Nigel and I need help.

I’ve already posted in the welcome forum and there’s quite a bit of information about my situation in that thread now, but I was encouraged to post here by @MrWorfMen's Mom. I don’t have anything to add at the moment, but my thread in the new members forum is titled “Can a single person with a diabetic cat stop have a life?”

 

http://www.felinediabetes.com/FDMB/...with-a-diabetic-cat-still-have-a-life.209797/

 

Ok. I have a couple of questions for you and a bit of homework to make this as easy as possible going forward.

Did you give insulin today? If so how much and how long ago (# of hours since shot not time)?
Was that reading of 308 taken before insulin or if later, how many hours after his shot?

It would be very helpful if you could set up a signature so everyone helping can instantly see some pertinent information rather than flipping back and forth between threads. It's the light grey text below my messages. To do this, simply hover your mouse over your user name in the upper right corner and select Signature from the left side menu. This gives you a text box where you can put information kitty's name, sex, weight, type of insulin, type of glucometer (Libre for now ...can be changed later if need be), current diet, any other health concerns along with what you'd like us to call you, and your general location, useful sometimes when offering help due to time differences amongst members and for supply suggestions). Once you've typed in your information , scroll down and click on Save Changes.

It would also be helpful if you would set up one of our spreadsheets for Nigel so we can track his readings on a very simple auto coloured SS that gives you a very visual way of seeing how thing are going. The instructions for the setting up the SS are HERE and THIS document explains how to use it.

We are expecting a major snowstorm here this afternoon, so I have to run out and pick up some cat food or my poor kids are going to be hungry. I won't be long and if you can work on the "homework" in the meantime, we can get you on the road to figuring out Nigel.

 

Hi and welcome!!

I just read your previous thread and let me tell you yes you can be single and manage a diabetic cat ( I do) , you just have to get everything organized and establish a routine, yes the first couple of months I did canceled everything actually I had to ask for a week off work when Babu was first diagnosed because we did had a bad couple of days since he was diagnosed while having an UTI and was not eating but it does get better.

I do suggest you get a time feeder so that he can have something to eat when you are not at home and at night while you sleep

And to have some back up, a friend family member or vet tech that can go to your house when you for some reason have to be out or as it actually has happend to me get stuck in traffic or on a meeting at work and won't be able to get home on time, the home testing is important it will help you know what to do to shoot or to skip a shoot if is risky and you are not going to be around.

Is good that you have a home metter besides the Freestyle libre because for what I've read (I actually bought one but couldn't get it applied on Babu ) it is a bit inaccurate when you get to very low numbers and those are the ones that are really dangerous because of hypoglycemia so you want to be able to test with other meter if he's going to low to be able to take action.

Hopefully since you catched the diabetes early you can get into remission but if not once he's regulated everything gets easier

 

@MrWorfMen's Mom thanks! I think that I got everything set up. It's hard to get very exact number with the FL app. The graph is pretty tough to read looks like maybe 310 before I gave him his shot and peaked at 360 before coming down again.

 

Grant I am not at all familiar with the use of the Libre short of seeing the advertising and pics. I thought it was possible to get a one time reading at any given time displayed on the portable device that communicates with the installed sensor as well as doing a dump of the data after the fact. Seems to me that the meter would be useless for diabetics unless it had this capability. It may however be that you need a different piece of equipment to do one off readings.
@Veronica & Babu-chiri can you shed any light on the various components included with the Libre so we can figure out how to get the data off it at specific times rather than a graph?

 

I'm assuming this is the reader you have for the system.


I just checked out the websites (both US and Canada) and cannot find the manual for the meter but I did find this video so have a peak and see if you can get to the log book. That will provide a list of the readings taken so far with times so we can start adding some data to Nigel's SS.

 

@Veronica & Babu-chiri Sorry for the tag. I think we got things figured out. Thx.

