Random hypos and where to go from here.

[Becky and Toby]

Hello, first of all this is my first time posting - although I have done a fair bit of poking around - so my apologies if this is in the wrong place/I do something else wrong

Our cat, Toby, is 15 years old and was diagnosed with diabetes approximately 6 months ago. His original, natural glucose levels were around 33-37mmol. He was put on Caninsulin, starting with doses of 2, going up to doses of 3, and then onto doses of 4 (admittedly quite quickly because he responded so well). This was when he had his first hypo. He very suddenly couldn't stand up and started sounding off, sounding very distressed. We rushed him to the vet, who later told us Toby started fitting as he was putting the glucose drip into him, his levels were too low to be read. He stayed there for the rest of the day and overnight, and then - putting it down to an accidental overdose of insulin because his blood results were consistently excellent - he came home with us and worked back up from 3 and 3.
Some time later, back on 4 and 4, he did almost exactly the same thing and we rushed him to an emergency vet. It took around half an hour from the start of the hypo until the vet saw him, and by then we'd stabilised him with sugar and his reading was 4.5mmol ("Not too bad," the vet said, although I wasn't too inclined to agree). He stayed overnight for monitoring anyway. After another consultation with his own vet, he crept back up to 4 in the morning and 3 at night, instead of the previous 4 and 4, and he was fine for several weeks.

I should have mentioned, but at first we were talked out of at home testing (our vet is wonderful in every other way, for the record). Anyway, we had two "mini-hypos" at home, where we realised he was showing some earlier symptoms and got a little syrup into him and some food, and he was fine. We bought a glucose meter at this time.

He started to show symptoms of low blood sugar every day for almost a week, and after checking his blood and finding levels between 1.7 and 3.1, we told the vet we were going down to 3 and 3. He agreed this was probably the right thing to do.
That takes us to Sunday night, where Toby went from looking perfectly fine to crying and fitting on our living room floor in a matter of seconds. We rushed him to an emergency vet again, and I'm not entirely sure where it went, but glucose was injected directly into his side, between his ribs, because we were that close to losing him. He went on a drip again, stayed overnight with the vet again, and I'm now terrified to put an insulin injection anywhere near him. I've never seen him like that before, and I just don't know what to do at this point.

I'm sorry that this is a bit haphazard, but I imagine you know how it is :cry: I'll try to fill in some blanks, but please let me know if I've missed anything vital. He has insulin at 8:45 and 8:45. Apart from the first hypo, all of this low blood sugar is happening between 1:30 and 3:30am. He has had problems with his 'plumbing' for most of his life and has always eaten Royal Canin Urinary SO dry food. For this reason, our vet originally recommended he stay on that food. Since he came home on Monday, we've only fed him the wet food instead. We're collecting data, although we can't do a full, on the hour curve until Saturday. He is happier right now than he has been in weeks, but his sugar is just too high. He's had glucose curves done at the vets several time, and apparently the results have always been "excellent". He's had several fructosamine tests, and apparently the results are "excellent". I just don't know what to do.
Thank you in advance.

EDIT: He's seeing the vet on Tuesday, it's just that he's currently abroad.

 

[Sue and Oliver (GA)]

If I were you, I would go out and buy a ReliOn meter, strips, a lancet device with 25-27 gauge lancets. I would start testing him tonight and not give another shot until I had a preshot number. You are incredibly lucky he is alive. He is most likely getting too much insulin and the only way to determine what the right dose is, is to get numbers at home. (Numbers are affected by stress and most cats are very stressed at the vet. Often the numbers are 100 points higher at the vet and doses based on those numbers are too high.)

Our premise is that we would not take our child to a doctor, get a prescribed dose of insulin and shoot blindly until the doctor checks her again in a couple weeks. We treat our 4 legged children the same way.

We have taught hundreds of people how to test over the internet and would be glad to teach you. You may be saving your sweet Toby's life. Please let us help.

 

[Becky and Toby]

If I were you, I would go out and buy a ReliOn meter, strips, a lancet device with 25-27 gauge lancets. I would start testing him tonight and not give another shot until I had a preshot number. You are incredibly lucky he is alive. He is most likely getting too much insulin and the only way to determine what the right dose is, is to get numbers at home. (Numbers are affected by stress and most cats are very stressed at the vet. Often the numbers are 100 points higher at the vet and doses based on those numbers are too high.)

Our premise is that we would not take our child to a doctor, get a prescribed dose of insulin and shoot blindly until the doctor checks her again in a couple weeks. We treat our 4 legged children the same way.

We have taught hundreds of people how to test over the internet and would be glad to teach you. You may be saving your sweet Toby's life. Please let us help.

We do have a meter now, after two hypos with seemingly no rhyme or reason we decided the vet would just have to cocoa on the no at home testing. We had too few strips left to dare to use them (just in case!), but just this morning more strips and lancets have arrived. We're all ready to go, just not entirely sure where we're going

We can't refuse to leave his side until Saturday, when we plan to do a curve. Even if we check his levels first, I'm far too scared to reintroduce when we can't stay with him all day. Other than that, we're open.

 

[Sue and Oliver (GA)]

So you have some tests? That's great. If you are still struggling, here's some great info to help:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

Maybe some general guidleines will help. We suggest new diabetics not shoot under 200. Instead wait 20 minutes, without feeding, to see if the number is indeed rising and over 200. (you don't want to add a new dose of insulin if the old one is still working). We generally consider a cat regulated if they are in the mid 200s at preshot and 100 or under at nadir (midcycle). Under 40 is our hypo range, when you need to add food and sometimes honey.

