No clue what I'm doing.... number too high?

[Cheri V]

Gracie was diagnosed last Monday, started on insulin on Wednesday (Lantus). I just tested and got 148. Here's my question: should I be worried about that? Is it too high? What should I do?

I didn't test for her two Wednesday doses and Thursday she was at the vet having a curve done, so I don't have all those numbers in detail. But here's what I've got:

Thursday morning (after her first two doses) 87. Too low, changed her dose to only 1/2 unit.
Thursday night before night dose: 107
Friday noon at the vet: 121
Friday night: 107
Saturday, about 15 minutes ago: 148

(This is from a Walgreens meter, I forget its name. Those are the unadjusted readings -- my vet says I should add 10% to the readings but I didn't for the above numbers.)

She gets her insulin at 1:00 PM and 1:00 AM -- odd times I know, but I picked up her prescription Wednesday at 1:00 PM and started immediately. All of above numbers are just before her insulin dose. She eats FF classic. She's just a bit crummy today... she threw up a couple of times this morning (after eating the other cats' dry food, so it's probably good that she threw up!) and she was picky about eating her breakfast. And she's been hiding so I know she doesn't feel well.

Thanks for any advice you have about what I should do........

 

[Squalliesmom]

Hi Cheri. Those are great numbers! I can't really comment about the dose without seeing more numbers and knowing when they were taken in relation to time of shot. I invite you to download and use our spreadsheet; it is an invaluable tool to help you track kitty's BG and helps you to see patterns and trends. It is also very helpful for us to be able to see all of the test results in an easy-to-read format, in case you need help. We work with 12-hour cycles and we use the designation "+ (hr)" to note the number of hours after a shot the test was done. In other words, +5 would mean the test was taken 5 hours after the last shot was given. We use AMPS (AM Pre-Shot) and PMPS (PM Pre-Shot) to designate the test taken immediately prior to the morning and evening shot. Feel free to click on the link to mine in my signature if you want to see an example (I have also added other information to mine).

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

Why did your vet tell you to add 10% to your meter results?!? If he/she thinks that will make it comparable with pet meter results he/she is wrong, it will not.

Are you testing her urine for ketones? You can buy urine test strips at any pharmacy.

I see Gracie has some other health concerns, besides FD; it it usual for her to have occasional vomiting, and to feel unwell and hide? Or is this new behavior?

 

[JeffJ]

Hi Cheri - welcome to the forum. Fancy Feast classic is a good food - low carbs, decent protein. You have good advice from Squalliesmom too. In general 150 is not particularly high.

I don't know when you are awake, but you can migrate the dose by 30 minutes over time, to get the dosing to a schedule that is better for you. That way if there is an issue, you can be around. I dose Leo when I get up, then 12 hours later, as an example.

 

[Cheri V]

Hi Squallie's Mom, Thanks for your reply! Responses in reverse order to your questions....

Yes, Gracie often feels unwell but hiding is a very bad sign. And while she is often nauseated, she hasn't actually thrown up in a month or so. (Often she's on Cerenia, though not today -- this snuck up on me.) Recently she's been so miserable that I've been thinking about euthanasia.... so I'm actually happy about her diabetes diagnosis because it gives me some concrete reason why she's feeling bad, and something to do to make her feel better.

I'm not testing her urine -- yet. I bought the test strips, just haven't quite gotten to figuring it out yet. (I unexpectedly acquired a litter of foster kittens yesterday.... I'm a bit behind schedule today.) Vet's last UA was Thursday and she had no ketones.

I have no idea why the vet wants me adding 10% to my readings.... I did test my meter against hers to "calibrate" mine so to speak, and got nearly the same result (mine = 121, hers = 123) from the same blood sample. Though I really like my vet, I wouldn't bet on her being up-to-date or knowledgeable about diabetes. I live in the far southwest boonies of Colorado and we don't have access to great vet care here.

I will try to figure out the spreadsheet soon.... I know I need some tracking but it's just one of many things I haven't gotten to! The 148 number was after eating, before insulin -- just about 12 hours exactly from her last shot.

