfortable giving insulin on numbers below that line, but at first, safety is the primary concern.

Carl
 
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