Canninsulin is not a popular insulin here. We like milder, longer lasting insulin like Lantus, Levemir or ProZinc. In most Cats, Canninsulin is too fast acting (taking the cat on a steep fast drop) and doesn't last a full 12 hours. There are cats here who have become regulated or gone into remission on Canninsulin BUT it requires a lot of monitoring.

How about if we start with some numbers. Anything you have gotten at home, when was it and how long after the shot? Then test before the next shot and post your number.

One thing that complicates this whole sugar dance is the bouncing that can occur if a cat goes into low ranges. Their body can release extra glucose and send their numbers high. This results in a roller coaster of highs and lows. Giving us some numbers to work with will help us figure this out.

 

[Becky and Toby]

I'm in the UK. I've been doing some reading around, and I'm not sure I have many options beyond Caninsulin. That's one to be brought up with the vet on Tuesday, but I'm not sure I should be holding out too much hope.

As for the numbers, we haven't done preventative hometesting in the past, only used the meter to check his levels when we've already been suspicious that there is a problem. I'm going to gather data over the next couple of days, and I'll report back with it. When it comes to the insulin, I plan to start very safe with a dose of 1, even though he started with 2 even for the very first time.

Thanks :smile:

 

[Sue and Oliver (GA)]

I like the idea of starting with one unit. Then you can increase slowly, as and if needed, based on his blood glucose levels.

I think that UK vets do insist on trying Canninsulin first. But we have several members who tried and demonstrated tht Canninsulin wouldn't work and then the vet prescribed another insulin. They have a ProZinc type insulin in the UK that has worked well for some cats.

 

[Hillary & Maui (GA)]

WE have several UK members here and it is challenging to get the vets to change the insulin - I believe you have to first try using the Caninsulin and when that doesn't work, then you can ask for Lantus.

I'm going to ask the UK peeps to pop over and help you.

 

[Elizabeth and Bertie]

Hello from Surrey!
And welcome to FDMB.

(And thanks, Hilary, for drawing my attention to this thread. :smile: )

Gosh, what a tough time you've had with Toby. (Here's a big reassuring (((HUG))) for you.) Things will get better though. Honestly. And you will find a lot of help and support here at FDMB.

Sue is right: Vets in the UK have to start out with Caninsulin because they are obliged to prescribe a veterinary medicine before they can prescribe a 'human'' one. And currently Caninsulin is the only veterinary insulin available for cats. However, if it can be shown that Caninsulin is not working well for the cat then (under the 'cascade system') the vet is permitted to prescribe another insulin (if they are willing to). An insulin that is becoming increasingly popular in the UK is 'Hypurin Bovine PZI'. And some vets will also prescribe 'Lantus/Glargine' or 'Levemir'.

Well done, you, for starting to hometest!!! :thumbup
It's highly likely that switching from dry food to wet food could have reduced Toby's insulin requirements quite a bit so testing will be very important. It's especially important to test before each insulin shot. That test lets you know that it's OK to actually give insulin. For newcomers to feline diabetes we suggest that no insulin is given if the blood glucose level (at the time of the shot) is less than 11(200 (US)).

Are you doing Toby's curve at home tomorrow (Sat)? (I'm happy to PM you my phone number if feel you might want to talk anything through during the day.)
And which wet food are you feeding Toby BTW?

Eliz

 

[BJM]

If you get comfortable with testing, you wil be able to show that the current insulin is not working effectively for your cat.

Then, you may choose from Levemir(detmir), Lantus(glargine), and a PZI insulin (Hypurion seems to do well).

Since you are now home testing, here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

[Becky and Toby]

Thank you for the replies and the support, everybody. It's starting to feel less scary already

Hello from Surrey!
And welcome to FDMB.
.......
And which wet food are you feeding Toby BTW?

Eliz

Right, I'll be approaching the vet with a list of insulins on Tuesday and we'll see what he has to say. From what I've been reading, even if we get on okay with the Caninsulin I'd really like to get a hold of one of the 'better' ones anyway. Although we've only been with him for approximately a year, he really is a very good vet and he's been very accommodating with Toby and our other pets (and we've had a bad year with the poor things!).

I think it'll take some working up to it for me to inject him when he's as low as 11 :shock: But I'm sure ditching the far too high dosing and the hometesting is going to build the old confidence, I'm just used to seeing him rest in the high twenties/low thirties.

We're doing the curve tomorrow, yes. Thank you very much for the offer, I'm feeling quite confident now that I've read up, but that would be excellent for the extra peace of mind :smile: Would you like me to send my number, too, so that you don't receive calls from strange numbers in case I happen to use it?

He's currently eating Royal Canin Urinary SO still, just the wet food instead. His habit of staring death in the face started maaany years ago with his plumbing issues, so it is something he needs =/

Thanks again!

 

[Elizabeth and Bertie]

Hiya,

Have PM'd you my home phone number. Do please call tomorrow if you want to talk anything through. I'm working from home tomorrow so should be around all day. :smile:

Regarding doing a Caninsulin curve, here are some things you may see if the pattern is 'typical':
You will probably find that most of the action happens in the first five hours after giving the insulin (although I expect there are some exceptions to that rule!).

