Please help I am worried....

My cat Anya who is 9 yrs old and had diabetes for 7 months now. 3 units twice a day of Lantus U-100. I really need to know how often I should be drawing blood to test. Also, need to know what I can do to keep her from getting all of these UTI's. I am really worried that I am not doing my job correctly and really want to help her out but I am getting aggravated. Please help me thanks

Jennifer

 

Jennifer:

Hopefully someone familiar with Lantus will be here shortly. I crossed posted on Community. Someone will come to help you.

Tina

 

The UTIs are probably due to under-regulated diabetes. Once you get her diabetes under control, the UTIs should go away.

May ask how you got to 3 units of Lantus twice a day? While there are some conditions (acromegaly, cushing's, steroid use) that might require that high a dose, what we often find is that cats are started at too high an amount of insulin, so they miss their optimum dose. They go into a problem called rebound, which makes the blood sugar levels go both very high and very low, and which can (yes) cause UTIs. Lantus should be started at no more than one unit twice a day, and I've seen folks start at half-a-unit twice a day. So, could you tell us how you got onto 3 units twice a day?

As for how often to test: you're going to want to test prior to each shot, to make sure that it's safe to give insulin. If you get a pre-shot reading of 200 or less, please do NOT give insulin until you get opinions from folks familiar with Lantus. It's possible to give reduced amounts of insulin at less than 200, but you need a lot of data to do so safely. Currently, you don't have that data.

And, right now, where you're trying to figure out dosing, the other time you'll want to test is when the blood sugar is at it's lowest (which is when the insulin is at it's peak). You'll want to test then to tell how low Anya is going on the dose, and whether the dose needs to be adjusted.


It sounds like you're home-testing already; do you happen to have any recent readings?


There's also a lot of stuff you'll learn here about controlled diabetes through diet (what are you currently feeding Anya?), but please don't make any change in her current diet until we can make sure that the insulin she's getting is the proper amount.

 

I have been trying to work with my vet. Dr did start her out at 2 units twice a day and since she was still drinking and eating alot (along with UTI's) he has decided to up her meds. I am trying to do home blood levels but I guess I am not doing it near enough. Now after reading some of the other posts I feel like I really need to start to take alot more blood. I have been only taking it 2-3 times a week (like the vet told me).

Anya is eating fancy feast wet food and some dry food at night if she gets hungry. I do have 3 other cats that we have and need to watch out for them also regarding there diet. I am willing to try anything but it the test strips seem to cost a lot of money. Do not get me wrong I will pay anything but to take all this blood I will be going through a ton of test strips. I have the walgreens monitor any suggestions? My head is just spinning right now. I thought I was on the right track but now I think I am way off.

Thanks for the help.
Jenn :?

 

I agree with all that JJ has said. Particularly important is to test before each shot. Lantus usually peaks 5 - 6 hours after the shot; it is important to test then also so that you will know how the insulin is working.

Diet is very important, too. Anya should be eating low carb canned food and NO dry food. I would suggest that you start over at 1unit twice a day; test as outlined above, and post your numbers on the Lantus support group.

While the numbers are high, it is also important to test her urine for ketones. Ketone strips are relatively cheap and can be obtained at any pharmacy.

You have come to the right place, you have your meter and know how to use it, and you will get help here to get Anya on the right track.

 

I agree that much more testing is needed. I cannot suggest anything on the test strips though, since I live in the Netherlands.

If you're using Lantus, you should follow this protocol:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf
When you read this, you will see that it is guiding you extremely well on what to shot on what number. But it therefore will require you to get the needed numbers. ;-)
So: test, test, test till there is no more drop in her. :mrgreen:

Absolutely needed numbers: pre shot, +6
I also try to test the +3, +9, +11.

The first couple of day's or when I feel very worried I test every hour.
The more numbers you have the better you yourself will feel, cause you will get some kind of control and no longer feel so helpless.
3 times a week is just not an option at all.

Testing is also important cause her insulin needs could be changing over time. It is advised to go slow (though I myself move quicker than most of the lot here). Start with 1 IE, in your case: start over with 1 IE. Then after 3 day's according to protocol (folks here wait 5 day's) increase with 0.25 or 0.5. Depending on her numbers. Here you have those freaking numbers again. :lol:

The food question:
I myself put Spacey cold turkey on wet food. It didn't make a lot of difference in her case. I think that you can do both: change food and insulin dosage as long as you monitor your cat. Never ever forget that every cat is different though.

