Smoke newly diagnosed, multiple health issues

[Mom to Smoke]

I apologize in advance for the lengthy intro, but Smoke has quite a medical history and has been under the care of an internal med vet about 2 hours away from where I live who is fabulous! Smoke is currently 15 years old. In 2013 Smoke was diagnosed via biopsy with IBD. That is currently controlled with feeding raw and 5mg of prednisolone every other day. We have tried less pred and he unfortunately will have a flare, so he's been on this for years with periodic trials at decreasing which don't work. (I know right now everyone is thinking it is steroid induced diabetes, but read on....). In 2016 he became hyperthyroid and he was given the I-131 treatment and returned to normal. In October 2018 he was diagnosed with a sterile pancreatic abscess and had major surgery to "remove" it. They could not remove one wall of it from his pancreas but he has an ultrasound about every 6 months to keep a check on it. As a result of the abscess and the surgery he lost weight and couldn't seem to get it back on. Then in March he was diagnosed with hyperthyroidism again (new tumor), and he underwent the I-131. He had to stay at the clinic for 5 days and apparently the stress brought on more pancreatitis, but we overcame that and he has gained almost 2 pounds. Fast forward to his 30 day follow up blood test for thyroid this past Tuesday, and his glucose was at 444 and his urine showed it too. Now diagnosed with diabetes due to the pancreatitis, pancreatic cysts (forgot to mention these that show on the ultrasound), and pancreatic damage from the sterile pancreatic abscess all resulting in decreased insulin production. So...prescribed 1 unit of Lantus twice a day. I've ordered that (in pen form), the U-100 syringes (31 gauge), and an AlphaTrak2 glucose testing equipment - although now I read I should use a human one which I already have one of those at home - so don't know! I just read something about everything on this site is based on a human glucose meter?
I feel like I've been thrown in the deep end. Dealing with his IBD, pancreatitis, and now the diabetes. I am familiar with giving shots (thankfully) since he gets adequan shots, and I give IV fluids as needed for the pancreatitis. Plus he's been getting B-12 shots as he tested low. I know, alot of stuff going on - but I'm here to learn the basics in dealing with a cat with diabetes. I've dealt with cats with lymphoma on chemo, so I guess I can learn this....Thanks in advance, Teresa

 

[Idjit's mom]

Hi again Teresa. I would say with certainty that, Yes, you can learn this. You have set up the signature beautifully, thank you so much.

You can use the AlphaTrak2 meter, some members do. I started out with the same meter, but changed because of the cost of strips and the fact that I had to order them online. The protocols for Lantus were written based on human meters, but pet meters are fine.

It's great that you are getting the Lantus pens, this will enable you to use all of the insulin as opposed to perhaps having to discard the insulin left in a vial when it becomes more ineffective (about 6 months).

I suggest, since you are going to be home testing, that you set up the spreadsheet we use here. This will be linked to your signature.
You will see how the trends and patterns emerge, and members can review his progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

You can begin getting Smoke used to the testing process by choosing a testing station that is comfortable for both of you, with good lighting. Touch and rub his ears a little bit, give him a low carb treat and let him go. Do this as often as you can, so it's not completely new when you get your testing kit.
Many members use Pure Bites Freeze Dried Chicken or Orijen Wild Boar Cat Treats for the treat.

You may experience information overload here at first. Just please take lots of deep breaths and know that one step at a time, you are going to learn this new "sugar dance" and Smoke is going to benefit from every step you take.

Some links to places you will want to visit going forward:
http://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/
In the Index, scroll down to find the Home Testing Links and Tips
Please pay attention to the Hypo information. I hope you never need it, but better safe than sorry.

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
This forum is dedicated to Lantus and Lantus type insulins. This is where you will learn about the insulin, and how to get the best use of it. When you are testing, getting data and injecting insulin, the experienced members can advise you as you go forward.

Ask as many questions as you wish. We are here to help.

 

[Mom to Smoke]

So here are some of my questions:
1) Since he is going to get (starting tonight after meds arrive) 2 shots per day, how exact to 12 hours apart do they need to be. I work and sometimes end up staying late to deal with issues that crop up.
2) I keep seeing to test before giving shot - do you also test 2 X per day? That seems like alot of sticking.
3) Do you give shots before or after they eat - or does it matter? Smoke is totally raw fed (gets freeze dried salmon for treats), so carbs from food don't seem like they would be an issue.
4) I see that you should keep insulin refrigerated to keep it longer. Do you let your syringe get to room temp before you give it?

I'm sure I'll have more questions as I really get started with everything, but these are the ones plaguing me right now.

 

[MindyC]

You'll get plenty of input on the Lantus board too, but I can answer some of these. I believe Lantus needs to be given pretty close to 12 hours apart. I think it can wobble up to 30 minutes in either direction from the last shot without much effect (so if last shot was given at 6, this shot can be anywhere between 5:30 and 6:30), but as close to 12 hours as you can get is best. There are more details on this over on the Lantus board, like how this insulin works and why they timing is important, when you're ready for the nitty gritty.

Yes, test before every shot, and as often as you can in between. You won't know how well the the dose is working just by the pre-shot numbers alone.

I give Max his shot while he eats. He doesn't even seem to notice it that way.

I do not let the syringe get to room temp--when you get your syringes and insulin, you'll see that 1U is quite small. The temperature does not seem to bother Max at all.

Good luck, and keep asking questions. There are a lot of people here with a lot of knowledge. No doubt you'll be helpful to others with all yours!

 

[Dusty Bones]

All I can add is that you have definitely given your all to keep Smoke alive and well despite all his issues. You're a great kitty mom!