SamCat - Diagnosed Today, Just Missing the Box

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chicagopjp

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I am grateful to have found this forum, because even a quick look reveals that you possess a wealth of information and compassion. I am sorry if this goes on and on, but I've got probably 48 hours until I can talk to the vet again, and I'm zeroing in on a couple of questions. First, I need help keeping her pee inside the box. Second, I need to understand the consequences of missing an insulin shot(s), once my cat is regulated. Details on both questions are below.

I took SamCat in to her vet today because she had been, usually, just missing the edge of the litter box. (That is going to be one of the things I need advice about.) By that I mean that she was getting in the box, and some of her urine was making it in the box, but the rest of it was hitting the ledge of the box and/or just going directly onto the mat underneath her box. This began happening maybe two weeks ago, around the same time it was dawning on me that she sure was peeing a lot. It is true, however, that she would occasionally just not get into the box and pee right on the mat. My guess on that part of things is that I had just missed her previous "overshoots" and it was kind of trapped in the mat, making her think that maybe that was an OK place to go now. But I have no idea.

Anyway, I feel bad for not previously having taken action as I finally did today. But other than this odd behavior, which was increasing in frequency, she seemed like her normal self. But with the benefit of hindsight as applied to what my vet asked today, and as to what I've read here since getting back, I now know that other warning signs (steady weight loss, very thirsty, very hungry, bad at grooming herself) were present.

When the vet checked SamCat's urine, she found glucose and did a BG test. I never got the figures, because once the vet started telling me that SamCat was diabetic, it was hard for me to really focus on what she was saying. Sam's had a tough road in some aspects to date. She is about four months shy of her 14th birthday (give or take, she came from a shelter) and along the way she's spent a long time at a nuclear medicine/vet place getting her thyroid removed. She also has some meaningful arthritis in her hind quarters.

Anyway, the vet today was not our normal vet. She seemed perfectly fine, but she was talking about insulin 2x per day, and while she was fine with us waiting the weekend to make a determination on what to do, she painted a dim picture of the future, perhaps just to toughen me up for the level of commitment that insulin treatment was going to require. (This is the other thing on which I need some guidance.) I expect to be able to speak to my normal vet about this Monday evening.

I gather from what I've read here and elsewhere that there is a strong school of thought that diet can, in some cases, be an effective way of treating FD. I don't dismiss that at all, and I hope that my normal vet thinks that's an option. But let's assume she says no way, the BG is way too high to rely solely on diet. In that event, and assuming we get to a point where SamCat is fairly well regulated and dialed in on her doses, I'm trying to get a clear answer to one thing:

1) How serious is it going to be if we miss a dose, or three doses, or a dozen? On the one hand, my instinct is that if she seems OK now and we've gotten her regulated going forward, how bad could it be for her to miss a few days' worth of insulin? Would she be any worse when we were able to resume than it is, say, today? On the other, the vet today led me to believe that any variation beyond a couple of hours would be problematic.

My wife is newly pregnant, and our condo goes on the market Monday. I travel frequently for business. There are a lot of ways I can see over the next many months in which we will simply not be able to get to her in time to do a shot every 12 hours. So how much of a problem will that be?

2) Assuming you're still with me, I need advice on getting her to keep her pee inside the box. It seems like she's just not squatting down quite far enough, to state it simply. My first instinct was to just start with a fresh, taller box. But she's not interested in making circus leaps to get inside, so maybe some big Rubbermaid thing with a makeshift ramp? I don't know, I'll try anything. What I've done so far is get her a Booda Clean Step box. That seems OK with Sam while the roof/dome is off, but with it on, she refused to use it at least once and just peed next to it.

Any thoughts on either of these concerns will be very welcome. Many thanks in advance.
 
Welcome!

First things first...take a deep breath! Diabetes is not a death sentence for your kitty, nor will it diminish quality of life. Yes, you will have to get your kitty's diabetes regulated, but we can help you with that as well.

Regarding insulin, there are different types of insulin and each work in different ways. Lantus is a popular one, but it is also the one that is most effective if a regular 12-hour schedule can be maintained. Other insulins are more forgiving, and I encourage you to check out each of the forums here that are dedicated to the different insulins (Lantus, ProZinc, etc.). They can be found here: http://felinediabetes.com/FDMB/viewforum.php?f=5.

Diet is important, and you cat will need to be on a wet (canned) low-carb diet. There are many varieties available (Friskies, Fancy Feast, etc.), that have low cab food. Please see Janet & Binky's food chart here: http://www.felinediabetes.com/diabetic-cat-diets.htm.