So, for example, you may find that the insulin begins to starts to lower the blood glucose about an hour and a half after the insulin shot (or a little sooner or later). Then, if it's a typical Caninsulin response, you'll see the insulin working at it's strongest over the next 2 - 3 hours. In many cats, a Caninsulin curve can reach it's peak (ie lowest blood glucose level) at around 4.5 to 5 hours after the insulin shot, after which the blood glucose will start to rise again. The blood glucose may rise slowly at first and then speed up as the Caninsulin leaves the system (maybe 8 hours after the shot). This is a fairly 'typical' Caninsulin pattern; but, we have no way of knowing at the moment if Toby is going to have a 'typical' response, so tomorrow's curve should provide a lot of useful information!

If you see that Toby's blood glucose is dropping fast (ie in excess of 5 mmols an hour) then you may well find that feeding a small snack will slow the speed of the drop. (In fact, many people using Caninsulin for cats aim to feed a snack a couple of hours after the insulin shot in order to slow the blood glucose drop.)

Good luck for tomorrow. I'm sure you'll do just fine. But please do call me if you want to chat about anything.

Eliz

 

[Becky and Toby]

He's been 'typical' when he's had his curves done at the vets (although I know that's subject to change!) and his low sugar issues have all happened around 4.5 to 6 hours after his shot. We'll soon find out! Thank you again.

 

[Becky and Toby]

Mr Tobe started the day at 25.3. He had his insulin at 8:45, and then had a pouch of his Urinary SO for breakfast. We checked his blood again at 10:45, getting a reading of 18.1. He had half of another pouch 'cause he's a hungry little man right now. We've checked just now, at 12:45, and he's down to 5.9. And 2 pouches of food ;-) I'm trying to be wary of overfeeding him, but I'm also aware that he must be very hungry. We're going to check again in an hour, since that is a bit of a drop.

EDIT: 1:45 and 11.2. Interesting.

 

[Sue and Oliver (GA)]

Pretty typical Canninsulin curve, unfortunately. In US numbers (multiplied by 18):

amps 355.4
+2 324 Fed
+4 106.2 Fed
+5 201.6

The food may have kept or brought the numbers up (I am not familiar with your food and don't know if it is low carb) so that may be an influence on the curve. But in general, he dropped more than 50% at +4 ( a gentler curve would have a 50% drop around +5-7 or so) and then started back up a little before the typical midcycle point on other insulins. Your +7-8 number may show you that the insulin is not lasting 12 hours....... If the food is higher carb, you might have had a more drastic curve - same general movement but to lower numbers - on a lower carb food.

If you are willing, we have a great Google document - a color coded spreadsheet that will help you (and us) see his numbers. It converts from British metric to US automatically so be sure to use the World document. Here are the directions:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I'd show these numbers to my vet (in spreadsheet form is a way to represent the fast drop, the fast move back up and the short duration) I don't know how long he needs you to "experiment" with Canninsulin, but he might accept a curve as good documentation.

 

[Becky and Toby]

Pretty typical Canninsulin curve, unfortunately. In US numbers (multiplied by 18):

amps 355.4
+2 324 Fed
+4 106.2 Fed
+5 201.6

The food may have kept or brought the numbers up (I am not familiar with your food and don't know if it is low carb) so that may be an influence on the curve. But in general, he dropped more than 50% at +4 ( a gentler curve would have a 50% drop around +5-7 or so) and then started back up a little before the typical midcycle point on other insulins. Your +7-8 number may show you that the insulin is not lasting 12 hours....... If the food is higher carb, you might have had a more drastic curve - same general movement but to lower numbers - on a lower carb food.

If you are willing, we have a great Google document - a color coded spreadsheet that will help you (and us) see his numbers. It converts from British metric to US automatically so be sure to use the World document. Here are the directions:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I'd show these numbers to my vet (in spreadsheet form is a way to represent the fast drop, the fast move back up and the short duration) I don't know how long he needs you to "experiment" with Canninsulin, but he might accept a curve as good documentation.

I can't find much information on the food myself, unfortunately =/ I get the impression that the Urinary food is low carb in general because carbs are bad for crystals, but I can't find any actual data on it. Another one for the vet, maybe?

Toby was diagnosed in May and he's been on the Caninsulin since then, so hopefully the vet will agree that it's been long enough. I'll start putting that spreadsheet together now.

Looking at his numbers today, I feel pretty stupid for persevering with the old doses for so long. Every time he had a hypo, because his numbers were otherwise "good", we could only explain it as an accidental overdose or a shot into fat. And I had read that low carb food was better, but just accepted "It's not worth bothering with, he needs the Urinary SO". Sigh. Hopefully we'll crack it now though.

 

[Elizabeth and Bertie]

Well done on the curve! Top job!

And it does look like it was a pretty steep drop between 2 and 4 hours after the shot (what in FDMB-speak would be called '+2 to +4'). In some cats the speed of that drop alone might cause the blood glucose to subsequently swing up high as a result.

And please be kind to yourself, there's no need whatever to "feel stupid", you're doing a great job!

The ingredients for the Royal Canin SO wet cat food are these (note that the second ingredient is 'cereals'):
Ingredients COMPOSITION: meat and animal derivatives (including beef 5%), cereals, oils and fats, eggs and egg derivatives, derivatives of vegetable origin, minerals, molluscs and crustaceans, various sugars.

