starting insulin again after remission

Status
Not open for further replies.

MelissaEbby

Member Since 2012
My cat Ebby was diagnosed with diabetes about 6 months ago. After about a month of treatment and switching to wet cat food she went into remission. About a week ago I noticed she was drinking and urinating more, so tested her urine for glucose/ketones, and her glucose was extremely high. So, we started on Prozinc insulin again. The vet said to start at .5 units

She has been on the insulin now for about 5 days and her urine is still not showing signs of improving. I increased her does yesterday to about .75 units. My question is does it take awhile before her urine would show more normal readings? I just expected that I would see results quicker since she responded so quick last time, but maybe because it is a smaller dose, it will take a little longer. Also, the prozinc insulin is about 6 months old. It is not expired and has been kept in the fridge, and the vet says it should be fine, but is there a chance the insulin has lost potency?

I know the importance of home blood testing and have a meter, but at this point am not testing her because she will fight it too much. However, I am working with her daily to get used to the testing, but know from experience I cannot go to fast and expect to get blood from her right away. At this point I am just getting her used to going to her testing spot, being somewhat restrained, and rubbing her ear....then she gets a treat, and I will build on this as she tolerates.

Any suggestions or comments on how long before I can expect to see improvement would be great. She has lost some weight in the past couple weeks, so I feel I need to get the regulated quickly. Thanks!
 
I might have her checked out completely at the vet, if you haven't. Could she have a UTI or infection?

How did you determine she was in remisssion? Did she get checked at the vet for blood glucose levels? It sounds you understand how valuable testing is and are working on that. Have you found a treat she loves that she only gets when you are messing with her ears or warming them?

Did you get a bg level from the vet so you are sure she is high enough for .5?
 
Thanks for quick response Sue,
I have not had her back to the vet, just been communicating with them. She does have one tooth that looks pretty red and dirty, but I don't know if it would be considered an infection. The vet looked at them last time we were there, and he didn't seem super concerned about it...just suggested cleaning when we got the diabetes under control. Not sure about the UTI.

As far as the remission, we had her down to .5 units before and she started acting pretty hypo: unable to walk well, would not get out of bed, and just looked out of it. So I took her off, and kept testing urine daily to make sure there was no glucose. I also had a fructosamine test done after she had been off insulin for a little over a month, and it came back normal.

I did not get a bg level from vet yet because I've questioned how accurate they are when the cat is stressed....but maybe I should just for a little more info.

I have found she loves Halo dried chicken treats, but have not reserved them just for the testing, so that's a good suggestion. She would probably do anything for those things! Yeah, this time around I'm trying to go slower with the testing thing and will TRAIN her to tolerate it. I think I just encouraged bad association last time by trying too fast.
 
Since the last time you were here, member Kpassa has shared a wonderful document she wrote up on "Ear Testing Psychology". Here it is:https://sites.google.com/site/michelangeloprofilefdmb/felinediabetes/ear-testing-psychology Or for those that have problems accessing it.

Ear Testing Psychology

I've had the privilege of owning three part-feral cats, two since they were around 8 weeks old. Semi-ferals are unique in that they're not as fearful, defensive, or nervous as full ferals, yet they retain many of those same traits to a lesser degree, even into adulthood. In fact, Michelangelo's unofficial name to this day is still "Skitty-Kitty." Domesticated cats, however, are much more subtle and nuanced in their characteristics and behaviors and are easier at ignoring or hiding their more wild traits. This doesn't mean these tendencies disappear; it simply means that it's less obvious as to what might be bothering them. It's because of this exposure to feral mannerisms that I was able to gain additional insight to the inner workings of fully domesticated cats (like Henry) and discovered that domesticated cats have the same fears and motivations as their more-feral brethren; they're just able to disguise it a bit better.

Location, location, location!
I see videos all the time of "difficult cats" and I want to scream at them that the cat would be less difficult if they didn't have the poor cat pinned to the ground between their legs in the middle of a room while they stab at the ear. All the while, you can hear kids playing in the background and other cats and pets wandering about in and out of frame. Of course the cat is going to be difficult!

Most cats are simply inconvenienced by being detained for testing. The majority of difficulties occur because a lot of people don't realize how easy it is to manipulate a cat or because they use tactics of domination and force that would work better on a pack animal who conforms to a hierarchical order (like a dog). Because Every Cat Is Different, yes, there will be the odd cat or two who is just unmanageable when it comes to testing. In those cases, a kitty burrito or more forceful methods might be necessary, but they are the very rare exception.

