Next steps for fern

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Fern

Fern

Member Since 2016
Newly diagnosed Fern has been on a schedule over the last two weeks

AM 6:30 - feed watered down FF pate 3 oz ( she frantically hovers her food )
Take BG test ( with ACCU-CHEK Aviva ) my husbands glucometer
Give 1 unit Lantus
PM6:30 - Same again

This morning her number was 30.1 (542) I tried to take a test +4 and she attacked my hand she seems to be getting progressively irritated with BG testing. I have a warm wash cloth and keep myself calm as I can. During the day instead of listlessly lying around she is now is constantly searching for food and very restless. The number 29 was taken at the vets 2 weeks ago at diagnosis
The lowest her reading has been is 19. Lower readings are usually before her PM feeding ranging from 19 - 24

when stores open I will buy some Go FIt and Free so potentially the cats can have something midday. I have a multi animal household and feeding multiple times a day seems to be prohibitive. I also have 1 cat who is rejecting wet food.

I am questioning why her numbers remain still so high

Fern is very stressed right now as she is starving. She has lost a lot of weight so of course my instinct is to give her more than the 2 cans of FF a day. All my cats have been on dry food and self fed. I realize there is a big learning curve for us all and wonder whether I should call the vet tomorrow to raise the insulin, also whether it is worth doing a glucose curve test day before her numbers have come down?

Thanking you in advance for your thoughts
 
Fern said:
I have a warm wash cloth and keep myself calm as I can.
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Many of us here take an old sock, put about 1/2 cup rice into the toe and tie it off. Heat it in the microwave until it's quite hot but you can tolerate it on your skin. The sock/dry heat seems to feel better to them and it stays warm longer.

Fern said:
She has lost a lot of weight so of course my instinct is to give her more than the 2 cans of FF a day.
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Yes, feed her more. Diabetic cats can't use food well because of the lack of insulin. She'll be hungrier than normal until her BG numbers are better. The FF cans are very small. I'd feed her more in multiple meals instead of just 2 meals. A baby scale is a good way to track her weight.

Fern said:
I am questioning why her numbers remain still so high
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The two main possibilities are that her dose is too low or her dose is too high. I highly recommend doing at least one test a day near the middle of a cycle to see if she's going lower on the 1 u of Lantus. If you're open to it, setting up a spreadsheet like the one we use here will allow others to see Fern's data. That's the way we're able to see trends and give advice.

Fern said:
whether I should call the vet tomorrow to raise the insulin,
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You need to know what this dose is doing before raising it. A glucose curve is a very good idea. That will tell you how she's doing on that particular day and it's valuable info. However, the best way to fill out the picture is by doing BG tests at various times scattered over days to build up the big picture.
 
Hi--

My initial thought is the same as Kris': 2 cans of FF probably isn't enough food for her, unless she is a very small cat, and definitely not enough while her blood glucose is so high. I think she needs more food-- not just because she "feels" hungry, but as a serious medical need. With such high BG numbers I worry about the possibility of diabetic ketoacidosis, and with rapid weight loss other serious health issues such as hepatic lipidosis can arise. In short, this is not the time for a diet-- let's get her blood glucose under control first (I'm sure Fern will endorse this plan!).

Mid-cycle blood glucose tests, or (even better) a full curve will help a lot to try to sort out what is going on with Fern. It's possible she needs to have her insulin dose raised, but you don't have enough information yet to make that call. As Kris said, the other possibility is that she actually needs less insulin! It doesn't seem to make any sense, but here's the rationale, and why those mid-cycle blood glucose tests are so important: if the insulin is bringing Fern's numbers down too low in the middle of the day, Fern's liver, which hasn't seen low numbers in a while, will "panic" and respond by dumping more glucose into the blood-- so by the time you get your next test at 6:30pm, the numbers are high again! Adding more insulin in this situation will just make it worse, and can be quite dangerous because eventually the liver can't compensate by dumping glucose. To make things even more complicated, this kind of effect can happen in the beginning of insulin treatment even if the dose isn't bringing the numbers down too far-- if Fern has been running in the 20's and above for a while, even a BG level of 15 (which is still quite high) can seem "too low" to her body.

It takes a while to figure out what is going on, but the fact that you are hometesting gives Fern the best chance at getting all of this sorted so that she can feel better again! In the meantime, here are a couple questions:

How old is Fern? What is her ideal weight? What led to her diagnosis (i.e., was she taken to the vet because of the clinical diabetes signs you noticed, or were there any other health issues diagnosed)?