ADDITIVES (per kg): Nutritional additives: Vitamin D3: 260 IU, E1 (Iron): 2 mg, E5 (Manganese): 0.6 mg, E6 (Zinc): 6 mg - Technological additives: Pentasodium triphosphate: 1.3 g.

ANALYTICAL CONSTITUENTS: Protein: 7.5% - Fat content: 5% - Crude ash: 1.5% - Crude fibres: 0.6% - Moisture: 80% - Calcium: 0.15% - Phosphorus: 0.14% - Sodium: 0.15% - Magnesium: 0.01% - Potassium: 0.27% - Chloride: 0.3% - Sulphur: 0.15% - Taurine: 0.13% - Urine acidifying substances: calcium sulphate (0.3%), DL-methionine (0.02%).

I've just run the label 'analysis' through my carb calculator and according to this the percentage of calories from carbs is a stonking 21.6%.
For diabetic cats we generally recommend that a cat food has less than 10% calories from carbs...

Was Toby always on dry food until recently? I'm just wondering if it was actually the dry diet that was causing his urinary problems....? And also wonder whether switching to wet food might actually resolve that problem...? I'm pretty sure that somewhere on Dr Lisa Pierson's website she makes the comment that 'the solution to polution is dilution' (ie, water in the diet)

I don't know if the additives in the Royal Canin food have any especially therapeutic properties (but someone here will surely know that..?)
But I'm thinking....wouldn't it be great if it were possible to switch to an ordinary good quality low carb wet cat food, and help the diabetes and the urinary problems.... confused_cat

Eliz

 

[Becky and Toby]

My immediate thought was that it was because of the sudden drop and I was going to have to deal with a 'bounce' (is that right?), so it was a bit of a relief to hear that it was 'typical'. We're just going to check him again now, hopefully we'll get an idea of which it was from that.

He spent most of his life eating primarily dry food, with one meal of wet food a day. I understand your thinking, but I am very reluctant to stray from the Urinary because when he was first diagnosed with the diabetes, we started to give him more meals of meat (due to having read about low carb diets) and for the first time in years he had a bit of a cystitis flare-up. Coincidence? Only possible because he was still on dry food too? I don't know, but it's something I want to watch very closely. As we get the sugar a little more stable, I might try throwing in some very low carb food alongside the wet Urinary and see if anything happens, but I'm sure you understand my reluctance. As for the foods properties, it basically causes very acidic urine.

He's at 16.1 now. Here's the spreadsheet.

Thanks again, everyone.

 

[Elizabeth and Bertie]

My immediate thought was that it was because of the sudden drop and I was going to have to deal with a 'bounce' (is that right?), so it was a bit of a relief to hear that it was 'typical'. We're just going to check him again now, hopefully we'll get an idea of which it was from that...

Re 'bouncing', yes, there are a number of things that can cause it. It can happen because the blood glucose drops too fast, or if the blood glucose drops too low (either dangerously low or sometimes just lower than the cat has become used to). It's also possible to see a sudden rise in blood glucose (that looks like a bounce) simply because the insulin is no longer acting in the system and the blood glucose returns to it's default (high) level. My cat has also appeared to 'bounce' for what has seemed to be no apparent reason, but I later found he'd got into the tub of food for the pond fish...(Ouch!)

... when he was first diagnosed with the diabetes, we started to give him more meals of meat (due to having read about low carb diets) and for the first time in years he had a bit of a cystitis flare-up. Coincidence?

Hmmm...impossible to know what caused that flare up of cystitis... Sometimes there is no obvious reason for it (our little tortie girl gets bouts of 'ideopathic' cystitis from time to time.) But diabetics are more prone to UTI's....

... As we get the sugar a little more stable, I might try throwing in some very low carb food alongside the wet Urinary and see if anything happens, but I'm sure you understand my reluctance. As for the foods properties, it basically causes very acidic urine.

He's at 16.1 now. Here's the spreadsheet.

I absolutely understand your reluctance about changing Toby's food. I'd probably feel exactly the same if I were in your shoes. I was just musing as to whether it might be possible to get the necessary therapeutic elements into Toby withouth the high-carb that comes with it (ie, wondering if the therapeutic elements could be given separately in a different form (a supplement?). (And in fact, if you were to feed lower carb food then the insulin dose would need dropping even more...)

Well done for setting up the spreadsheet. (I've never managed that in all the time I've been here! :lol: ) But I couldn't access it. When I tried to I got a message saying I 'needed permission'. So, maybe there's a box somewhere that needs ticking in order to make the document publicly available...?

You've done amazingly well today. I would think a nice glass of wine should be in order as a reward.... Or chocolate... Or both... ;-)

Eliz

 

[BJM]

There's an option in the spreadsheet File menu list to publish to the web and another option for sharing. Both must be done.

When you select sharing, you select "share with anyone who has the link". The link given allows others to see, but not edit, the spreadsheet.

When you select "Publish to the Web", it allows the link to be used.

 

[Sue and Oliver (GA)]

And if you include the spreadsheet link in your signature (the url that goes with "Publish to the web") it will come up each time you post, updated.

This website by a vet has some interesting ideas on urinary issues and food: http://catinfo.org/?link=urinarytracthealth She is a great resource and one of the early advocates of wet low carb food.

 

[Becky and Toby]

There's an option...it allows the link to be used.

Ah, thank you for that. Should be all good now.