I guess as long as 148 is a reasonable number, I won't panic. Yesterday I asked for guidance from the vet about what to do based on the numbers I get, and she gave me a lot about low numbers but that's it. And on this holiday weekend we have zero vets available around here, even to call. Gracie does this to me all the time..... she specializes in health crises over weekends. If it's a holiday weekend, a crisis is pretty much guaranteed!

 

[Squalliesmom]

..... she specializes in health crises over weekends.

I have one of those too, lol.

148 is a very reasonable number. I see, though, that you mentioned it was after eating but before her shot. It's best to test before they eat at shot time so your results aren't influenced by food. We recommend test, feed, and shoot, in that order. Also it's best if you can arrange her feeding schedule so that she has not eaten prior to 2 hours before her AM and PM shot tests. If you can manage to get some occasional tests in during the cycle it will help to show you where her nadir (lowest point) is and how low she actually drops. On a human meter, you don't want her to drop below 50, that's getting into hypoglycemic territory.

You'll need to set up a Google account, if you don't already have one, to download and use the spreadsheet. If you have problems setting it up just sing out - we have people here who can help! You can also provide a link for it to your vet; that way she can access it anytime if you have questions and need her help. My vet routinely looks over Squallie's just to make sure all is well and, because he has the information, I can do a phone consult with him if I need to.

You're not alone with your vet, lots of vets know very little about feline diabetes, and even less about nutrition and what type of diet is appropriate for a diabetic kitty.
I just re-read your earlier post and see that Gracie has kidney disease. A lot of the foods we use, including Fancy Feast Classics, are fairly high in phosphorous, which you don't want to feed to a kitty with kidney disease, so I am giving you a link to Tanya's CRF/CKD site. Lots of good info there and also a list of foods that may be more appropriate for Gracie. If you can't find a food that will suit both her diabetic low carb needs and her CKD needs you can talk to your vet about a phosphorus binder.

http://www.felinecrf.org/

Awww, kittens! Who can resist kittens?! But it would be good just to get an occasional urine test for ketones. I know it can be difficult to actually catch them in the act. You can try using gravel (like plain aquarium gravel) in one of her boxes; after she goes you can just dip the test stick in the urine, and you can rinse and reuse the gravel for the next test!

As far as adding 10% to your test readings...I really don't know what your vet is thinking but don't do it, it will just make things confusing. If she is using a pet meter and you are using a human meter there is no "comparison" that can be done. They use completely different scales with no shared constant. Most of our stuff here is geared toward human meters, but some people use pet meters and just use a different scale on their SS. My vet can not wrap his head around the idea of me using a human meter, lol. I have tried to explain the different scale and that it still has markers for numbers that are too high or too low, but it just doesn't seem to sink in. He's finally given up and figures I know what I'm doing, and that's what's important. Squallie has never had a single BG test at this vet's (he had a couple at his other vet's, but we quickly came to a parting of the ways over her lack of knowledge of FD and her insistence that I do things that were unhealthy for a diabetic cat). I do them all at home, curves as well, and it works out well for all concerned.

Poor Gracie, I'm sorry she frequently feels unwell. Hopefully getting her diabetes under control will help her feel better!

 

[Cheri V]

Actually I'm pretty sure I can test Gracie's urine fairly easily, if I just catch her in the act. Gracie doesn't believe in litter boxes. She uses the bathroom rugs just next to the litter boxes. But in this case I think that's a good thing, if I get to the puddle while it's still wet.

[Had to stop typing for a minute there to feed Gracie... She came looking for me, screaming for food. It's a good sign!]

Could you please explain about not eating 2 hours before shots? How critical is that? Gracie doesn't really have a feeding schedule. Whenever she asks for food, I offer it. Which might be 5 or 6 times a day.... or every half hour. Or every 5 minutes. I believe what happens is the food hangs up in her throat due to her esophageal stricture (which she got from meds, by the way) so she stops eating until it clears. At most she eats an ounce or two at a time. I puree all her food with water so she's able to eat it.

