Tentative Diagnosis of Diabetes Mellitus & Kidney Disease

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Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Is Pharmasave where you bought your syringes? It could be I got the free sharps box because I got my syringes at Save-on. When it's full, just return and they give you an empty one in return.

Have you done your +2 test yet?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Sorry, missed your post while I was typing. Looks like Grady is likely going to have a nice but not too low cycle tonight. We usually ask people to get a +2 test with Lantus, because it can give us an idea what the cycle is going to look like. If the +2 is the same as preshot, you'll likely have a normal lantus cycle. If it's lower, then it'll be an active cycle which means you might have to test more to make sure he's safe. If it's higher, then it'll be a quieter cycle. You are probably OK with just a test before bed if you can. Do you leave food out for him overnight to snack on? If he's at 200 or above in the morning, then it's safe for the shot. If below, post and ask for help.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Yes, I got the syringes and insulin at Pharmasave because it's close by. He generally doesn't snack during the night because he doesn't like it when his wet food dries out. I'll do another test before retiring for the night.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Have you tried adding a little bit of water to his food. About one tablespoon, mix and stir. That helps to prevent the food from drying out.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

He tends to get weirded out by that but I'll leave a little bit out overnight and wet it down.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Spiked up high this morning. 424.8. 1 unit of insulin given.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I wonder how low he went last night, he was dropping still middle of the night.. The reading you took at +4 was likely not the lowest point (nadir) . Now I don't think he went too low, but maybe lower than he has seen in a while. This could have triggered a "bounce".. If so, he may stay high all day and then come back down. It's very normal.


Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Looks like bounce is clearing. Be interesting to see PMPS. Might want to get a +11 so we can prep in advance if he is under 200 again.

Numbers looking nice though.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

397.8 an hour before shot time. Should I test again in an hour or just shoot and then feed?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Test. Always test before the shot. Its a good habit to get into, its good data and you never know when they will surprise you

Maybe not a bounce then. But anyway the lantus is still settling in..
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

A couple of hours after shot and meter reading is 453.6, the highest yet. Seems odd.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Its just the first week still. Could still be a bounce from the other night. and the depot is still building. We just keep going for the week and we can adjust the dose after that.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Literally off the charts this morning. 597.6! Tested twice just to make sure.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

It does sound like he is bouncing. Just to check though - he isnt getting into any dry is he? Dry treats?

Keep checking for ketones.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I did put a few pieces of kibble in a bowl to try to get him to eat more. But when I say a few I mean you can actually count them. So, while he probably did eat some dry stuff, it wasn't a lot. It was a little freaky when the meter couldn't read any higher. Next test is at one.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

no kibble!!! Freeze it. Some cats are very carb sensitive and even a few pieces can spike their blood sugar for over 24 hours.

You want to tempt him to eat more try sprinkling freeze dried chicken or parmesan or oregano on it. or fortiflora.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Last time was a couple of nights ago. Came back negative. I'll try again tonight.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Sounds good. I suspect this is a bounce combined with kibble .. so hopefully it will clear tomorrow. Bounces can last 72 hours and this is a hard one which makes me wonder how low he went on the night of the 27th.

No more kibble. :)

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Nobody does. But its early days and patience is key here. Many cats bounce and gradually the bounces get less so the cat spends more time in normal blues and greens.. and then hopefully.. the bounces stop and the cat goes into remission.

I give my Bailey 5 pieces of kibble and his blood glucose doubles.. and it lasts for over a day.

As long as we dont have ketones then high blood sugar wont hurt him short term.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I tried sprinkling some oregano on some of the food he wouldn't eat. He sniffed it then walked away. Same for the parmesan. I have a feeling no matter what I do he's just going to do things his way. We end up throwing a lot of cat food away.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Wendy asked me to look at Grady's SS and condo. I think there could be several things going on here, not just one cause to kick those numbers into high gear. Here are some possibilities:

1. Grady is very carb sensitive. Dry food can stick around in the digestive system for 24-48 hours or more. Wendy has already suggested that you do not give any more dry food and I concur. We can do a food test later with some higher carb wet food to see how carb sensitive Grady might be. We don't want to do that now because of these high numbers though. Let's leave the food test for later.

2. Fur shot. This morning could have been a fur shot, where all or some of the insulin did not go in. I'm suggesting that because the insulin seemed to have no affect on Grady's BG numbers at +5. One way to check for a fur shot is to run your hand lightly through the fur after the shot and check for any wetness. If you feel that wetness, than either the needle poked through the tent of skin or some leaked out afterwards.

3. Bounce. He bounced from the skipped shot on 7/26 AM AND could have gone lower on 7/28 PM to get a second bounce for that high number for this mornings reading.

4. 7/29 AMPS and +5 could have been a bad test. Whenever you get numbers that do not seem to be in line with what you have been getting, it's always a good idea to get another test within a few minutes to confirm. (I see you did that this AM. Good job!)

5. An infection is kicking in, like a UTI or kidney or teeth or something. That could be causing higher numbers. Wink could shoot up 50-100 points in the first day or two of a UTI/diarrhea episode coming on.

Again, I want to say I think it's a combination of some of these factors, not all, but some. Really difficult to say which ones. No matter. He is too high. We need to get those numbers down, but I'm not sure how low he would drop on an increase and we are still waiting for the bounce to clear.