Your other cats. I would suggest a different topic on that in Health. Like *4 cats on different diet* Need help with foodquestion... something like that. It'll possibly trigger people with a lot to say on food to help you. :mrgreen:

good luck and hang in there..

 

Jennifer, let me start by saying welcome and that you have come to the right place to get GOOD help for Anya. First off I would suggest posting over in the Lantus support group. You can get there by going back to the board index. There is a section titled "Insulin Support Groups" and you will click on the one for Lantus (Glargine). That is where you can post your questions regarding Lantus and where you can get help with proper dosing. There are a number of posts (we call them stickies) at the very top of the list of the posts. Read these as they contain great information. I would strongly suggest reading the one on New to Group and Tight Regulation Protocols. These will give you valuable information and the protocol will help you understand the best way to dose Lantus.

Having said that, there are a lot of factors that go into determining Anya's correct dose. Most vet's (mine included) don't see enough diabetic cats to be an expert in the field. Also, Lantus is a relatively new insulin and dosing is very different from the old insulins that they are used to. With Lantus you start off with a low dose, usually 1 unit, and raise it gradually until you see results, then you start dropping it back down until one day, hopefully, Anya will not need insulin any more. Unfortunately, the vets are used to the old insulins where you start out high. Mine started me at 8 units! THANK GOODNESS I came here and followed the advice I was given. My Indy would probably have died from a hypo if I hadn't gone against what the vet prescribed and followed the protocol here.

As for testing, at a minimum you would want to test prior to each shot and at about 6 hours in, which is supposedly the point where her blood glucose should be at it's lowest. Finding the low point is important as that is the basis for making dosing decisions with Lantus. However, most of us test more often than that. Starting out, I tested every 3 - 4 hours. That way I had the information to know when Indy was likely to hit the low point and how much his blood glucose changed throughout the cycle. It gave me confidence and made it easier to know what to expect after I gave him his insulin.

As for meters and test strips - I hear your concern over the cost of home testing. First of all you probably want a human meter, not a cat / animal meter. The Lantus protocol was developed using a human meter. I am using a One Touch Ultra, which is great, but the strips are very expensive. A few weeks back there was a thread on this subject and the person was using a TrueResults meter from CVS that we determined was not giving very accurate numbers. People posted that the Relion meters from Wal-Mart are accurate and the strips are less expensive. I realize the cost of treating a diabetic cat can become astronomical, but home testing on daily basis is essential for the long-term health of Anya. On the proper dose of Lantus you have the chance that Anya will one day no longer need to have injections. Since 2008, there are over 100 cats on Lantus that visited this board who are now diet controlled diabetics that don't need to be poked! It is inspiring.

 

Thank you everyone I know I have a lot to learn it is just a little over whelming and I REALLY appreciate all the help that everyone is giving me. I am going to start fresh today and see what I get. I have the true test meter and I was thinking about getting a new one and maybe I will look into that in the next couple of days.
I am feeling a little more relaxed (a little more..) just knowing that I have some people here able to help me out and get us through this. I do not want to lose any of my cats. I have a feeling I will be on here a lot.

Hope everyone has a great day.

Jenn

 

Regarding the cost of testing, you may want to check around on the cost of test strips. As you've found out, the test strips are the most expensive part of home-testing. In fact, there are companies that give away their meters, knowing that they'll make up the cost of the meter in test strip profits So check around on the prices of test strips. One of the least expensive ones out there is the ReliOn from Walmart; IIRC, it's about $44 for 100 strips.

You may also want to check on eBay. There are people who's health insurance provides them with way more test strips than they use, so they re-sell their spare test strips to help cover the cost of their other supplies.

Lantus is a really good insulin to start out on, so it's great that your vet has recommended it for you; it just looks like s/he may not be completely familiar with using it to it's best advantage.

Also, I myself am not completely familiar with the way that Lantus works myself (we use PZI), but for the other insulins, you do most of the +6 readings here at the start, to make sure that your cat isn't going too low and to adjust the dose if necessary. Once your cat is settled in on a dose (or is in remission, where their diabetes is controlled solely through diet, no insulin required), then -- at least in other insulins -- you can do the +6 tests intermittently. If Lantus is the same as the other insulins, you shouldn't look at the +6 readings as a permanent part of your life.


Also, I didn't ask: when Anya was taken in and diagnosed with diabetes, did the vet note if there was anything else wrong with her? I ask because if Anya has some problem that's causing pain, inflammation or infection (beyond the UTI), then those things raise blood sugar levels. If you can treat the source of the pain / infection / inflammation, even if it's something minor like tartar build-up on the teeth, you can hopefully lower Anya's need for insulin and maybe increase her changes for getting into remission.