Testing: Right now I'm only testing twice a day -- before each shot -- because I'm still really bad at getting the blood sample and I don't want to annoy Gracie unless I absolutely have to. With all her meds, SuQ fluids, insulin -- she gets enough times during the day when I'd doing something to her she hates. Once it doesn't take me 10 tries at stabbing her ear to get a blood sample, I will test more often.

Diet: Gracie is incredibly picky. Right now all she'll eat is FF, so it's a good thing it's reasonably OK for her. I'll check out the other suggestions but it might be very hard to switch. Among other things, most likely I can't buy any of it where I live.... Chewy, here we come.

Vet: My vet's meter and mine must be somewhat congruent -- I took my meter to the vet and we used both on the same blood sample, to make sure we had an "apples to apples" comparison, and got 121 vs 123. So I will just have to remember to add 10% when talking to her, but don't add 10% when talking on this site. My vet is somewhat resigned to me finding out stuff online and telling her, but sometimes she gets huffy about it. She's great for basics -- she does literally hundreds of spay/neuters a year for our humane society because she's the only local vet we trust to do it! -- but she generally doesn't know anything about newer ideas, diet, specialty care, etc. I have a wonderful internal medicine specialist at CSU for Gracie, but she's 500 miles away, and she's on vacation in Mexico at the moment. (For that matter, my regular vet has been out of town since last Wednesday and I've been dealing with her replacement vet..... I think Gracie checks everyone's schedules before having a health crisis to plan it for when there are the fewest possible vets available.) The quality of vet care here little annoying sometimes -- I got charged a total of $150 for two "diabetes consults" last week, but by that time I had spent two days on the internet and they didn't tell me anything I hadn't already found out. AND they didn't tell me the things I did need to know, like what do I do about the BG numbers I get when I test? In fact they were somewhat shocked when I showed up with my own meter and said I would do home testing.... Ah well. They should be used to me by now.

I had better quit typing and feed Gracie.....

 

[Rach & Honeybun]

Hi Cherie, have just been reading your posts, you make me chuckle
If it's any consolation it seems most people on here have the same experience with the vet, mine pretty much wiped out my bank account in 2 days -I spent the weekend on the internet and realised I probably learned just as much as her...she did phone me and go a little crazy when I cancelled my consult,glucose curve and whatever else they were going to tack on to it,and told her I was going to home test, and had been online -in fact she told me not to do it as I would put my kitty at risk yada yada yada. I chose to make my judgement based on the knowledge of hundreds of people with firsthand experience and personal expertise rather than someone who was out of vet college 18m and whose expertise is small animals. Needless to say I am in the process of switching vets but I understand you don't have that option.
This is a fantastic forum and the people here will teach you anything and everything you need to know

P.s I am very envious of you being in CO! My dad lived in CO Springs for many years and I miss it like crazy! What a beautiful State

 

[Squalliesmom]

It's best not to feed 2 hours before AM and PM shot-time testing because if your results are influenced by food (food will make BG go up), you may be shooting when in fact it might be unsafe. In other words, her results may look like it's safe to shoot but if food has driven her BG up that is an artificial rise and her actual BG, uninfluenced by food, could be much lower. However, I understand Gracie's esophageal issues and, if she is only eating a very small bit at a time, you'll probably be okay, just try if possible not to give her very much or very late in that two hour window.

I have picky eaters too, especially my IBD baby. I'm really limited in what I can feed her that she will tolerate well and, of course, she never wants to eat any of those foods!

The whole concept behind testing BG is to understand how your cat reacts to and handles insulin, and to keep her safe. The more frequently you test the more you will understand her insulin cycles and where certain doses will take her. It will also let you know if she drops too low say, mid-cycle, and you need to make a dose reduction.