 

Actually when you scan the sensor with the reader it shows the current ( with a few seconds delay ) reading , and a small graph with the past 8 hours reading, I think there's an Iphone app but I haven't seen that one,
here's a link on how it looks . If it is not showing the current reading maybe is a matter of configuration on the reader

https://www.freestylelibre.us/system-overview/freestyle-14-day.html

 

Don't worry I'm happy you figured it out since I haven't really used it very much since I couldn't get it on Babu, he was way to skinny at the time and the so called filament is not so small

 

Sorry Grant. What a ditz I am .....forgot to give you the video link https://www.freestylelibre.us/support/overview.html

 

Hi Grant, I'm the guy that can never give a short answer
You asked "Can a single person with a diabetic cat stop have a life?" This is an honest answer and much of it depends on how much you value life, your own and your cats. First off, I'm 61 and have had cats for 40+ years and through sheer luck the first 30 years were the stupid "out-door cat/I have 3 jobs/my roommates are idiots/party all the time" years. A few stitches here and there, one episode of crystals, a few eye infections. I once rented a house on a tree farm, 640 acres of coyotes and my two big Toms came back every night. One lived to 17, his brother to 23. Back then I didn't even know cats could develop diabetes.
Something changed when I moved, got a real girlfriend, bought a house and somehow ended up with nine cats and a dog. I wouldn't trade that for anything. Then my cat Nigel who was slim and trim developed diabetes. We had a great vet who showed us everything and Nigel was a sweetheart. I'd thump the table and up he'd jump for his poke and injections. And he loved riding in cars and showing off at the vet. Not everyone is so lucky. Vacations were limited to stays at my sister's cottage and Nigel loved the adventure. To be brutally honest if that had happened when I was 20 I would have done what was best for the cat (meaning I was a lazy dumb-ass) and had him put to sleep.
If you're here now it's because you care but you cannot lock yourself indoors and sacrifice everything, that won't be healthy and you may even resent Nigel as impossible as that seems now.
This is how we managed. 1) With certain insulins you can push the boundaries of the 12/12 shot cycle but please research this very carefully. I don't speak for the board, the practice is not at all advisable and can be extremely dangerous in the long run. 2) Having a partner who is fully in the loop is invaluable. Anything from being stuck in traffic to a broken ankle can screw everything up so being able to call home and say "Honey, Nigel is up to you tonight" is a huge help. 3) The dreaded funeral, vacation, visit with in-laws. In a big enough city there are always alternatives. Sitters who are qualified for this, friends who do more than drink your beer and the dreaded boarding a cat. Nigel was a breeze but his brother Noah, our second diabetic was a nervous mess. After a few years we finally had to board him and to be honest I thought I'd come home one cat short. The vet who boarded him and his staff were great and Noah came home safe and sound.
The last line in my signature, "Forever has to mean something" is a promise not easily kept and we have made sacrifices but in return I have learned a great deal about what we get back when we respect life.
Our Nigel was born upstairs in the same home we live in now with his three brothers and was named after Nigel Mansell the race car driver. Of course I cannot let this go without showing you some photos of him. The dog was his best friend and they adored each other. Just click on the photos for full size.
Wishing you and Nigel a long and happy life.

 

Thanks for all of the comments. Sorry the less than thorough responses, but my computer is having problems so having to use my phone. You’re Nigel looks like a sweet cat!

My situation is that I’m single, I have no family in the area as of this week (my parents are moving to the other side of the country and my brother is moving to Oregon), I’m broke, I run a struggling small business and I have figure out its future by the end of March when the lease on my shop ends, the business is 20 to 30 minutes from my house depending on traffic, and I need a lot of exercise to stay sane. But, I love my cat to death and want to see him pull through in spite of this being the worst timing imaginable for this diagnosis.

I’ve added quite a bit more info to the spreadsheet. Can anyone make anything of it?

 

Hi Grant and Nigel. I've never met another Nigel so I'm a bit unnaturally invested in this. Nigel was low maintenance so the cost of him having a good life was next to nothing. I'm hoping your Nigel has the same good luck. There are lots of ways to save money; ordering insulin from Canada, strips from the web etc. I never used Lantus so I'm no good to you there. Many of us feed our cats Fancy Feast, the pig-slop of cat food. If you can get over the yech factor and don't fall for the vet's "prescription" food you can save lots of money. Our Nigel lived a good life, it was not diabetes that got him in the end.
There is always a way and I know how you feel.
Once you get the general things figured out and feel comfortable here you can post in the Lantus forum for more specific dosing advice. There is no rule here about sticking to one forum as long as you don't post the exact same thing in two forums. Come over here Nigel and let me rub your chin.

 

How lucky of you that you live so close to your work !