We encourage hometesting. Not only does it cut down on vet bills (you will be able to do your own blood glucose curves) and provide your vet will invaluable information, it allows you to know your cat's BG level prior to giving insulin. You can learn about hometesting here: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287. The other benefit of hometesting is that your BG information is likely to be more accurate than the vet will be able to get in his/her office - cats often suffer from "vet stress," which causes their BG levels to increase and may lead your vet to recommend an insulin dose that is too high.

Speaking of too much insulin, hopefully you will never have to deal with a hypo incident. However, since hypo's can be lethal, you should prepare for that possibility. Please see here http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=2354 for items you will need to have, and here http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122 for information on what to do in the event of a hypo.

We can provide you with what we call a "newbie kit" to get you started. If you would like one, please see here: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=19528.

As to your specific questions:

Can you miss a dose (or many doses) of insulin? If you cat is insulin dependant, you should only skip a dose if the BG level indicates that is the wise course of action. If you test before giving insulin and the BG level is low, then you shouldn't shoot. For people just getting started, if the BG is 150 or lower, you probably shouldn't shoot. As you learn more about how insulin effects your kitty, you will learn how/when to shoot at lower numbers. With all that said, everyone has a life and sometimes it just isn't possible to shoot every 12 hours every day; however, if you anticipate missing the 12-hour mark often, then you should consider an insulin that is more forgiving than, for example, Lantus.

It is possible for a cat to be diet-controlled, and that is another reason why testing is so important. When you change the diet and begin insulin, there will likely be a dramatic drop in the BG level. Between now and when you next see the vet, you may want to go ahead and get a glucometer and test strips (many people here purchase from WalMart) and change your cat's diet to low-carb. Even in the day or two between now and when you see the vet, there will likely be a drop in the BG level.

As far as peeing outside the box, a couple of things come to mind. Since your kitty has peed outside the box before, the outside of the box likely smells like cat pee (at least to the cat). You may want to replace the pad under the box with one that doesn't smell. You also mention she has arthritis in her hind legs and doesn't seem to be squatting far enough for all her pee to hit inside the box. Perhaps talking to the vet about arthritis relief will make it less difficult for her to squat down.

There is alot of information, I know. I also know you are having the same feelings all of us had when we were told our kitty had diabetes...you are overwhelmed and just don't see how you can possibly do everything that needs to be done. We've all been there and you can do it.

Please post back with your questions/concerns...we're here to help you help your cat.
 
Hi chicagopjp, who I'm just going to call SamCat's dad (if that's okay...), and, of course, you too, sweet SamCat,

I'm still with you. Just need to keep re-reading your post...



Okay, let me just tell you that, I too, did not know that frequent drinking and peeing were signs of diabetes. I mean, I knew Giz was doing both for a couple of weeks (also just shy of her 14th Birthday...); but, simply thought what goes in goes out. Yeah... Yet, we danced for four more years! What I'm trying to say is, don't beat yourself up, okay? You've got the diagnosis and you're here now.

Sorry, need to re-read....



Has SamCat actually been diagnosed with meaningful arthritis in her hind quarters? The reason I'm asking is that this could be diabetic neuropathy which can be completely reversible. Giz was on her back hocks and could only walk a bit before resting; but, after starting insulin, was back on her toes after a while; and, remembered she used to be a Nascar racer...

Also remembered she was a diva, and started grooming again...

Treating SamCat's diabetes could help her get back in the litter box. Also Methyl B12 can help with neuropathy... Someone will give you the link, or I will later, okay? Also, a low litter box might help... Or, some here have cut a bit out of the side for easy entrance...




Still re-reading...

Yes, some cats here are diet-controlled.

And, no, missing one shot isn't the end of the world. Missing three could be a problem. Missing 12 could mean death. But, and sometimes buts are good. Yes, shooting every 12 hours is optimum. But, I have shot at +14 and +15 when work caused it. Life and jobs and responsibilities happen. But, I never shoot earlier than +10. And, I home test, so know it's safe to shoot.



There is an immense amount of life which can be had in 12-hours increments, dear SamCat's dad. And, I believe there are a few people from this Board who are in your area. Perhaps they might help you learn to home test. Perhaps they might be even able to help with SamCat's shots when you have to travel and your wife can no longer see her toes.

You'll never know until you try. I can tell you that life with a sugar cat is very precious. There's a bond you can't even begin to imagine. And, once you get the hang of it, it only takes a couple of minutes twice a day.

Welcome to the place you never wanted to be; but, will be blessed for having found.