First of all, the most important tip is that it takes TIME. Have patience and the longer you do it, the more familiar you'll both become and the more routine it gets. After that, what it comes down to is basic cat psychology: cats generally don't like being towered over or enveloped or trapped. In order to figure out where and how to position your cat, think of where they spend the most time and why it might be their favorite spot.
1.Where is it located: up high, eye level, seat level? In a corner, near an entrance, in the middle of a room? Is it in the sun, in a dark corner, under a couch or bed?
2.What does it prevent from bothering them: loud sounds, lots of people, kids, other animals, lots of noise, bright lights? Think of anything that might scare, overstimulate, or irritate them and how this spot might offer protection from it.
3.If you were to pick them up from that spot, how do they normally like to be held/carried: not at all, cradled like a baby, slung over the shoulder like you're burping a baby, "proper cat position" with one arm under his back feet and the other across his body? Do they like to be squeezed tightly (usually they don't) or held relatively loosely? How long can you hold and/or carry them around before they start getting impatient and want to get down again?


Place
When first starting out, a consistent place to test is key because it lets Kitty know when to expect it during the first couple of weeks of tester incompetence and testee unfamiliarity. It helps Kitty realize he's not going to be tested every time you approach him or hold him; he only gets tested when you pick him up and take him to the testing spot. That way Kitty isn't running in fear every time he sees you coming. Eventually, you'll be able to test him practically anywhere, but this is helpful starting out.

Find a place that meets the cat's criteria of calmness. Easiest way is if your cat's favorite spot is seated on a couch or chair, then you can simply make that his test spot. If your cat likes a non-human friendly spot, you will have to get a bit more creative. For example, for cats that startle at noise or people/animals, you want a quiet room where there won't be a lot of noise or traffic going in and out so the cat can feel safe while he's being vulnerably "trapped" in your arms. Look around the room and see where a potential "attack" might come from and figure out a spot that the cat would be able to best "defend" against such an attack. If the cat prefers to monitor entrances, choose a spot with clear visibility of the door and little-to-no possibility of a "rear attack". If the cat prefers to watch the outside, find a spot with a good window view.

You also want to pick whether the floor or a seat or platform is a better choice. If the cat doesn't generally lay or sleep anywhere on the floor, you might be better off doing it seated in a chair/couch to give the cat at least some height off the ground. If the cat likes hanging out under the bed, then the floor might be a better choice. You might even find it easier to place the cat on a high table, counter, or platform (like on top of a Kitty Condo) with you standing next to him to test him.

Position

A consistent position to test is also key because you're setting yourself up for future success (being able to test Kitty anywhere). This is where I see people make the most mistakes (even experienced testers). You want to figure out how to not piss off the cat by trapping them, confining them, or traumatizing them unnecessarily. For most cats, as long as they feel like they're not defenseless and are "free to go," they're more likely to settle in for a moment or two (although this does take a few days to get them used to the concept of "agreeing" to sit still for a minute as long as they can go after you're done).

Find a position that allows the cat to observe his surrounding territory and to be able to either "fight" or "flight" in response from any impending perceived threats. You're not really going to let the cat fight or flee but you don't want the cat to know that, otherwise he's going to feel trapped again. The simplest way to do this is to change the way the cat is facing. You want to place the cat in whichever way he might prefer (most cats prefer "defensible" positions). If the window he loves looking out is to your right, you don't want him in your lap facing left with his back to the window. If he prefers corners, you don't want him facing in toward the corner, but out toward the rest of the room (otherwise, he's a "cornered" animal and you're just making him feel trapped again).

Since you need to test the cat's ear, this position not only has to meet your cat's needs, it also has to meet your need to access the ear with proper lighting and visibility. If you think back to how most cats like to be carried, they generally prefer to have their back feet supported and their upper body higher. Slightly elevating the front of the cat will bring him more into your line of sight as well as having him on more equal ground with you (instead of being cowed over by your frame). You'll also want to make sure whatever you're using to elevate them is not going to suspend them, either (i.e. you don't want them elevated so high that they have to stand on their back legs). You can use a cat bed, your knee, an armrest, a pillow, a TV tray, etc...try them all till you find one that works.