The other part of controlling Anya's diabetes is diet. After you've reduced Anya's Lantus dose to 1 unit twice a day, it would be best to switch her to an all-wet low-carb diet. Some of the Fancy Feast flavors work well. If you follow the links here http://www.felinediabetes.com/diabetic-cat-diets.htm, you'll find Janet and Binky's food charts, which will give you carbohydrate and other information for a lot of different foods. For Anya diabetes (and assuming she doesn't have any other health issues), you're looking for any food that's less than 10% carbs.

If the foods you're currently feeding meet that limit, that's great. If they don't, take the charts to the store and buy a selection of low-carb foods and taste-test them on your cats. You're looking for foods that are less than 10% carbs, that your cats like, that fit into your budget, and that are fairly easy to find in your area.

You mentioned needing to watch out on the diets for your other cats. Do they have any problems in particular? If so, what are they? We have folks who have to choose foods that work for multiple conditions, and may be able to offer advice.


However, please remember not to change foods until you've dropped the insulin levels; switching to a low-carb food at your current levels of insulin can cause Anya's blood sugar levels to go entirely too low, which can be dangerous. It's a problem called hypoglycemia. If you go to the bottom of the page, there's a list-box that lets you go to other areas of the site. If you go to Health Links, you'll find two posts there. One is Melissa and Popcorn's post on recognising and treating hypos. Read it, print it out and tape it to the side of the fridge. When you suspect that Anya is having a hypo is not the time to find out that your internet connection has gone done. The second post is Jojo's post on stocking a hypo toolkit, so that you'll have the necessary materials on hand and easy to find if Anya's blood sugar levels go too low.


Finally: I think it's great that you're looking after Anya so well, and I can tell how much you love her. I know that, when I was where you are, there were times that I felt like a complete failure; everyone else here seemed to handle everything so easily and I was overwhelmed and in tears and certain that I was the only person who was having problems. It turned out that everyone who's come to this site has had that same feeling. You can get Anya through this, and we can help you.

-- Jean and her Gwyn

 

Dear Jean and her gwyn....
You have hit the nail on the head. I do feel like a failure since I can not seem to keep her regulated. I am so glad that I have someplace to go to help me through this. She is our little princess and want to keep her around here for a very long time. Thanks for the help and suggestions I have a lot to look into.

Jen :sad:

 

Jen has found LL

viewtopic.php?f=9&t=4285

 

(((Jen))) You aren't failing-- you're taking the best care of your girl that you can right? You chose to treat her, right? No way is that failing!

The others have already discussed the diet and insulin, my question is in regards to the UTIs.... how have they been diagnosed? Did your vet get a sample via cystocentesis (a needle directly into the bladder to obtain a sterile sample)? Was the urine then sent out for a culture and sensitivity (to determine if there is an infection and what antibiotics would be appropriate)? If not, then there's no way to know if there really is an infection or inflammation. Check out Dr. Lisa's site (she's a vet who posts here and has an amazing site): http://catinfo.org/feline_urinary_tract_health.htm (this is the section on feline urinary health).

Don't be afraid to ask any questions... there's generally someone here 24/7 since we are an international group.

(((more hugs))) and scritches to Anya.

 

Ok, regarding the testing for UTI's the vet wants me to bring in a sample of her urine every once in a while when she starts to pee outside the box. I do know that she does pee outside the box when she is mad at me but usually I can tall when she is pissed at me. Is there anyway to know without taking her to the vet for testing constantly?

Jen

 

By 'draw blood' I hope you do NOT mean drawing blood with a syringe from a vein, like the vet
does for blood tests.

Home BG tests are done by getting a very small drop of blood by pricking the edge of
an ear, using a lancet.

 

No, I am sorry I do use a monitor and lancets, etc.

 

Taking in a probably contaminated sample obtained at home is an improper way to test for UTIs. The best way is through a sterile urine draw called a cystocentesis. http://www.peteducation.com/article.cfm ... 73&aid=995

Then the sample should be sent off to a lab and have a culture grown to determine what bacteria is growing, which will then determine which anti-biotic is best to treat.

Our esteemed Dr. Lisa Pierson http://www.catinfo.org has said time and again this is the only way to properly determine whether a UTI exists - not all peeing outside the box is UTI, it can be behavioral.

Gandalf was treated for 3 UTI's simply because the vet saw bacteria in his urine. Once I insisted a culture be done, it came back no infection. He had been needlessly given ABs.