For food: what flavors/varieties of FF are you feeding? I am not familiar with the Go Fit and Free food, but I just looked up the nutritional info online, and it looks to be around 15.5% carb-- much much better than most dry foods, but still too high for a diabetic kitty (should be <10%). There are only two dry food options appropriate for diabetic cats that I know of-- Evo Cat+Kitten and Young Again (only available online). Generally, wet food is best for cats, but if you've got a kibble holdout and a multi-cat household, those two can be excellent transition/supplemental foods to have around. The other thing people around here do for midday meals is to have a timed feeder, which is great for diabetics (frequent small meals are better than infrequent large ones), but again it can be tough to manage in a multi-cat household-- depends on the personalities of the cats!

Good luck on the testing-- a calm manner going in helps a lot, but the most effective technique I found for making my cat accept the tests was just to make her associate the testing with all kinds of fun stuff, by which I mostly mean yummy treats. I think she positively misses the frequent tests now that she is in remission (but I sure don't!).

Happy new year to you too!
 
Ah, sorry, I just went back and checked out your intro post, which I had missed. I should have caught that you were probably Canadian by the mmol/L BG scale and the unfamiliar cat food brand!

Anyway, regarding food: I retract my earlier statement about the Go Fit + Free not being appropriate. I don't know if you can even get the two foods I mentioned as being diabetic-friendly in Canada, so a 14-15% carb kibble is a pretty good option under those circumstances. I totally get the difficulties in managing the feeding of a multi-cat household, you just have to do what you can!
 
Wonderful information, and some great tips
Yes we are in Atlantic Canada, and per advise the Go Fit and Free is the best we can do up here for low carb.

I have just wrapped her in a towel and used the rice sock. It was easier to get a reading this time and mid cycle +6 she is showing 22.4 (403) she is currently grooming herself, good sign and I will give her .5 of FF pate to tide her till supper.
 
Good job getting the test. While she is so food motivated right now, it may be a good idea to feed her a little low carb FF like you did, immediately after each test (unless it is 2 hours or less before shot time, then you can feed some no carb freeze dried all meat treats up until test time) as that may help her to associate testing with good things. Pets, lovings and "good girl"s (no matter how high the number!) and whatever she likes will help too.

As far as the bouncing (when her liver panics (because of lower numbers than she is used to) and dumps glucose), they can last up to 3 days. If you happen to get a +6 mid-cycle test on a day when she is still in the middle of a bounce, you will still see the higher numbers. I would try to get a mid-cycle test for 6 cycles in a row, if you can, to really know how low the current dose is taking her.
 
I went back over your response and will answer the questions raised
Fern is 12 years old and was in good health until we moved from our farm where my cats lived in a piece of heaven on PEI to a postage stamp ( still rural ) in Nova Scotia Canada. I knew it would hard on the crew. Since Our move 6 months ago I have had a hip replacement, my horse has been diagnosed with COPD, my Newfoundland with hypoglycaemia, my collie shepherd x with an autoimmune disorder causing him to lose his nails, my cat Sinbad with an infected joint and my other cat Spook with a UTI. have gone through $4000 in vet bills. When I noticed fern dropping weight I de-wormed them all and changed their kibble from purina cat chow to a good kibble hoping I would see the difference. No change.
After then noticing the signs increased drinking, the weight loss and excessive urination I took her in to the vets where they first supected hyperthyroidism a complete blood work up was done and I mentioned the possibility of diabetes and sure enough when they did a urine test on her next visit December 18 her glucose levels were 29. the vet sent her home on the recommendation of purina DM 1.25 cans a day ( 5.5oz can) 1 unit lantus twice a day and check her before meals and insulin dose.
I will try to get consecutive + 6 BG levels six days and start a spreadsheet. Where do I find the spreadsheet that the forum uses.
Thanks
 
Oh my goodness, you poor thing(s)! What a cavalcade of pet issues!

Spreadsheet instructions (and other tips and tricks) can be found in "stickys" in the "Suggestions, Tech Support & Testing Area" part of the forum. The spreadsheet instructions are here, just holler if you have any trouble with them-- I probably won't be able to help because I've only set up my own, once, but there are lots of folks on here with expertise.

Another part of the forum you might want to check out is the Lantus+Levemir forum-- it's a very busy place, but the stickys there have lots and lots of information that you can go over at your leisure.
 
