Patty Cake, re-introduction

[plemochoe]

Hello.

I joined the forum about two years ago when my cat was diagnosed. PK has done pretty well since then. She has had diabetes for about 27 months. She gets two doses of Lantus a day. Her dose right now is 1.5 units a day, and she gets her shot in the scruff of her neck. As for her blood glucose, I don't know what it is. I have been monitoring her by weight, appetite and activity.

I have returned to the forum for a couple of reasons. First, I would like to monitor PK's blood sugar more closely. I will have to do this myself for a while, because getting it checked at the vet's is expensive (but I might be better able to bear the cost next year). Second, we are thinking about moving to a place at 4500 feet.

Patty Cake is probably at least 15 years old. Her front claws were removed before I found her. She seems to have been hit by a car back in that time period, because one of her haunches has a reduced muscle and she has a "hitch in her getalong". She still has good mobility. I have always had her food up on a table so she has to jump a short distance for it (there is actually a two-step pathway, so it's not a full floor to table jump). She goes outside in a secure area and hunts and eats grass.

Last year she was getting too much insulin and I didn't realize it. Her blood sugar got too low, and she had to spend a couple of hours on a glucose drip, but there were no other consequences. After that I started her back at one unit of Lantus twice a day. Again, judging by the size of clumps in the litter box, I increased her dose to 1.5 units (measured by dead reckoning).

She eats different kinds of Fancy Feast, and also the regular Innova dry cat food. For the Fancy Feast, she makes her wishes known, usually. The dry food is always there. Her weight has remained stable. She spends a lot of time licking her feet these days, and it makes me think of peripheral neuropathy. Her mobility has declined a little in the last few years, but I didn't want her on top of the refrigerator anymore. What she lost in athleticism she gained in having a secure yard, so she gets more exercise. Judging by her response to that cat toy that has a mouse going back and forth under a plastic sheet...her reflexes are still very quick.

I didn't have a very good opportunity to give her the best care up to now. I would like to improve her care. I'm concerned about the effect of high altitude, although 4500 feet is kind of in the border region for most health-related things. If I thought it would make a difference - I would find a different place.

Thank you, and my best wishes for all your cats

 

[Sue and Oliver (GA)]

Welcome! We'd love to help you learn how to hometest. You're right; it is not only a way to save money, but it will give you great peace of mind to know how she is doing and whether her levels are safe. We have lots of videos, links and advice on testing here:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

My diabetic lived in Colorado at 7000 feet and was fine. Maybe if you are coming from sea level, it might take humans and cat a little while to adjust. I don't think of 4500 as very high altitude; the city of Denver is 5280 and visitors don't usually have any issues until they visit the mountains.

 

[BJM]

Welcome back.
Take a look at my signature link Secondary Monitoring Tools to see some other assessments you can make to evaluate how she is doing while you work on the blood testing. I'd suggest food and water intake and output, dehydration, weight, and urine glucose and ketone monitoring with KetoDiaStix or generic equivalent. Those are some of the things vets will ask you about when you bring a cat in.
Then, to work on home blood testing, pick up an inexpensive human glucometer (ex Target Up and Up, WalMart Confirm or Confirm Micro). matching test strips, and lancets for alternate site testing (25-28 gauge). Read over the manual. Practice on a grape or apple, then yourself, to get a feel for the process and timing. I like to put the test strip halfway in the Confirm, do the prick, then get the sample.
Once you're a bit familiar with the process, you're ready to test your cat. Take a look at the picture of the sweet spot, to see where to prick.

Pick a spot where you are going to set up for testing. I used a half bathroom so I could shut the door and keep out my other cats. I put Spitzer on my lap as he was easy to test. Gracie was pretty relaxed and I tested her on her bed on a shelf. Some folks use a couch and place the cat on a towel between the armrest and themselves.
Make sure the ear is warm - a warmed washcloth in a plastic bag, or rice in a sock that is then microwaved a bit work. You want it baby bottle warm - test on the inside of your arm. If it is too hot for you, it is too hot for the cat.
Brace the ear with a folded tissue, make up pad, etc. as this helps you make a successful prick without stabbing yourself through the ear.
Always have a low carb treat or two to give, even if you're not successful.

 

[plemochoe]

I'm almost ready to try to home test. What I would like to know is exactly what the aim is. Based on the result, do you give smaller or larger amounts of insulin? Is this substituted for the every 12 hours dose?

I have an advantage with regard to ketones. I can smell them. She hasn't had any of that since the initial period two years ago. I did smell them on her breath one time.

I should have said this, PK has been to see vets. She has good blood and urine tests, let's see, that was just 2-3 months ago, so we're not completely ignorant of those values. What happened when she had her one episode, I had changed another cat's food and she was getting into it. Suddenly she was eating almost all protein, and her relatively high insulin does at that time was too high. Since then, PK has adopted a mixed diet. She likes to eat the dry food sometimes, and I like to see her eat it, since it means her teeth are still working. I'm afraid to get them professionally cleaned. She does have slightly swollen submandibular lymph glands sometimes, and she has had a few minor infections in that area that cleared up more or less on their own. But I imagine that's because of the condition of her teeth. I wish I could get the courage to take her to a vet for a cleaning.

 

[BJM]

See my signature link Glucometer Notes for feline-specific reference ranges.
Starting out, do not shoot if the glucose is less than 200 mg/dL. Once you have some tests about 5-7 hours after the shot, you'll know how low she goes on the dose she is getting.
Getting her completely on a low carb canned diet may reduce her glucose levels 100-200 mg/dL and may reduce the insulin needed 1-2 units.
Getting her teeth and gums cleaned and any infection removed will make her more comfortable and may further reduce her insulin needs. Plus, dental infection can go systemic and cause sepsis, which may be fatal. What is the nearest dental vet specialist? Veterinary college? They may be more equipped to work with an older cat and use more regional nerve blocks to manage the procedure, rather than ketamine.

 

[Mitzelplik's Mom]

Welcome back to the forum! I understand your concern about getting your older cat's teeth cleaned, but it can be done. Mitz is 20 and had her teeth cleaned in May and she ended up needing 2 teeth pulled. I did opt to go to a vet dental specialist instead of the regular vet. It was expensive but the regular vet was not able to do dental x-rays which are really important, and the specialist was able to monitor everything that can possibly be monitored while she was under. They took very good care of her.

Good for you for wanting to start home testing. It took me a few months to work up the nerve but now I can't imagine not doing it. It really will give you peace of mind as Sue said, not mention saving all the money you won't need to spend at the vet. I don't even consult the vet on dose changes anymore. I just ask here if I'm not sure.