Please, try really hard to get a Ketone test tonight on Grady. Those high numbers concern me. In combination with his reduced appetite, that is a big concern.

I'd like to see this evenings PMPS but I need to head off to bed early tonight, early morning for me and I won't be able to be on the board in the morning. I would suggest you shoot the 1U tonight if Grady is over 200. Stall, with no food and retest in 30 minutes if he is under 200.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Hello.
I saw Wendy's post asking for input.

on the food....
Is there any way of finding out what the carb % and phosphorous levels of these cat foods are? Natural Choice was his favourite but I don't want to keep giving it to him if it's bad.

http://www.nutro.com/natural-cat-food/n ... tfish.aspx
http://www.nutro.com/natural-cat-food/n ... icken.aspx
http://www.nutro.com/natural-cat-food/n ... r-cod.aspx
Click to expand...

I called Nutro when they changed all their formulas because I liked one of the old ones which is now gone.
They claimed that in this new line, the low carb ones are the senior canned recipes.... they ranged from 1% to 4% carb. There are 4 flavors in existence.
I suspect the adult ones are not low carb.

This might be contributing to the high bgs.


Deb has some good points on possibilities too.

I would suggest that you try to get a +7 or a +8 or +9....in the evening cycle just to get some data to see where Grady's going. Just try to wake up somewhere in the wee hours once and grab a test.
With the little data there is so far ( it's only been a few days , afterall ) it appears that Grady is bouncing from blue numbers..... and goes to the red.....
but then these new blacks.....

there might have been something lower in the missed area. ( that's my personal opinion)
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

547.2, so he has come down. I also thought I had done a fur shot when the numbers didn't go down after insulin and as a matter of course I run my hand across his fur to see if it's wet. It wasn't. I usually go to bed around 1:30 am so I'm able to do a few more tests in the meantime. Thanks for all the input! We only have a few cans of the Nutro and only give them to Grady when he absolutely won't eat anything on the approved list. Good to know only the Seniors are low carb.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Figured out part of the problem. There was an air bubble trapped in the end of the vial. I was wondering why he wasn't reacting to the injections anymore. Because he wasn't being injected with anything except air! As it's such a small amount it's very difficult to differentiate between liquid and air. Now that I know what to look for it won't happen again. He definitely got tonight's shot. I'll test him again in a couple of hours. Should he have any food? He's just sleeping right now. Grady eats about 1.5 - 2 3oz cans of food per day. If we try to give him more he'll just leave half of it behind and then we end up throwing it out.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

The BD syringes are notorious for their bubbles and I find a very uneven level of quality between them. I find using a magnifying glass to look at what's in the syringe helps. When you put the syringe in the Lantus cartridge/vial, make sure you have the plunger pushed in hard. I usually draw out .5 -1 unit extra, then pull the syringe out. I then pull the plunger down a little to form an air pocket at the top, then flick the syringe to dislodge bubbles. Bubbles seem to like to go up to the air pocket. Then depress the plunger to expel the air. Then I take a look with the magnifier to make sure I've gotten rid of all bubbles. If not, pull back the plunger again and flick and repeat until bubble-less.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Reading at +5 388.8 heading in the right direction finally. My issue with the air bubble was with the vial rather than the syringe. I would tip it back and forth to try and dislodge any bubble before sticking the syringe in, but I guess it just stubbornly stuck in the neck where I couldn't see it. This last time I gave the vial a flick and up it popped. Certainly a lot to learn in this ongoing process. It feels like I've been doing this forever already and it hasn't even been a week.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

No thanks. I can only really do that while I'm on my lunch. I can only test before the shot at 8:30am, 1pm when I go home for lunch (maybe around 2pm just before I leave for work again), then any time between 5:30 pm and 1:30 am. Thankfully, I get an hour for lunch and I only live five minutes away.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Ah well.. nice to see some blues though! Hopefully we see some greens soon! How many shots do you think were missed due to the air bubble?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I think it was two shots. I've noted it on the spreadsheet as a reminder of my stupidity.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

It's good to note it, but you aren't stupid. I don't know if I would have guessed it was a trapped air bubble either. Are you using a vial or pens?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

We've got five 3mL vials, so that should last a fairly long time.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Small Vials? I didn't know they came in small vials, just the white flat pack of 5 plastic grey pens, or 10ml glass vial in a white box.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Meter reading 162. Skipped insulin injection. The vials are actually cartridges for an injection pen, but it amounts to the same thing.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Ahahhaha.. I use the pens too and those air bubbles are a pain. Don't inject air into them, as they are designed with pressure that pushes the insulin down.

To get the insulin, first press the plunger of the syringe to expel all air, and keep holding the plunger pressed firmly while inserting into the pen's stopper. Otherwise there is air in the rubber flexible end of the plunger that will get in.

If you do get air in there, turn the pen with the stopper end up in the air and flick till all the air is at the top, then remove with a syringe. Helps a bit.

And watch out when you get towards the end of the pen, as it tends to be mainly air then.

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

It's good to be back! 320.4 this morning. Gave .75 unit shot. Now off to work I go! Yay.
 
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