Yes I will look for the spreadsheet and work on setting one up.
I'm jolly glad I have found all of you
Heartfelt thanks
 
Fern said:
I went back over your response and will answer the questions raised
Fern is 12 years old and was in good health until we moved from our farm where my cats lived in a piece of heaven on PEI to a postage stamp ( still rural ) in Nova Scotia Canada. I knew it would hard on the crew. Since Our move 6 months ago I have had a hip replacement, my horse has been diagnosed with COPD, my Newfoundland with hypoglycaemia, my collie shepherd x with an autoimmune disorder causing him to lose his nails, my cat Sinbad with an infected joint and my other cat Spook with a UTI. have gone through $4000 in vet bills. When I noticed fern dropping weight I de-wormed them all and changed their kibble from purina cat chow to a good kibble hoping I would see the difference. No change.
After then noticing the signs increased drinking, the weight loss and excessive urination I took her in to the vets where they first supected hyperthyroidism a complete blood work up was done and I mentioned the possibility of diabetes and sure enough when they did a urine test on her next visit December 18 her glucose levels were 29. the vet sent her home on the recommendation of purina DM 1.25 cans a day ( 5.5oz can) 1 unit lantus twice a day and check her before meals and insulin dose.
I will try to get consecutive + 6 BG levels six days and start a spreadsheet. Where do I find the spreadsheet that the forum uses.
Thanks
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My goodness, you have a lot on your plate! At least we can help you with Fern's diabetes.
 
Thanks for Words of consolation! So far everyone else is stable and my new hip well new lease on life.

I am sorry I have looked around the forum and still cannot see the spot for a new spreadsheet for Fern. Would appreciate the link if possible.
 
Can you order Evo Cat and Kitten food from the Internet? It's not ideal but a relatively lower carb choice then others. (My favorite low carb is young again zero but I understand shipping charges internationally are really high).

I agree with others that said to please feed her more if she's hungry and loosing weight. Two small cans are not a lot for cats whose bg is not yet controlled.

It may be that your cat will need a higher dose of lantus, so the sooner you can get the ss going the sooner advice can be given.

I spent about $4500 in vet bills in a years time too, so I feel your pain.


One thing going that makes bg testing go smoother is offering a treat at test time (low carb of course... A bit of chicken or turkey... Roast beef...) do that and kitty will soon look forward to test time.
 
Adding a warm welcome to you. Glad to hear you and most of your other animals' health issues have resolved or settled down. Man, that was whole lot all at once, so sorry! My cat Uncle was just diagnosed in October. I really don't know what I would've done with out the support and consistent guidance from the wonderful people here. You are definitely in the right place to help Fern. I hope you will feel comfortable to ask as many questions that come up as you go along.
 
JanetNJ said:
Can you order Evo Cat and Kitten food from the Internet? It's not ideal but a relatively lower carb choice then others. (My favorite low carb is young again zero but I understand shipping charges internationally are really high).

Young again is having a hard time shipping to Canada, not only is the freight exorbitant but Canada post has been returning shipments. I looked at their site today. I haven't looked into Evo as from different threads I thought they had recalled food.

I agree with others that said to please feed her more if she's hungry and loosing weight. Two small cans are not a lot for cats whose bg is not yet controlled.

I gave her at today's noon half a can more FF pate smooshed up with water to appease hunger pains.

It may be that your cat will need a higher dose of lantus, so the sooner you can get the ss going the sooner advice can be given.

Yes will work on this

I spent about $4500 in vet bills in a years time too, so I feel your pain.

Thank you it is just too much and has hobbled us financially at this time.


One thing going that makes bg testing go smoother is offering a treat at test time (low carb of course... A bit of chicken or turkey... Roast beef...) do that and kitty will soon look forward to test time.
Click to expand...

I have some freeze dried lung that she enjoys and will follow up with this suggestion, thank you.
Nan & Amber said:
Here you go!

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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i am hoping there will be some help with this as I have difficulty with spreadsheets but I am determined.!
 
Fern said:
I have some freeze dried lung that she enjoys and will follow up with this suggestion, thank you.

i am hoping there will be some help with this as I have difficulty with spreadsheets but I am determined.!
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There definitely is. Just shout out when you need it. There are a couple of people who are experts at that and help newcomers all the time. Someone point you to them (or them to you)!
 
Young again is having trouble shipping to Canada currently.
I will have to look into evo
I fed fern half a can midday mixed with warm water and she lapped it up! So hoping this is enough as I am sure she would eat until she could no more at the moment.
Will work on SS asap
Such a warm welcome from you all.......blessings.
 