And if you include the spreadsheet link...of wet low carb food.

Signature all loaded up and I'll check out that website, thanks.

Hmmm...impossible to know what caused that flare up of cystitis... Sometimes there is no obvious reason for it (our little tortie girl gets bouts of 'ideopathic' cystitis from time to time.) But diabetics are more prone to UTI's....

And we have no idea how long Toby's been struggling with diabetes. I mean, he's lived this long so surely it's not been (fully-fledged, at least) too long, but he was only around 2 years old when he started having problems with his urinary tract and he's always been a very hungry boy. We took him to our old vet around three years ago now, because he seemed to have completely lost interest in cleaning himself (not that it was ever very far up his 'to do' list :lol: ) and was developing a rather matted coat, only to get a diagnosis of "clinically lazy" because he was otherwise in good health :shock:

I absolutely understand your reluctance about changing Toby's food....(And in fact, if you were to feed lower carb food then the insulin dose would need dropping even more...)

It's definitely something I'll be looking into. When it comes to cystitis with Toby, what we got was a couple of bouts of rather mild cystitis which were promptly treated by a vet, and then coming home to him one day, unable to stand and crying. My Dad's reaction was that he'd been hit by a car, and he was rushed to the vet only to discover he was close to popping. Now, I'm only 23 now so I don't really remember it happening, but apparently he seemed perfectly fine before then. No blood, he used to urinate outdoors so nobody had noticed a lack of it, no sign of discomfort until then... The little guy doesn't do things by halves.

Well done for setting up the spreadsheet. (I've never managed that in all the time I've been here! :lol: ) But I couldn't access it. When I tried to I got a message saying I 'needed permission'. So, maybe there's a box somewhere that needs ticking in order to make the document publicly available...?

You've done amazingly well today. I would think a nice glass of wine should be in order as a reward.... Or chocolate... Or both... ;-)

Yes, I'd dropped the ball and missed that box :?

Thank you! We do have some 'cake pops' waiting around to be devoured :mrgreen:

 

[Sue and Oliver (GA)]

Spreadsheet is working great! Don't you love the colors? It makes it so easy to see exactly what is going on.

Not bad to only have a 70 point rise between +5/7. That is slower than we sometimes see with Canninsulin. It would be nice if it lasted longer than customary.

 

[Blue]

When are you feeding and how often?
I can't see where it's been mentioned that Caninsulin is harsh, pulling cats' numbers down hard, and fast by +4, so what you want to do is manipulate the numbers with feedings at certain times.

You are feeding at shot time, yes? Now, you also want to give food at about +2.5 or +3 because you want to slow down, delay the drop and then you won't have such a bounce to higher numbers later.
If you wanted, you can divide the food into mini meals at shot time and then a Tbsp every hour for the first 4 hours of the cycle which will delay the drop and give smoother numbers that will feel better to your cat.

Gayle

 

[Becky and Toby]

Spreadsheet is working great! Don't you love the colors? It makes it so easy to see exactly what is going on.

Not bad to only have a 70 point rise between +5/7. That is slower than we sometimes see with Canninsulin. It would be nice if it lasted longer than customary.

Yup! It's great. I had a spreadsheet going on my PC, but it's definitely nice to have one all colour coded and ready to go.

It would, but I fully intend on asking about a 'better' insulin anyway, and I'm not opposed to going elsewhere for it if need be.

When are you feeding and how often?
I can't see where it's been mentioned that Caninsulin is harsh, pulling cats' numbers down hard, and fast by +4, so what you want to do is manipulate the numbers with feedings at certain times.

You are feeding at shot time, yes? Now, you also want to give food at about +2.5 or +3 because you want to slow down, delay the drop and then you won't have such a bounce to higher numbers later.
If you wanted, you can divide the food into mini meals at shot time and then a Tbsp every hour for the first 4 hours of the cycle which will delay the drop and give smoother numbers that will feel better to your cat.

Gayle

Sorry, did you mean what? If so, he's eating Royal Canin Urinary SO wet, but I am looking into lower carb alternatives. As for how often, today he ate at shot time, 2 hours after, 2 hours after that, and then at his second shot time. And he's just now (around 2 and a half hours after that) demanded some more grub. It seems he knows exactly what he's doing :mrgreen:

Thanks for the pointers.

 

[Becky and Toby]

Does anyone know how fast cats respond to stress? As in, it is only really being at the vets that can push glucose up, or if you have a little bit of a scrap to get a sample, is that enough?
Toby's a very good boy about treatment in general, but he can be a bit fussy about samples because he just plain old doesn't like his ears being touched. I don't intend to fight him too hard for it anyway, but it got me wondering.

 

[BJM]

While you work on the home glucose testing, you might find it helpful to use some of the Secondary Monitoring Tools in my signature link to assess your cat.

 

[Sue and Oliver (GA)]

Is he sure getting a treat after every poke? This is the secret to testing. Once he realizes he will get a treat every time he lets you poke his ear, he should eventually decide it is worth it for the treat. (You do want to find something low carb that he REALLY likes)

Here are some choices: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

 

[Becky and Toby]

While you work on the home glucose testing, you might find it helpful to use some of the Secondary Monitoring Tools in my signature link to assess your cat.

Thank you. We are currently getting all of the blood we need, but I'll have my eye on these things too.