So get the culture and sensitivity done (that's what that type of culture test is called) and you possibly won't have to keep having her treated. Or you will, but will be with a good anti-biotic instead of simply throwing one at it and hoping it works.

Good luck.

 

Carolyn said:
> You aren't failing-- you're taking the best care of your girl that you can
> right? You chose to treat her, right? No way is that failing!

I have to agree with this sentiment 100% !! You are most definitely *not* failing.


> Ok, regarding the testing for UTI's the vet wants me to bring in a sample of her urine
> every once in a while when she starts to pee outside the box. I do know that she does
> pee outside the box when she is mad at me but usually I can tall when she is pissed at
> me. Is there anyway to know without taking her to the vet for testing constantly?

Hmm ... okay, first off, there are several reasons that a cat can urinate outside the box. Some of the causes can be because they're annoyed at you (as you know ); because their litterbox is dirty; because they had difficulty getting into the box due to arthritis or something similar; they mis-judge where the edge of the box is and, standing completely inside the box, they accidently aim over the side; that they had difficulty getting into or standing in the box due to diabetic neuropathy; or there was some urgency to going and they didn't make it into the box in time.

I'm assuming that you keep the box clean and that it's not a problem with arthritis or mis-judging, because this appears to be a new problem. I'm also assuming that it's not diabetic neuropathy; that's a problem where cats start to walk lower on their hind legs and sometimes their legs slip out from under them. You haven't mentioned any problems walking / standing, so let that go for now.

*If* there was urgency in going, that could be a symptom of a urinary tract infection. Other symptoms may include trying to go frequently, going in inappropriate places (mine favored peeing on plastic bags in the living room, right where I could see her so that I would know there was a problem), a pinkish tinge to the urine, blood clots in the urine, pain or meowing when going. But there also may be no symptoms at all. (You can see this article for a bit more info http://www.marvistavet.com/html/urinary_tract_infection.html.)


May I ask how you're getting the sample to give to the vet? If you're cleaning it up off the floor, then the sample's almost certainly contaminated. There are two ways to get a urine sample from a cat. The one way that absolutely guarantees that the sample has not been contaminated is to put a needle into the cat's bladder and draw a sample directly from the source. The alternative is to have the cat pee directly into a sterile container; unfortunately, these samples may be contaminated by bacteria / fecal matter /etc around the urethral opening, and the results of the Culture and Sensitivity (C&S) test therefore may reflect the contamination: it may show an infection when there is none present, and the "infection" may present as not responding to some antibiotics.

So, if you suspect a UTI, the ideal is to bring the cat in to have a sample drawn from their bladder. Some vets don't like this procedure and will 'encourage' a cat to pee in a sterile container, or will try to catch a sample if the cat starts to pee at the vet's office. I've ometimes done free-catches at home and brought the sample in for testing, but I always remember that, if the results from a free-catch sample shows that Gwyn has a UTI, it doesn't necessarily mean that she actually *has* a UTI; the sample could have been contaminated.

If you do free-catches at home, remember to catch the sample in mid-flight, not by holding the container directly against Anya's fur or anywhere her fur might contaminate the sample. Seal the container immediately afterward, and refrigerate it until you can bring it to the vet.


To clean urine from the floor, I use part of an old towel to mop up the spill (if it happened next to the litterbox, there may be urine on the bottom of the litterbox as well). Then I splash the area with white vinegar, swish it around for a minute, and mop it up with the rest of the towel. (If the urine has been sitting for a while, I may let the vinegar sit for a few minutes as well.)

To clean the towel, or any other material that's been exposed to urine, throw it in the wash with your normal detergent, but add a cup of white vinegar to the laundry as well. (I'll use two cups if cleaning a comforter or pillow or something thick.) The white vinegar will get rid of the smell of urine. You can get white vinegar in gallon jugs at some stores; prices in my area range from about $1.79 to $3.29 per gallon jug.

If Anya *does* end up urinating around your house / apartment and you have problems finding the spot. you can get a black light from some hardware stores (in the fluorescent lightbulb section) or a thing called StinkFinder in many pet stores. Wait until dark, turn all the lights out, and run the light about 1-2 feet from any suspect surfaces. The urine (and some other stuff) will fluoresce in the light, making it easy to identify and clean the spots.


> No, I am sorry I do use a monitor and lancets, etc.

Remember to put pressure on the lancet 'wound' for a few seconds after you get the sample; that'll help reduce bruising.