Fern said:
AM 6:30 - feed watered down FF pate 3 oz ( she frantically hovers her food )
Take BG test ( with ACCU-CHEK Aviva ) my husbands glucometer
Give 1 unit Lantus
PM6:30 - Same again
Click to expand...

Do BG check prior to feeding. :)
Fern said:
I am questioning why her numbers remain still so high
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I see you've been on 1.0IU Lantus for two weeks. You need to start adjusting the dose based on Fern's nadir BG values.
Fern said:
Fern is very stressed right now as she is starving. She has lost a lot of weight so of course my instinct is to give her more than the 2 cans of FF a day.
Click to expand...
While Fern's not regulated she will need more food. She needs help keeping weight on. When you start getting her to a better dose she will be able to start using her nutrients properly again and will regain the weight she needs. For a cat at her stage of treatment it is acceptable to free-feed and just restrict access to food for the two hours prior to her insulin dose (so that the preshot test is not food-influenced - important for safety).

There are two methods of treating with Lantus recommended by FDMB. Here are some stickies for you to learn more:

Start Low, Go Slow Method

Tight Regulation Protocol

The Lantus and Levemir support group is very active and they can provide help and support with dose adjustments. Here's a link direct to the group's board:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

There are a lot of really helpful stickies at the top of the board to help you learn more about the Lantus insulin you're using.

Your vet has prescribed a sensible starting dose of Lantus for Fern. She has been on it now for quite some time so with her clinical signs and BG numbers you need to start increasing to help her become better regulated.

Lantus dose needs to be adjusted in small increments - 0.25IU typically - so that you don't skip over a really effective dose (some vets advocate adjusting in whole units but this can result in the 'goldilocks' dose for a cat's current needs being jumped over and that may cause numbers to go higher (cat's system pushes up BG as protection from too-high dose) or it can increase risk of hypo. Lantus is a depot insulin so it takes several cycles for the 'tank' of insulin it builds up in a kitty's body to fill up to the new level after an adjustment. Therefore it will be 3-5 days before you can judge the full effectiveness of a dose (another reason why small adjustments are important).

It would help for you to get your BG data into the spreadsheet. I see Nan has kindly posted a link to the spreadsheet instructions in an earlier post and also that you'd like a bit of help with the setup. I'm tagging @Chris & China to ask her to assist you with this. (You will need the International (World mmol) / human meter version of the spreadsheet to go with the units you are using and your Accu-Chek Aviva meter.)

Here's another forum sticky to help you understand the spreadsheet headings, etc.

Understanding the FDMB spreadsheet

There's a very active Lantus and Levemir support group here at FDMB where you will be able to get a lot of help with Fern's Lantus treatment.

Fern said:
wonder whether I should call the vet tomorrow to raise the insulin, also whether it is worth doing a glucose curve test day before her numbers have come down?
Click to expand...
This would be very helpful. Lantus adjustments are based on how low the dose takes a kitty so by testing every 2 hours after the dose was given it will give you the information you need to work out the dose adjustment. Tracking the BG info in your spreadsheet will also help you to manage Fern's insulin needs plus it will help members helping you here to make better suggestions.

Sorry to hear about the boatload of stuff you've been through recently. Glad the hip is making life better for you.

:bighug:


Mogs
.
 
Nan raised an important issue earlier: the importance of testing for ketones.

With Fern on a low dose of insulin, in high numbers, and underweight it's a very important precaution to test her every day for urine ketones. You can get ketone test strips at pharmacies (e.g. Keto-Diastix). Here are more useful stickies telling why ketone testing is important and also some helpful tips on catching samples.

Are you testing kitty for ketones? If not, do it!

Tips for catching and testing urine


Mogs
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Thank you
Today 1.Will test every 2 hrs today and work on spreadsheet. I will contact Chris and China for help
2. Will contact vet and ask about increasing the lantus to 1.25 units
Tomorrow will pick up ketone strips and test.
Bless all of you
 
For mogs....
Be it that the lowest carb kibble food I can get here is Go Fit and free ( I don't have it yet but will get tomorrow ) at 14% carb is it still okay for me to leave it out and let all the cats free feed but pick it up 2 hours before insulin P M and AM. Still continuing with wet food meals also?
 