Love and encouraging hugs for you and your family,
Deb and Nikki -- and Giz, forever dancing in my heart...
 
Jana + BK + Chester said:
Welcome!

First things first...take a deep breath! Diabetes is not a death sentence for your kitty, nor will it diminish quality of life. Yes, you will have to get your kitty's diabetes regulated, but we can help you with that as well.

Regarding insulin, there are different types of insulin and each work in different ways. Lantus is a popular one, but it is also the one that is most effective if a regular 12-hour schedule can be maintained. Other insulins are more forgiving, and I encourage you to check out each of the forums here that are dedicated to the different insulins (Lantus, ProZinc, etc.). They can be found here: http://felinediabetes.com/FDMB/viewforum.php?f=5.

Diet is important, and you cat will need to be on a wet (canned) low-carb diet. There are many varieties available (Friskies, Fancy Feast, etc.), that have low cab food. Please see Janet & Binky's food chart here: http://www.felinediabetes.com/diabetic-cat-diets.htm.

We encourage hometesting. Not only does it cut down on vet bills (you will be able to do your own blood glucose curves) and provide your vet will invaluable information, it allows you to know your cat's BG level prior to giving insulin. You can learn about hometesting here: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287. The other benefit of hometesting is that your BG information is likely to be more accurate than the vet will be able to get in his/her office - cats often suffer from "vet stress," which causes their BG levels to increase and may lead your vet to recommend an insulin dose that is too high.

Speaking of too much insulin, hopefully you will never have to deal with a hypo incident. However, since hypo's can be lethal, you should prepare for that possibility. Please see here http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=2354 for items you will need to have, and here http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122 for information on what to do in the event of a hypo.

We can provide you with what we call a "newbie kit" to get you started. If you would like one, please see here: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=19528.

As to your specific questions:

Can you miss a dose (or many doses) of insulin? If you cat is insulin dependant, you should only skip a dose if the BG level indicates that is the wise course of action. If you test before giving insulin and the BG level is low, then you shouldn't shoot. For people just getting started, if the BG is 150 or lower, you probably shouldn't shoot. As you learn more about how insulin effects your kitty, you will learn how/when to shoot at lower numbers. With all that said, everyone has a life and sometimes it just isn't possible to shoot every 12 hours every day; however, if you anticipate missing the 12-hour mark often, then you should consider an insulin that is more forgiving than, for example, Lantus.

It is possible for a cat to be diet-controlled, and that is another reason why testing is so important. When you change the diet and begin insulin, there will likely be a dramatic drop in the BG level. Between now and when you next see the vet, you may want to go ahead and get a glucometer and test strips (many people here purchase from WalMart) and change your cat's diet to low-carb. Even in the day or two between now and when you see the vet, there will likely be a drop in the BG level.

As far as peeing outside the box, a couple of things come to mind. Since your kitty has peed outside the box before, the outside of the box likely smells like cat pee (at least to the cat). You may want to replace the pad under the box with one that doesn't smell. You also mention she has arthritis in her hind legs and doesn't seem to be squatting far enough for all her pee to hit inside the box. Perhaps talking to the vet about arthritis relief will make it less difficult for her to squat down.

There is alot of information, I know. I also know you are having the same feelings all of us had when we were told our kitty had diabetes...you are overwhelmed and just don't see how you can possibly do everything that needs to be done. We've all been there and you can do it.

Please post back with your questions/concerns...we're here to help you help your cat.
Thank you very much for such a thoughtful and thorough reply. I'm grateful. You've given me plenty to look at and think about before talking to our vet on Monday. I will definitely be asking about a more forgiving insulin than Lantus. I'm fine with home testing and the vet we saw yesterday was certainly contemplating that. There's no was the stress of taking her in to the vet for for regular testing could be a good idea, and I'm OK with doing it myself.

Sam's already been largely a wet food, Fancy Feast eater. That started when we started giving her Cosequen for arthritis quite some time ago. We keep dry food out to fill any gaps, but she rarely bothers with it.

I've replaced the litter box, the mat under it, and thoroughly cleaned the floor below. Knocking wood, she has not yet directly peed on the mat, though last night she had another "spill," - partly inside, partly outside. Fortunately, the outside happened to be not on the rug, but down the "ramp" of the Booda Clean Step that I bought most recently.

Speaking of that Booda Clean Step (it's the kind that looks like an igloo, with a ramp on one side that she's supposed to use to get "in" to the box, we're using it now without the roof because she seemed quite resistant to the whole roof thing before. The thought with the roof was to physically prevent her spills, but of course that won't work unless the roof is on and she agrees to go in -- does anyone have advice on how to convince her to go inside with the roof on?