Is he sure getting a treat after every poke? This is the secret to testing. Once he realizes he will get a treat every time he lets you poke his ear, he should eventually decide it is worth it for the treat. (You do want to find something low carb that he REALLY likes)

Here are some choices: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

I think he realises that already, he starts looking for the food when he hears the beep :lol: He's just not quite accepted that the poking bit is a completely necessary part of the process. We'll get there.

 

[Becky and Toby]

Toby had to have his insulin an hour late today (not because of his BG, because something came up =/). We're out in the morning and he will have to have his shot at 8:45 (we're available to check him at 12:15 and he will have a watcher in the morning, just not someone who can give him his shot). If his BG is high enough tonight, can we resume at 8:45 or am I better off skipping a dose? He's burning through the insulin today and has had pretty high numbers when we've checked him (they're on his spreadsheet).

Thank you!

Oh, oh, also... I have it in my head that ears are the preferred site for testing (less chance of infection, maybe?), but we tried a paw with Toby and he seemed to tolerate it a fair bit better. Should we persevere with the ears or give the man what he wants?

 

[Elizabeth and Bertie]

Hi,

Sometimes stuff just crops up, and giving insulin an hour late ain't the end of the world. Given Toby's (often high) blood glucose numbers I would not recommend missing a dose.

Can I just clarify that I've understood you correctly? (Sorry, was up at 5am and have had a looooong day so my brain is a bit tired....) Are you saying that you gave Toby insulin this morning (an hour late) and are asking if it's OK to resume shooting schedule this evening 12 hours after the morning shot...? If so, then yes, absolutely.
Caninsulin usually has a short duration in cats and is often 'done and dusted' after about 8 hours. So it may not even be necessary to wait until 12 hours after the previous shot. (Although I realise, as I now look at the clock, that it will have been more than 12 hours anyway...?)

Actually, some people give 3 shots a day with Caninsulin because of the (typically) short duration (perhaps initially splitting the entire daily dose into 3 shots instead of 2). I gave my cat 3 shots a day (every 8 hours) for about a year and a half. Long term, it is quite a hard schedule to maintain; but some people find it worth doing short term in order to keep some insulin in the cat's system for longer, and keep the blood glucose levels more stable. I expect it's especially beneficial if a cat is a candidate for remission. (Remission means that a cat's diabetes can be diet-controlled). An alternative, of course, would be a longer lasting insulin....

As for testing sites: Absolutely do whatever you and Toby are most comfortable with! Most cats tolerate tests done on their ears better; but a minority seem to prefer paw testing.

Sorry if this is a vague rambling message. I'm totally done in and in need of some Zzzzzzzzz's.....

Oh, by the way, what is your name?

Nighty night...

Elizzzzzzzz.......

 

[Becky and Toby]

Hi....Elizzzzzzzz.......

I was wondering if I could give the shot after only 11 hours, because the only time I'll be able to do it in the morning is his usual 8:45 time. As luck would have it, it's the very first time we've had to give him a dose more than 20 minutes late (and he's only ever missed one shot :smile: ), so I just got a little worried. I went for it in the end though. I have my trusty glucose meter and he was at 29.3 so he'll be fine :smile:

As for the longer lasting insulin, that's still top of my list to bring up with the vet on Tuesday. After spending the weekend on here, I'm starting to think that appointment is redundant We're still going though, it'll be nice to check weight and BPM and harass the vet a little :mrgreen:

We've done two on the paw now, and it definitely looks like the way to go.

Doh, I keep meaning to share my real name. It's Becky. EDIT: In fact, I've changed the username now.

Goodnight, and thanks for taking the time to respond despite face-on-keyboard issues :mrgreen:

 

[Sue and Oliver (GA)]

Welcome Becky!

Sure don't like seeing those blacks. If you can monitor, I'd consider raising the dose by a little bit. With Canninsulin, it won't mean a nice general improvement overall, but it might help with those 500 preshots numbers. Just be sure to monitor the first cycle.

Do you have ketone strips? If not, I'd get some and start testing for ketones.

http://www.felinediabetes.com/ketones.htm

When they are in higher ranges, it is something you want to be careful about. You buy the same strips humans use and stick it in his urine stream. (if this is a problem, we have ways to get it done)

 

[Becky and Toby]

Welcome Becky!

Sure don't like seeing those blacks. If you can monitor, I'd consider raising the dose by a little bit. With Canninsulin, it won't mean a nice general improvement overall, but it might help with those 500 preshots numbers. Just be sure to monitor the first cycle.

Do you have ketone strips? If not, I'd get some and start testing for ketones.

http://www.felinediabetes.com/ketones.htm

When they are in higher ranges, it is something you want to be careful about. You buy the same strips humans use and stick it in his urine stream. (if this is a problem, we have ways to get it done)

Thanks for the welcome :smile:

They are a worry, and he's had a bad day today =/ It was my partner who gave him his shot this morning, and I really don't think it was a furshot, but when we got to do our first check, at +4, he was right back where he started :shock: My partner gives him his shots all the time but of course we don't know if this has ever happened before because we've only just started to hometest >_< It's the first time we've left him for several hours since starting to hometest though, so maybe he got into something =/

We can monitor him properly on Wednesday, but not before then. I'm hoping to get the go ahead on a better insulin tomorrow, but if the Caninsulin is still around come Wednesday we'll bump him up a little. I'm going to take a look at those ketone strips. Oh, Toby :sad:

Hm, looking at his spreadsheet, maybe we need to try a little harder/sooner with switching to more of the low carb food. He does better left to his own devices than he does post-food. Cystitis is still a worry though =/

 

[BJM]

The more moisture in his diet, the better for the cystitis - it helps flush out irritants.