Fern said:
For mogs....
Be it that the lowest carb kibble food I can get here is Go Fit and free ( I don't have it yet but will get tomorrow ) at 14% carb is it still okay for me to leave it out and let all the cats free feed but pick it up 2 hours before insulin P M and AM. Still continuing with wet food meals also?
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It's a tricky position because you don't want BG to get any higher but also Fern needs more to eat right now. Ketones can develop when a kitty isn't getting enough food and enough insulin (hence why you need to test urine ketones every day for the time being to keep Fern safe).

The problem here is that for now Fern needs extra food to try to address the weight loss issue and minimise the risk of ketones appearing. The ideal approach would be to let her eat more of the wet, low carb food throughout the day (with the exception of the 2-hour fasting period before preshot tests). If it were possible to sequester her in a room on her own while you're out of the house or asleep so that only she would have access to the food left out that could help. Taking her into a room on her own and feeding her extra wet food at normal mealtimes is another option. If that's not manageable then leaving out some kibble for grazing would be the only other thing I can suggest.

Feeding will get much more straightforward as you get Fern's insulin dose 'better tuned'; her body will start to use food properly, she'll regain the weight she lost and you'll be able to schedule mealtimes more easily.


Mogs
.
 
Fern said:
2. Will contact vet and ask about increasing the lantus to 1.25 units
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It might be an idea to email him the link to the SLGS document (Start Low, Go Slow Method). It contains simple instructions on when and by how much to adjust the Lantus dose. It's a good document to use as a basis for discussions between yourself and your vet about treatment strategy and dose management.

Blessings to you and Fern, too!

:bighug:


Mogs
.
 
JanetNJ said:
Can you order Evo Cat and Kitten food from the Internet? It's not ideal but a relatively lower carb choice then others. (My favorite low carb is young again zero but I understand shipping charges internationally are really high).
Click to expand...

Fern said:
Young again is having trouble shipping to Canada currently.
I will have to look into evo
Click to expand...

Unfortunately our customs regulations regarding importing pet food are such that you would think pet food was an illegal drug! EVO used to be available here but I think the red tape (inspection paper work required which was recently increased) was at least in part instrumental in their decision to exit the Canadian market. It doesn't surprise me that Young Again is having trouble shipping here now. I was forewarned of this possibility months ago and therefore didn't pursue that option for my kibble addict. In short, those of us in Canada with diabetic kibble cats that refuse to be transitioned are up a creek with no paddle! So much for regulations "protecting" our pets! :arghh::arghh::arghh::arghh::banghead::banghead::banghead::banghead::banghead::banghead:
 
Hello Mogs
I think for now and while I can I will give her more wet At AM and PM and then a midday meal also. Once we get stabilized I will try the kibble. One of my other cats is stuck on kibble. Most important right now is to balance her.

And yes I will get the info to the vet. I am also in touch with Chris and China regarding SS.
Thank you thank you.
Fern and Judy
 
MrWorfMen's Mom said:
Unfortunately our customs regulations regarding importing pet food are such that you would think pet food was an illegal drug! EVO used to be available here but I think the red tape (inspection paper work required which was recently increased) was at least in part instrumental in their decision to exit the Canadian market. It doesn't surprise me that Young Again is having trouble shipping here now. I was forewarned of this possibility months ago and therefore didn't pursue that option for my kibble addict. In short, those of us in Canada with diabetic kibble cats that refuse to be transitioned are up a creek with no paddle! So much for regulations "protecting" our pets! :arghh::arghh::arghh::arghh::banghead::banghead::banghead::banghead::banghead::banghead:
Click to expand...

Yes most definitely extremely frustrating
It is like navigating a minefield especially when vets are recommending food that is both expensive and inappropriate
I was instructed by vet to feed purina DM and 1.25 cans a day.
I expect she will eat today 3 cans of fancy feast hoping that will satisfy her.
Now time to do +4 test then snack then rest for mum as I am recovering from a bronchial infection to top it all off!
Actually feel semi self today.
Thank you
 
Fern said:
I think for now and while I can I will give her more wet At AM and PM and then a midday meal also. Once we get stabilized I will try the kibble.
Click to expand...
Sounds like a plan, Judy. Once you get Fern onto a good dose of insulin she should be fine just on the wet, low carb food. You can keep feeding her a little extra wet, low cab food and track her weight until she gets back to ideal. Once there you can gradually ease her back to a maintenance amount of food so she stays nice and trim! :)

Sorry to hear about the bronchial infection, Judy; I hope you feel much better very soon. :bighug:


Mogs
.
 
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