I may not have responded to everything you've said here, but none if it is ignored and it is all appreciated. Thanks again.
 
Deb415andNikki said:
Hi chicagopjp, who I'm just going to call SamCat's dad (if that's okay...), and, of course, you too, sweet SamCat,

I'm still with you. Just need to keep re-reading your post...



Okay, let me just tell you that, I too, did not know that frequent drinking and peeing were signs of diabetes. I mean, I knew Giz was doing both for a couple of weeks (also just shy of her 14th Birthday...); but, simply thought what goes in goes out. Yeah... Yet, we danced for four more years! What I'm trying to say is, don't beat yourself up, okay? You've got the diagnosis and you're here now.

Sorry, need to re-read....



Has SamCat actually been diagnosed with meaningful arthritis in her hind quarters? The reason I'm asking is that this could be diabetic neuropathy which can be completely reversible. Giz was on her back hocks and could only walk a bit before resting; but, after starting insulin, was back on her toes after a while; and, remembered she used to be a Nascar racer...

Also remembered she was a diva, and started grooming again...

Treating SamCat's diabetes could help her get back in the litter box. Also Methyl B12 can help with neuropathy... Someone will give you the link, or I will later, okay? Also, a low litter box might help... Or, some here have cut a bit out of the side for easy entrance...




Still re-reading...

Yes, some cats here are diet-controlled.

And, no, missing one shot isn't the end of the world. Missing three could be a problem. Missing 12 could mean death. But, and sometimes buts are good. Yes, shooting every 12 hours is optimum. But, I have shot at +14 and +15 when work caused it. Life and jobs and responsibilities happen. But, I never shoot earlier than +10. And, I home test, so know it's safe to shoot.



There is an immense amount of life which can be had in 12-hours increments, dear SamCat's dad. And, I believe there are a few people from this Board who are in your area. Perhaps they might help you learn to home test. Perhaps they might be even able to help with SamCat's shots when you have to travel and your wife can no longer see her toes.

You'll never know until you try. I can tell you that life with a sugar cat is very precious. There's a bond you can't even begin to imagine. And, once you get the hang of it, it only takes a couple of minutes twice a day.

Welcome to the place you never wanted to be; but, will be blessed for having found.

Love and encouraging hugs for you and your family,
Deb and Nikki -- and Giz, forever dancing in my heart...
Thanks very much for taking the time to read and reply. I really do appreciate it. I'm absorbing all of this, gratefully.

SamCat does have previously diagnosed arthritis, but that never seemed to have caused the pee issue we've got now. So I think it could well be prompted by diabetic neuropathy, which your post, others here, and other sites have all brought to my attention. I've got lots more learning to do, and your encouragement is a big help. I'm sure I'll be back here soon.
 
Hi and welcome! There is a lot to learn but you're getting a great start already. Congrats on the new human addition too.

You also might want to visit Dr. Lisa Pierson's site http://catinfo.org/ Tons of great info there and the section on litterbox problems might help you. When my previous two kitties got older, they both shot over the edge of the box so it may just be difficult for your kitty to stay down in a squat with her arthritis. To catch the overage, I put the litterbox in a cardboard box lined with a garbage bag and newpapers which were changed frequently. If I were doing it again, I'd take Dr. Lisa's advice and get a higher sided container. My cats tolerated an enclosed kittybox for a while but I dispensed with it when reading what Dr. Lisa says about them.
 
I wouldn't be quick to disregard the Lantus. It is a good insulin and if you can generally shoot 12 hours apart and getting tests in around 6 hours after, it has worked for many cats. If it looks like that really won't be possible at all, you could try PZI. It is easier to vary shot times. The difference between the two is basically that Lantus builds up a shed and skipping shots or delaying shots can set you back because it can deplete the shed. ttp://www.felinediabetes.com/FDMB/viewt ... ?f=9&t=150. Wiith PZI there is little overlap, so when you shoot, you are basically shooting the number you see. But you will still need to test often enough to know what is safe to shoot and to see how the insulin is working in your cat. There is no set protocol with PZI so it is a little more on you to decide with input from others. Here is a document on PZI that explains a lot about how it works: viewtopic.php?f=24&t=32799 I agree with others that you should check out the Insulin support groups to see what matches your lifestyle: viewforum.php?f=5

Just to get the dry food out of the mix, you can free feed wet. We freeze the wet using a silicone cupcake pan and plop out the frozen pucks. It thaws and they can graze as it melts. You can also use an automatic feeder so you feed small frequent meals during the day to help support the pancreas.
 