Looking at your SS (spreasheat) you are getting a more o less normal curve for a cat that is starting to get insulin, higher numbers around the time of his shoot and his nadir (lower number ) around the middle of the cycle (12 hour period) at +4 or +5 all of which is good, his numbers are a bit high but that's also to be expected since you are just starting

When was his first insulin dose? he will probably need a bit of a dose increase but we still have to give him a few days before changing dose, usually is recommended that they stay on the same dose at least a week when you are starting to give his body time to get used to the insulin and the depot to form properly

 

My goodness this is so timely as I too single and living my life according to my Simba's medical needs. Him and his geriatric older brother, a feral save with FIP who is now going on 17 with attitude. I pretty much have put my life on hold for now and at least enjoy the quiet while establishing my new household in a over 55 community I enjoy very much so far. If there is to be any romance it has to be on my terms at my house since I am on a timeline for pokes and shots. Travel is out of the question for now as any kind of overnights away from home until this resolves one way or the other. DOSING: after two months of treatment I am closing in on a proper dose of 2U 2X insulin but wonder when I should be judging for less insulin when his numbers are lower? How long a trend does one watch until dropping dosage?

 

I go to the market, does that count?

 

Travel means overnight. Market is back within hours and that seems to be my highlight of the day! ... :^)

 

Yes, I could always live further from work. Just trying to make the point that I’m not in the position for this to be a full time job like it seems to be for some.

He’s had 10 doses so far. So does this info confirm that he’s diabetic or indicate anything about severity?

My Nigel is a little more needy than most cats, but that his part of his charm. I’ve never met another cat with that name either. Mine got the name because I thought a ginger cat needed a good English name.

 

I get it but to hear someone makes 20 minutes to work with traffic makes me green with envy.

By 10 doses you mean 10 days or 5 days with the dose twice a day? ( Just trying to make sure I understand correctly)

And unfortunately with numbers over 120 on top of 1 unit of insulin it looks pretty much like he's diabetic but it also looks like he's responding very well to insulin since he's curve is looking very well

 

Thanks!

Yes, it’s been 5 days so far.

 

Wow! Being able to get all that data is really helpful. Too bad it isn't a practical solution for long term use.

Unfortunately it looks like Nigel does indeed still have high BG and based on those numbers, it looks like he is diabetic. I know that is not what you want to hear and I can see why the timing really stinks for you but this really is quite manageable. The good news is that he is getting a decent curve so you're on the right track.

There are ways to save money treating a diabetic cat and it's possible a diet change might help bring his numbers down too.
I checked the TJs salmon and rice and it has a carb level of 11%. While not high, we recommend keeping carbs below 10 and optimally 6 or less. Some cats are more carb sensitive than others so even a 50% reduction could have a lowering effect on Nigel's BG.

My suggestion would be the following:

1. Have a look at this food listing for foods that have 6% or less carbs. Popular inexpensive brands are Fancy Feast Classic (Pate) or Friskies Classic Pates.
2. Get a human glucometer and use the time while you have the Libre installed to learn how to test and get Nigel accustomed to it. Then when the Libre falls off or the sensor runs out of time, you'll be able to carry on without missing a beat.
3. Get a fasting BG before every shot by withhold food for at least 2 hours prior to checking the pre-shot BG.
4. While the Libre is installed you can download whatever other readings you choose noting that the peak action time (lowest BG) with Lantus, frequently falls in the +4 to +7 post shot period.
5. Keep inputting the data on the spreadsheet as you are able. (Cantankerous computers are a pain!)
6. It is helpful to get a test around +2 or +3 as these times can in many cats predict how the rest of the cycle is going to go.
7. Always take a test before bed at night so that if Nigel's BG looks like it's going to be an active cycle, you can take action to keep him safe and allow you to get some sleep.

I'm also going to give you a bit more homework to do. In the Lantus/Levemir forum, there are stickie notes at the top. Read through the notes there to familiarize yourself more with how Lantus works and the dosing methods we follow here. Ultimately, you will want to choose which method you prefer and then we can help you accordingly.

One other question. Did you get a vial of Lantus or do you have the pen? If you are currently injecting using the pen, it only allows dose adjustments in 1u increments and we recommend smaller dose adjustments of 0.25u or 0.5u at the most. The pen can be used somewhat like a vial so we use syringes with it. The syringes should be 3/10ml with 1/2 unit markings, 31gauge, and either 6 or 8 mm needle. Walmart has very reasonably priced syringes and there are some online retailers with good prices too. Let us know if you have any questions about this.