 

[Becky and Toby]

The more moisture in his diet, the better for the cystitis - it helps flush out irritants.

Yup Not one dry biscuit passes his lips nowadays, and he drinks like... well, a diabetic. We're weaning off the higher carb Urinary (just taking a little time; he almost 'popped' as a baby so we have a healthy dose of paranoia), and keeping an eye on him to see if moisture alone will do the trick.

It's just curiosity, not a substitute for the ketone sticks, but is it possible to have an issue with ketones without any of the listed symptoms?

 

[Sue and Oliver (GA)]

Usually ketones are a combination of an infection, high numbers and not enough insulin. But every cat is different and there are cats on the forum that are very ketone prone. For them, a ketone test every couple of days is necessary, even without any visible symptoms. The only factor Toby seems to have are the high numbers. But it is a cheap test to get and if you can figure out how to test him, it is worth its weight in relief for you. Our Oliver would not let us watch him in the litter box. He would refuse to go until we left the room. So we got aquarium gravel, cleaned out the box and put it in. Then left him alone with it for awhile. He hated to see a clean box so he would go. We could then go in and get our sample, because it wouldn't absorb into the gravel.

 

[Becky and Toby]

Usually ketones are a combination of an infection, high numbers and not enough insulin. But every cat is different and there are cats on the forum that are very ketone prone. For them, a ketone test every couple of days is necessary, even without any visible symptoms. The only factor Toby seems to have are the high numbers. But it is a cheap test to get and if you can figure out how to test him, it is worth its weight in relief for you. Our Oliver would not let us watch him in the litter box. He would refuse to go until we left the room. So we got aquarium gravel, cleaned out the box and put it in. Then left him alone with it for awhile. He hated to see a clean box so he would go. We could then go in and get our sample, because it wouldn't absorb into the gravel.

Toby has a "If you want to watch me pee, you're the one with the problem" attitude (I guess cystitis from a very young age did have one perk) so I'm not too worried about getting the samples, it's just that it's 8:30 at night here and I'm trying not to fret :mrgreen: Thank you for the information.

 

[Elizabeth and Bertie]

Hi Becky,

I tested Bertie's pee for ketones quite a bit when he was first diagnosed. He had pretty high blood glucose levels (rather like Toby). You can get Ketostix (that measure ketones) for about a fiver from most pharmacies, or Keto Diastix (that measure ketones and glucose) for about a tenner. Keto acidosis is a nasty and dangerous condition and very expensive to treat, so it is good to have some reassurance that all is OK while the kitty is still in high blood glucose numbers. At the same time as testing for ketones though it's still worth keeping an eye open for any symptoms (especially for breath that smells of pear drops/nail polish remover).

Here's a link to the Sugarpet page on urine testing:
http://www.sugarpet.net/urine.html

When buying Ketostix some folks have found that the pharmacist wouldn't sell them if they'd been told they were for a cat! (Crazy but true...) I used to say that I was buying them for a diabetic friend.... ;-) You can probably get them on Ebay or Amazon too.

Eliz

 

[Becky and Toby]

Hi Becky,

I tested Bertie's pee for ketones quite a bit when he was first diagnosed. He had pretty high blood glucose levels (rather like Toby). You can get Ketostix (that measure ketones) for about a fiver from most pharmacies, or Keto Diastix (that measure ketones and glucose) for about a tenner. Keto acidosis is a nasty and dangerous condition and very expensive to treat, so it is good to have some reassurance that all is OK while the kitty is still in high blood glucose numbers. At the same time as testing for ketones though it's still worth keeping an eye open for any symptoms (especially for breath that smells of pear drops/nail polish remover).

Here's a link to the Sugarpet page on urine testing:
http://www.sugarpet.net/urine.html

When buying Ketostix some folks have found that the pharmacist wouldn't sell them if they'd been told they were for a cat! (Crazy but true...) I used to say that I was buying them for a diabetic friend.... ;-) You can probably get them on Ebay or Amazon too.

Eliz

Turns out Amazon and eBay both have them, but I'll try the more immediate option and take a look in the pharmacy tomorrow, and be sure to bend the truth a wee bit just in case =]

16.6 just now. An improvement, but still looking forward to trying with something else.

 

[Tara & Buster]

Hello Becky and Toby! Great job so far! For what it's worth, my Buster was on Urinary SO dry when he turned diabetic. Initially, my vet said to stick with that diet it and try the insulin. We couldn't get his numbers to go down and the insulin dose kept going up. After reading about food on the catinfo.org site, I took a leap of faith and switched to non-prescription, low carb canned food only. I also add a bit of water to the food just in case. It's been over a year and he hasn't had any urinary issues at all. Buster only had one bout of struvite crystals and never had any other urinary issues once we put him on the SO.

I hope we can help get Toby back on track soon!

 

[Becky and Toby]

Hello Becky and Toby! Great job so far! For what it's worth, my Buster was on Urinary SO dry when he turned diabetic. Initially, my vet said to stick with that diet it and try the insulin. We couldn't get his numbers to go down and the insulin dose kept going up. After reading about food on the catinfo.org site, I took a leap of faith and switched to non-prescription, low carb canned food only. I also add a bit of water to the food just in case. It's been over a year and he hasn't had any urinary issues at all. Buster only had one bout of struvite crystals and never had any other urinary issues once we put him on the SO.