Grip

Finally, a consistent and firm grip is key because you want to keep your cat in position to get a poke and a test yet you also don't want to force your cat into compliance. You want to loosely hold them in place, yet have a firm enough grip that when they try to leave, you can usually keep them from going anywhere. If you're holding them tightly (the biggest mistake I see in many of the videos), they feel trapped and will more likely attempt to escape, resulting in a battle. If you hold them a bit more loosely, they either won't attempt to leave at all or they'll feel like they can leave if they want to; they just have to figure out how to be faster than you (which might happen from time to time). The easiest way to do this is by using your body to block escape from one side and your flat hand pressed gently against their other side, almost as if your hand stalled out while you were in the middle of petting them. Depending how big the cat is, you can also drape your forearm against the side of their body. This helps keep them from scooting out backward from your grasp. When they try to escape, use this hand or arm to press them firmly against your body and use your other hand under their chin and flat against their chest (not their neck!!) to keep them from darting forward. This will usually chill them out and calm them down. Keep your grip firm and consistent until he settles, then loosen it. If he tries to get away again, tighten your grip till he settles. Keep doing this each time the cat tries to get away. Don't struggle with the cat; patiently wait him out till he gives up. At first, this might take several minutes. The more you do this, the less time it takes, until the cat eventually realizes it's not really worth the time and effort to fight you for the 15 seconds it takes to test him. Most importantly, if there is a disruption during the testing process, i.e. someone entering the room or a loud noise, STOP WHAT YOU'RE DOING AND WAIT for the the cat to get comfortable again, otherwise you're just instigating another battle with Kitty.

Of course, this will take a few days to a few weeks before it becomes "natural" for them to wait for you to finish testing, so it helps to start with a set time-frame in mind. Think back to how long they're willing to be held or carried for. Use that number as the starting goal: you will hold onto Kitty in test position for X seconds and then be willing to let him go if he struggles. Every time you get him into test position, extend it out a bit longer as you slowly inch past Kitty's natural "confinement threshold." Michelangelo doesn't like to be held and is not a lap cat in any sense of the word. The first day, I started out "holding" him next to me. The next day, I worked on getting him to let me "hold" him for a few seconds in my lap. The day after that, I worked on increasing the amount of time I held him in place on my lap. After about a week, I could get him to sit still in my lap long enough for me to get halfway through testing before I'd have to restrain him. By the end of the second week, I no longer had to even restrain him or pull him back into my lap during test time. To this day, he still hates being held for anything longer than 15 seconds and he still hates sitting on laps...except at test time.

You also want to encourage your cat's "freedom" by immediately releasing your loose grip after you get your (successful) test in. By "release," I mean you simply stop firmly holding them in place to keep them from escaping. I hold Mikey loose enough that sometimes he thinks I'm done before I really am (especially if the meter returns an error and I have to test him again). When he attempts to get off my lap prematurely, I tighten my loose grip on him and say, "not yet." (Over time, I've managed to create voice cues for him so he knows when it's time to test, when I'm not finished testing, when I have finished testing, and even when it's time for his shot.) He settles back in, I finish my test, and then I "release" him and move my hands visibly in front of him as I enter his BG reading into his book. Half the time, he remains sitting on my lap a little bit longer because he's either thinking I'm not finished testing yet or he's wanting more praise and some cuddles; the other half the time, he wanders on his merry way and waits for me to toss him his after-test treat.

If the cat struggles vehemently or manages a successful escape, grabbing them and wrestling them back into position will not calm them down and they will only try to escape more, so if they do escape, let them go! Unless it's a pre-shot test or his numbers have been running low, there's no reason to chase down the cat and exert your dominance over them by forcing them into a test they don't necessarily need. That might work on dogs but it does not work on cats, who might be just as social, but are much more autonomous. If it is a necessary test, wait a few minutes before attempting again to give the cat some time to cool off. If you start out knowing that it's okay to "lose a few battles" at first, it'll help keep you from getting too stressed when they escape and it reassures them that they can still get away if they really want to. This makes them more complacent when testing because they think they're "allowing" you to test them.

In the future, you might be on a cross-country road trip with your cat, stopped at a hotel next to a 4th of July picnic with fireworks going off and lighting up the sky, and kids running around screaming everywhere. All you will need to do is get your cat into his testing position. And it doesn't even have to be you. I have taught numerous people to test Michelangelo over the last few months, including complete strangers he normally runs and hides from! The biggest key to their success is getting Michelangelo into his "testing position." He'll comply because experience has taught him that it takes longer to fight than it does to sit through a test, he can escape if he really needs to, and he'll get a yummy treat when it's all over and done with.
 
I'm feeding canned Wellness grain free chicken and turkey, and she only gets dried chicken treats. She is currently eating well.
 
I just got back from the vet, and Ebby did have a bad infected tooth. Had it pulled today. Might have been the reason for her bg increase and why she wasn't responding to insulin. Just wanted to let everyone know in case they run into a similar situation. Thanks for all the help and suggestions! I'm sure she'll be feeling better soon.
 
Great! Keep an eye on her now a- hold off on the PZI and keep testing her urine to see. She will get post surgery antibiotics and they might take a week to clear any infection at which time her blood glucose could drop.
 
Status
Not open for further replies.
Back
Top