Last but not least, if you get a pre-shot BG test under 150, please do not feed Nigel or give him insulin and post here for advice. We will advice you to stall for 15 or 20 minutes and take another reading and then based on the second reading, offer suggestions as to how you should proceed. Information about this can be found in the stickies I mentioned above.

 

And just to be clear, this is not your new full time job although it may seem that way right now. It actually doesn't take much time at all, but in the beginning there is a lot to learn and we can help you get a routine that works for you .

 

Well with 5 days on insulin I also suggest you take a look to the information on the Lantus forum and decide which protocol you are going to follow, although for people like us that are single and work out of home, etc probably the Start Low Go Slow protocol is a bit better because you may not be around to test much during the day but is your call.

Lowering his carb intake will lower his numbers still a bit more so if you are planning to change his diet hold the 1 unit for a few more days until you transition him, doing it while he still has the Free style libre is probably a good idea and you can assess his dose after a few days on the new food. If you do not change his food then according with protocols you may need to increase his dose to 1.25 units in a couple of days

And really it gets easier once you establish a routine

 

Thanks again everyone!

I went to Walmart on my way into work and picked up a glucometer (ReliOn Prime), testing trips, and lancets and Friskies Pate.

Since I'm doing the Freedome Libre 2 hours before feeding him in the afternoon, it should be easy enough to get a fasting shot.

Also, I'm using the Lantus pen with syringes but they only have ticks for a single unit so I'd have to eyeball .25u.

Good to know about being below 150 being of concern.

I'll take a look at the Lantus forum later when I have time.

 

Just to clarify.......you want a fasting test just before you give Nigel his shot so you know that his BG is high enough to give him insulin safely. The routine would be fasting test, feed, give insulin all within 5 or 10 minutes.

 

Sorry for the confusion. I meant that I’ll have to be home two hours before his shot so it will be easy to take away his food. Thanks!

 

Yes the 0.25 u has to be eyeballed, when you can get syringes with half marks on them (there are no syringes with 0.25 marks) those make eyeballing the 0.25 and 0.75 easier

 

It would be better if you were to start a new thread of your own with this question and we'll be more than happy to help you out. Don't want to get kitties confused here!

 

So he’s at 161 right now. Is that something to be concerned about?

 

He just threw up some stomach acid.

 

Should I give him Karo syrup?

 

Hmm back up to 197 and purring.

 

No karo syrup. He doesn't need it. Is he willing to eat now? Mash his food down to avoid scarf and barf . His BG is high enough to give insulin but I'd suggest you feed him a bit to make sure he is willing to eat before giving shot.

 

Curiosity.....how often are you feeding Nigel?

 

I put his food up, thinking that I was gonna do the two hour fast. Should I give him food? Two hours until his shot.

 

I feed him twice a day but he eats it over the course of the day.

 

Doesn’t look like he’s eaten a lot today. Only half a can.

 

Ok. Sorry my misunderstanding. No don't feed him now. Wait till shot time.
It sounds like Nigel is a grazer. That's ok but you may need to leave a bit more food out for him to keep him satisfied.
If he only ate half a can today, how much does he usually eat? How much is in the can?

 

He’s a big cat and has been eating two cans a day. The cans are 5.6 ounces.

 

I take it he hasn't been off appetite wise before now? Has he ever spit up Stomach acid before? It could be the lower BG numbers but it's something we need to keep in mind.

 

He’s always been pretty inconsistent with his appetite or at least he’s never been super food driven. Even in the morning when I feed him he’ll eat a bit and then leave. If I pick him up and put him in front of his food he’ll eat a bit more.

The last time that he threw up was also mostly just stomach acid.

 

So would it be a bad idea to leave him tonight after I give him his insulin?

 

Not necessarily but until we know what his pre-shot BG is and that he will eat, it's impossible to say for sure. Also if you are going out tonight, how long after his shot do you expect to be home?

 

I have to go put out garbage and throw around some salt due to a major deep freeze coming after a big snowfall. Be back soon.... before shot time.

 

I’ll probably just stay in at this point and make sure he’s doing ok. Thanks again for your help!