I've got a good feeling about you, SamCat's dad...

... and, therefore, have a good feeling about SamCat...

Please let us know how it goes with her vet on Monday, okay? You know, when and if you find a free moment and you're brain isn't on overload... Been there, done that!

Nikki's on Levemir, by the way. Not to add to your brain overload... She came to me on Lantus (I was the one rescued...). I never really understood Lantus. I'm not all that sure I understand Levemir either; but, what I do understand is that Levemir likes Nikki.

Please do take time out of your feline diabetes crash course to hug your wife -- and, of course, SamCat -- and eat and breathe and play, dear SamCat's dad. And, remember one thing. She's still a cat. She's just extra-sweet!

Love and our encouraging hugs continue for you and your family,
Deb and Nikki -- and, Giz, forever dancing in my heart...

PS: Speaking of Giz, I was wrong last night in saying she was also just shy of her 14th Birthday. She was actually diagnosed 6 weeks after. Is there such a thing as after shy? Or, would that be post shy? Not to add to your brain overload...
 
Deb415andNikki said:
Please let us know how it goes with her vet on Monday, okay? You know, when and if you find a free moment and you're brain isn't on overload...
Absolutely. Thanks for your support, and the information on your own experiences.
 
Sue and Oliver said:
I wouldn't be quick to disregard the Lantus. It is a good insulin and if you can generally shoot 12 hours apart and getting tests in around 6 hours after, it has worked for many cats. If it looks like that really won't be possible at all, you could try PZI. It is easier to vary shot times. The difference between the two is basically that Lantus builds up a shed and skipping shots or delaying shots can set you back because it can deplete the shed. ttp://www.felinediabetes.com/FDMB/viewt ... ?f=9&t=150. Wiith PZI there is little overlap, so when you shoot, you are basically shooting the number you see. But you will still need to test often enough to know what is safe to shoot and to see how the insulin is working in your cat. There is no set protocol with PZI so it is a little more on you to decide with input from others. Here is a document on PZI that explains a lot about how it works: viewtopic.php?f=24&t=32799 I agree with others that you should check out the Insulin support groups to see what matches your lifestyle: viewforum.php?f=5

Just to get the dry food out of the mix, you can free feed wet. We freeze the wet using a silicone cupcake pan and plop out the frozen pucks. It thaws and they can graze as it melts. You can also use an automatic feeder so you feed small frequent meals during the day to help support the pancreas.
Thanks for the idea about freezing the food. I read that elsewhere in my flurry of research but I'd forgotten it. A trial is in the freezer now.

I'll read up on the various insulin options so I have a clue when I talk to the vet. Thanks for the references, and for your time.
 
Carol & Yoshi said:
Hi and welcome! There is a lot to learn but you're getting a great start already. Congrats on the new human addition too.

You also might want to visit Dr. Lisa Pierson's site http://catinfo.org/ Tons of great info there and the section on litterbox problems might help you. When my previous two kitties got older, they both shot over the edge of the box so it may just be difficult for your kitty to stay down in a squat with her arthritis. To catch the overage, I put the litterbox in a cardboard box lined with a garbage bag and newpapers which were changed frequently. If I were doing it again, I'd take Dr. Lisa's advice and get a higher sided container. My cats tolerated an enclosed kittybox for a while but I dispensed with it when reading what Dr. Lisa says about them.
Thanks a lot. I read Dr. Pierson's discussion on litter boxes and went out and bought a 30 gallon tote, cutting a door in the side just as she describes and moving the Booda out of the mix. Too soon to say whether that's going to fly, but if she'll go in, it seems like it might be a great idea.

After I'd cut the door out but before filling it, I left it out for SamCat to explore and rub on, which she did. I think I'll pick her up and gently deposit her in it now that it's full of litter, just to make sure she gets the point. She'll either oblige me or pee on the mat right outside of it. Should know soon enough.

Thanks again.
 
I had a diabetic years ago who missed the box repeatedly. What I did:
I put his normal litter box inside a huge Rubbermaid box, the kind you store clothes in under the bed - I think it's a 30 gallon.
I put this in a place where I could put old carpeting around it. The sides were so high on this outer box, he couldn't miss.
I also hated to do it, but I confined him to the laundry room at night where he cud do little harm and he had access to this huge litter box in a box. He was good at getting into it, but if he missed, no big deal.

Hope this helps.

That huge box is now in my trunk to keep grocery bags from jostling all over the place.
 
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