My old vet, who I really liked and had used for years, wouldn't test Squallie the first time I took him in and told her I thought he had diabetes. Finally, two months later, she tested him. She told me, with some surprise, that he was diabetic; she acted like she expected me to be surprised, too. I guess she forgot that I had asked her previously to test him for it! She wanted me to bring him in several times a week for BG tests, and most definitely did not want me to test at home. I stood my ground and she conceded and ordered me a pet meter, very $$. Then she told me I could only use blood drawn from a vein in his leg (!), which I learned to do but never did it at home, using an ear, instead (she said you couldn't use the ears because it was way too painful, but actually cats have very few nerves in their ears). Se sold me a bag of "prescription diabetic" dry cat food, also many $$. I fed it to the other cats and went out and bought Fancy Feast for Squallie, lol. When I went in with him the next time, the receptionist asked me what I was feeding him and I stupidly told her the truth. She kept stressing that the dry food they sold me was made especially for diabetic cats, and I kept trying to tell her it was loaded with carbs and NOT good for diabetics. Well, she just couldn't wrap her empty head around this idea because, "The dry food is made just for diabetics, and is the only food you should be feeding him!" Then she ratted me out to the vet who told me, literally, that I was killing my cat by feeding him Fancy Feast and testing his BG too much! I never went back to her office again. It's also a good thing I didn't listen to her about testing him less, or not at all; he had two asymptomatic hypos and probably would have died if I hadn't caught them because I home tested him! But I love my "new" vet (been with him over a year, now), he's awesome. Even though he's not used to it in his clients, and I think it made him nervous before he got to know me and my kitties, he recognizes that I want to play a hands-on roll in any health issues and treatments whenever possible. He acknowledges that I know what I'm doing and that he has treated Squallie for other things, but never for his diabetes, lol! He follows my spreadsheet to keep up with Squall's BG and dose changes.

The bottom line here is: you need to test to keep kitty safe, and you need a vet you can trust, one who will learn along with you if they don't know much about FD!

Has she said anything to you about high phosphorus levels in some foods? A diet high in phosphorus is not usually good for CKD kitties, and Fancy Feast tends to be high in phosphorus. I would ask your vet about it, and see if she thinks Gracie may need a binder. Since she's a picky eater and has tummy troubles it's probably best just to keep her on the food she will eat and add in a phosphorus binder, if necessary.

If you go to the Forums page you can find sections with lots of good information about any- and everything to do with FD. And never be afraid to ask questions!

Please ask your vet why she told you to add 10% to your BG readings, I am dying (I really NEED, lol) to know Why???"

 

[Cheri V]

Good afternoon all.... and here we go again. Gracie quit eating this morning. She does this, frequently. I thought perhaps it was due to too much mucous in her throat from her permanent URI. That probably wouldn't affect the average cat, but with Gracie's esophageal stricture it's sometimes enough to make her feel like she can't get food down. So I syringed about 9cc's of water to clear it -- didn't help. Then she was acting nauseated -- I gave her Cerenia. Still wouldn't eat a thing. By then it was time for her insulin. BG = 154, just before her insulin was due so 12 hours after last shot.

There are no vets available where I live for love or money this weekend, so I called the emergency service at CSU (Gracie's own CSU vet is also unavailable this weekend -- AAARRRRGGH!). They said do not give insulin. They said it's very important for Gracie to eat so give her transdermal mirtazapine. (I have this on hand for those times she quits eating.) And so now -- naturally -- she's demanding food constantly and eating again, very little at once but frequently (which suggests the problem really is the esophageal stricture). And with no insulin on board.

I will test periodically through the afternoon and evening -- at least this will give me lots of practice!

Here are today's questions.....
- How often should I test this afternoon? Is there a pattern I should follow, e.g., before she eats vs. after? (Keep in mind that she will eat very small amounts very frequently, especially with Mirtazapine on board.)
- Is there a "danger" number I should be watching for, for example if BG goes over xxx then she might need insulin before her next scheduled dose?
- Her next insulin dose is due at 1:00 AM -- should I give as scheduled, as long as she's eating at least a little?