 

It’s at 130 now. What should I do?!

 

He’s acting normal though. He just jumped up in my lap to give me a kiss.

 

Grant, Nigel is still a tiny bit elevated above normal so no problem there. He is in no danger whatsoever. Ok so if you are planning to stay in, let's stall on the food for 15 minutes and test again then to see if he is coming up on his own or still dropping. That lower BG could be from not eating as much today or it could be that the initial readings you got off the Libre were still elevated from the stress of the vet and having the Libre installed.

 

Should I feed him? He seems hungry.

 

It's been 15 minutes so test him again now without food and we'll decide about insulin.

 

It’s at 115.

 

Is this +11?

 

Oh that's interesting. Feed the poor guy and let's hold off 10 minutes or so just to make sure he's keeping his food down.

 

@majandra Nope we are at pre-shot now. Interesting turn of events but Nigel didn't eat as much today so not sure if what we already saw was a bounce or stress or now is just lack of food.

 

Hmm, he wouldn’t eat. It is the Friskies Pate. I’d give him som me of the TJ’s food but I’m all out.

 

Do you have any parmesan cheese? If so sprinkle some on the Friskies to see if that will entice him. Or some tuna in water .... is there anything else he likes you have on hand?

 

Alright, I gave him some other food and he’s eating. Guess he doesn’t like the Friskies.

 

Oregano sometimes entices them too!

 

He’s not usually a picky eater. Guess I should take the Frieskies back and try some other brand.

 

What is the other food you gave him?

 

Oregano??? Lol

 

It’s a TJ’s cat tuna. It’s less than 6% but supposedly shouldn’t be eaten daily.

 

Yeah I wonder if it smells a bit like nip to them. Who knows but a lot of people have used it.

 

So should I still hold off on the insulin?

 

Ok. So if he manages to keep that on his tummy for now since he's interested in eating, and taking those dropping numbers into account knowing he didn't eat much today, I'd suggest you try a dose a 0.5u tonight and see we'll see how that looks tonight. More to follow but you can go ahead and give insulin.

 

Cool, gave him 0.5. Guess I’ll have to share the spreadsheet with the vet at the end of the ten days so that she takes into account the fact that he wasn’t always give a full 1u.

 

The funny thing is that he’s acting more like his normal self right now than he has when his numbers have been higher.

 

Here is a synopsis of what I am thinking right now.
Since we have no data before yesterday and that was the day the Libre was installed, we can't be sure of what is going on so I lowered the dose for safety sake tonight.
1. It's possible that Nigel was in what we call a bounce that is now breaking. A bounce is a rise in BG due to the cat's defense systems. It will go into action if the cat drops to BG levels it is not accustomed to (a low BG for a diabetic used to being in high numbers), a fast drop in BG, or a significant drop in BG. ETA by significant I mean too low!)
2. Nigel may have been extremely stressed with the installation of the Libre and just getting used to it today which may have caused him some stress BG elevation that is now subsiding.
3. It may be that he just didn't eat enough today and the insulin pushed him down further than usual.

It's impossible to know which of these scenarios is at play here. Since you are home tonight, please get a reading at +2 and +3 post shot so we can see what Nigel is up to for tonight.

Believe me it's not usually this complicated but you were totally convinced all outward symptoms of diabetes had stopped so I think we have to keep that in mind and take this step by step and err on the side of caution with the reduced dose tonight.

I'll check back in at 830 or so your time to see what the +2 is and whether any further action is needed at that time. Any questions?

 

Ahh interesting and good to know! Most cats that have been in high numbers for awhile do just the opposite....seem a bit off when they finally attain better numbers.

 

He’s 108 now. Any reason for concern?

 

No The insulin won't start to take effect until about +2 and the food probably hasn't bumped him up yet. Patience. He's still quite safe. Normally I'd say no action is needed unless he drops below 50 however not knowing what Nigel is up to yet, if he drops to 60, give him a tsp or so of food just to boost him up at bit.

 

I’m sure the vets visit was super stressful for him because there was some sort of emergency going on with a dog yelping and he was there for 3 hours.

So the cans of Fancy Feast are much smaller than Friskies. Are they still calorically similar?

 

The Fancy Feast tends to run around roughly 90 to 100 cals per can. Not sure about the fish flavours though.... they might be different.