I hope we can help get Toby back on track soon!

Thank you It's helpful to know other people have overcome similar.

I forgot to mention, but Toby has had some on and off issues with constipation (since becoming ill enough to go to the vet and eventually get the diabetes diagnosis). It does seem to be evening out with the wet food and the insulin, but it's another little thing that makes me reluctant to mess too much with his diet. If he hops in a tray and back out, it's hard to know which is bothering him and I really wouldn't want to miss trouble related to cystitis. I'll continue with the slow incorporation and try and get his BG a little more level... and then start the maths all over again when he can eat more LC :lol:

 

[BJM]

You might find this site on Feline Constipation helpful. It explains how the GI tract is supposed to function, how it may become dysfunctional, and options on managing the problem safely and correctly when it happens.

 

[Becky and Toby]

You might find this site on Feline Constipation helpful. It explains how the GI tract is supposed to function, how it may become dysfunctional, and options on managing the problem safely and correctly when it happens.

Thank you. I'm currently on lunch break, but I'll take a good look later.

Toby had comprehensive blood tests when he was diagnosed with diabetes (the vet was actually looking for kidney failure or hyperthyroidism, and skipped right to them on his results, and when he found they were both looking good he said he thought "Nope, there is something wrong with this cat", and read the rest to get a bit of a shock when he saw BG of 33) and he's doing rather well, so I'm quite sure it is just a side effect of the diabetes. Touch wood, but he's not had any issues recently

He's almost definitely finding something to eat when we're out though, hmm.

 

[Sue and Oliver (GA)]

Automatic feeders work really well to keep hungry cats eating small, frquent meals during the day (thought to be good support for the pancreas). I love my Petsafe5. You can order it online; it is available at PetSmart stores in the US- not sure about the UK.

 

[Becky and Toby]

Automatic feeders work really well to keep hungry cats eating small, frquent meals during the day (thought to be good support for the pancreas). I love my Petsafe5. You can order it online; it is available at PetSmart stores in the US- not sure about the UK.

The only problem is, we have two other moggies and a dog (Toby can't really get himself up to high places right now). He'd need to be kept locked up somewhere, and I don't think he'd appreciate that =/


We went to see the vet and spent almost an hour with him. He had a good "Oh, get you" laugh at me and 'my' colour-coded spreadsheet, but - despite initially saying not to hometest - fully approved of it. We discussed different insulins, and he's not opposed to the idea but needs some more consistent evidence before he'll prescribe one (looking at Toby's spreadsheet right now, that's fair enough). He's slightly alarmed that Toby gets as low as he does on 1U when he starts off so high (especially because he was "okay" on 3 and 4U...), and says he really can't recommend a dose increase at this point. He suggested that with Toby's glucose under control he might not need the Urinary SO but... yeah, 'diabetic food', twice a day. We'll skip that one. I've been using a Codefree monitor and haven't been able to find any information on it, so I took it along and we compared it to the Alphatrak. When the Alphatrak read 29.2, the Codefree read 27.5, so that's not bad at all.

I'm basically thinking that whatever I do with Toby's diet, I need to make it consistent, I need to stop him from getting at whatever he's gotten at over the last two days (Kitten knocked some biscuits down from up high? Secret stash somewhere? Learnt to use tesco.com?), and I need enough data to show that he is just burning through the Caninsulin quickly. Overall, I'm quite happy though.

 

[BJM]

Can you get some baby gates and set them up with just enough clearance underneath that the cat can get under them but the dog cannot?

And the same low carb food may be fed all your moggies. (I had to add the word to the dictionary for my browser, LOL!)

 

[Becky and Toby]

It's certainly possible, size-wise, to keep the dog entirely away from the cat food (she's a big ol' border collie), and I have no issue with the girls eating LC (all these issues with Toby are actually steering me towards that anyway =]), but baby gates would be an issue because we have a family member with some quite serious mobility problems and it wouldn't seem fair on them. Hmm. I need to think of something, though. I'd use some sort of hop-up so that Toby could eat up high too, but knowing the dog she'd go all Crufts on me and use it to her advantage too :lol:

As it happens, I have almost two whole weeks with nowhere I need to be now Perfect time to monitor Toby closely, and hopefully I'll have a system by the time we need to leave him.

Mine yells at me about certain words, but it accepted moggies no problem... A British thing, maybe? :lol:

 

[Becky and Toby]

Toby's vet did seem a little skeptical that it could be food alone pushing him up as high as he has been for the last couple of days, and suggested that his numbers were so low on the first two days because he was more sensitive to the insulin after his little break from it, but looking at his numbers today... go, Toby

 

[BJM]

They make some baby gates that you install like a half-door. It swings all the way open for complete passage. That might work if you can find one there.

 

[Becky and Toby]

They make some baby gates that you install like a half-door. It swings all the way open for complete passage. That might work if you can find one there.

Yeah, that's the kind I had in mind, but the issue is Parkinson's and it's doors, corners... starting and stopping in general that's the issue. Maybe if I can find a gate that swings both ways, but there'd still be the issue of stopping to unlock it. I'll get him trained to eat up high or feed him in an area such as behind a couch where the dog can't get.