 

Your SS says 98- is that a typo for 108?

 

It still keeps going down. He’s at 78 now.

 

Ok Grant. See if you can get him to eat a bit more. How much did he eat at shot time? Usual amount or less than usual?

 

I keep checking, since it’s super easy with the Freestyle Libre and it keeps going down. But yeah he’s acting perfectly normal.

 

He ate about the usual amount, Linda. Also, just got him to eat some more. But yeah looks totally normal and acting super affectionate.

 

Higher is better than having too low numbers. If the vomit is yellow-ish, like bile - it is when the cat is getting ready to eat and has not yet been fed and that is the natural reaction of waiting too long to eat. What is the 2 hour fast thing about?

 

I keep forgetting you have that- Dang that's handy!

 

Well Nigel is surprising all of us right now but we'll just keep monitoring him and work with what he gives us. I expected his BG to rise a bit....not go down so much so fast it definitely looks like this is going to be an active cycle. It may be a bit of PJ party for awhile but I will stay with you.

 

Grant, the sensor display gives you a BG reading and there is also an arrow telling you if BG is going up or down so when you take the next reading please let us know what the arrow is saying (up or down) along with the BG number. I'd suggest you grab another reading in about 15 minutes. That will tell us if the extra food is bumping him up at all.
BRB. Have to go feed my clowder.

 

It’s going up a little. A 79 now.

 

@MrWorfMen's Mom Do the Libre meters have the 20% variance like the others?

 

An interesting question. I'm not sure if the technology is more accurate than manual readers or not. I'm also not sure if the arrow beside the readings are designating BG is rising because a reading is higher than the last reading or if it is actually indicating BG is on the rise at that moment. The problem is that BG is never static so tests 5 minutes apart won't necessarily be the same.....likely close but not the same.

 

Now 70. :/

 

Just to clarify....glucometers have a variance allowance of 20% so all those readings (70, 78 and 79) are all within normal meter variance. We're just not sure if the Libre has the same variance allowance or not.
Check Nigel again in 15 minutes please.
Please also note......this is not how things go on a regular basis.

 

It’s at 65. Should I make him eat more?

 

Ok with that drop I suggest you put a little karo on his gums. Mix a tsp of food with some karo (1/4tsp) and give it to him. Retest 15 minutes after he finishes the food.

 

It’s at 74 now and looks to be going up.

 

That is just the sugar you gave him and that will wear off quickly. I'm wondering if the filament is still well positioned and whether the readings you are getting are totally accurate. The only way to be sure would be to test Nigel with the Prime you bought. So I think it's time for a crash course in BG testing. Get the meter, strips and lancets out and ready and I am going to find a video for you to watch and then I will walk you through it.

 

He’s at 105 now. So you think the Karo will wear off and it will fall again?

 

Karo is a simple carb so yes it will wear off in a relatively short time. We usually suggest folks keep some gravy foods around for situations like this. We were just getting you sorted out and no one could have seen this coming based on the numbers you were getting so we are going to have to work with what you have. Don't feed him anything else right now and test again in 15 minutes. It's possible his BG is going up some on its own too so we test again without feeding again to see if he is holding his BG steady or rising. Unless he starts falling again, no need for more food or karo.

 

Here is a link to some videos of how to test Nigel yourself. You will have to scroll down the page a bit to get to the videos.
I have to go give one of mine some medication. Back soon.

 

So the Freestyle Libre is showing him at 154 now. Do you think I still should test on the Prime? I feel like I’ve manhandled him enough this evening so kinda not feeling like doing it but guess it would be good to know if something is wrong with the FL.

 

No if Nigel is at 154 now, I don't think it's urgent that you learn to test right now however it wouldn't hurt to take a peak at the video so if we should need to check at any time, you'll have some idea how to proceed. I'll have to go back and check but I seem to recall some comments about the Libre and low numbers....just can't recall what they said now. Ok let's give everyone a little rest and recheck him in a half hour this time.

 

I tried to use the Prime just now and it didn’t work out. I’m pretty exhausted and I should probably look at the instructions when I’m more with it.

 

The one thing that my human friend said about the meter is that there is a 15 min delay between the blood reading, and the interstitial fluid the Libre reads. That may be why they reccomend being able to test with a regular meter.