Tentative Diagnosis of Diabetes Mellitus & Kidney Disease

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Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Reading went up to 320.4 at +2. It was Amie's first turn at giving Grady his insulin. Everything looked fine. I held the skin while she put the needle in and injected the insulin. But you know how the stuff has a very strong scent? I could smell it afterwards, when usually I can't, so now I don't know if he actually got his shot or not. It's not like you can give him another one "just in case". We'll do another test later on and wait for the morning shot, I guess.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

+4 reading at 235.8, so it came down quite a bit over the next two hours. Still don't know why it went up at +2
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Could have gone right through and given a fur shot. I always touch to make sure it hasn't gone all the way through and then again after to check for wetness and sniff my finger.

Some cats get a food spike at +2. But in this case it looks like its just within meter error.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Are you able to get some spot checks in this weekend to fill in the data a bit?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Thanks, more tests to fill in the gaps on the SS are always appreciated. We know how tough this can be to fit into your life.

Hoping to get a better handle on the dose for your kitty.

Sending some {{{{{hugs}}}}} and de-stress vines your way. Hang in there.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Yup, it's a long weekend here. 212 at +9. Been out most of the day. Got some freeze dried chicken. He does not seem interested. He's turned his nose up at pretty much every treat I've ever tried, with the exception of process cheese slices.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Since we were running low on meter strips, my wife popped out on Friday and picked up a package of 50 from a pharmacy in our neighbourhood. They were approximately a dollar each. Does anyone know of a less expensive source for these strips?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Nope, still no meter. I'm thinking their estimate of 4-6 weeks was probably accurate.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Must have changed it because when I ordered mine and a few friends did a year ago, it came by purolator in a few weeks.

So far things are looking good with this dose but we may need to practice shooting low soon.. It's something all newbies need to learn to do, shoot low to stay low if you want to get good control or remission.

Read up on this http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

And next time he has a low preshot under 200, stall. Don't feed or shoot, and come on here and start a new thread with a 911 so you catch our attention and we will come and advise. We will help you shoot at a lower number safely.

Meanwhile let's give this dose a little longer and revaluate.
Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Pretty good day Saturday. Numbers were in the 200s or less for most of it.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Great numbers - looks like the dose is working well so far. Now we want some greens please. If we dont see any greens by end tomorrow we may increase 1/4 unit - but can you get some more tests in today and tomorrow we want to be sure he isnt dropping low and you are missing it. Like last night at +4 he was 157 - after that I would have tested every hour or two to see if he dropped further.

Tomorrow also can I suggest a AMPS +3 and +5?

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I will try my best. That +4 was at 12:30 am and I was feeling pretty wiped, nodding in and out of consciousness on the couch. I'll see if I can get more data to analyze.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Caught the lowest reading at 2:30 in the morning at 146. So very tired.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Note on naps!

The human sleep cycle is about 45 minutes.
If you try to wake in the middle of a sleep cycle, it is usually more difficult to do and you may feel pretty crappy.
If you try to wake at the end of a sleep cycle, it is usually easier to do, plus you may actually feel somewhat rested.

Thus, if you need to nap between tests (or whatever), make it a multiple of 45 minutes.
Ex
1.50 hours
2.25 hours
3.00 hours
Etc.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Great job! Today an amps+3 would be good as well as your usual preshots. If he doesn't dip into green today then its 1 unit starting tomorrow.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Got the AMPS +3 and +5. Down to 155 in the afternoon.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Ok great! Now tomorrow morning I am thinking a dose increase will be needed to 1 unit unless you see a green today. However I am going to recommend at this point you transition over to the Tight Regulation Board. http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Reason I suggest this is that they are more experienced on that board around dosing and will help you maintain momentum, plus there is a great sense of community. I myself post there every couple of days for my 2 cats for them to keep an eye on them. As long as you post every day or two they will continue to watch your cat, and advise where needed.. esp if you have a question! You are doing a great job with Grady and they will help keep things on track, esp if/when you start to get into lower numbers. I will continue to check on you too.

Here’s how to post:
Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report, or the home you live in and the cat trees some people have)

Subject line: The subject has the date/cats name and BG readings ie 06/23 CATname AMPS 400 +2 333 + 5 224. You add a ? icon if you have a question. You should update your subject line in the very first post for the day as you get a reading, or whenever you have a question. For your first post put "newbie" also in your subject so everyone can welcome you!

Contents: The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today CATname was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?

There is no rush to post there. I like to suggest that people go over to their insulin specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. Get a feel for how the forum works. See if you think it would be a good fit for you.

But you are always welcome to post here in the Feline Health forum for as long as you want.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Hi all.

Wow, the group has been just awesome with the replies on this matter. If I didn't thank all of you enough when I was a newbie, I'm thanking you now on behalf of all newbies.

Anyway, due to the differences between Canadian and U.S. values, I thought this website would be very helpful in this case (I will also post this separately):

http://dwjay.tripod.com/conversion.html

In has been an invaluable tool for me, as I am from the U.S., and I am now living part of the time in Canada. So, it is the only way I can decipher Sarah's labs here.

The site contains just about anything you can imagine from a lab, including glucose. So, that reading of 21mmol/L was U.S. 378 mg/ml

Now for the good news. Your kitty can still have a long life, but it will take effort on your part. Sarah just celebrated her 16th birthday a month ago. She has been CKD for a solid two years now and diabetic for 10 months. She has never crashed and still screams at me for meals. But, she does require a lot of my time.

Okay, now for the other portion: ckd in conjunction with diabetes. I’m sorry this is so long, but I didn’t see anyone providing information on this opposing combination of dietary problems.

Did I miss kitty's phosphorus lab value? EXTREMELY important here, especially when deciding which foods to feed. Also, I didn’t see a Urea/BUN value.

VERY good that you got kitty off of k/d - I'm fairly certain that is why my cat now has diabetes (the CKD was first). Her pancreas is totally shot, so she will always be on insulin. If you can, I highly recommend getting an fPL or ultrasound to determine your kitty's pancreas health, because that will give you an idea of your future and if diet and insulin will ever get kitty off the juice at some point. I’m really glad that I know, because I would be very frustrated she is still on insulin if I had any hope otherwise.

Next, with multiple vets' approval, I am feeding 1/2 Hill's m/d (diabetic) and 1/2 Royal Canin Renal LP (not the gravy flavor). The combination cuts down on the fat and carbs of the renal diet, while Sarah benefits from the additional nutrients included in the renal diet. The Hill's m/d has the lowest phosphorus content of just about any non-renal food out there. You really want a canned food with < .5% on a dry matter basis. The m/d is .69% and the Royal Canin is .47%. So, we are just slightly higher at .58%. Sarah’s phosphorus has always remained excellent. You can use phosphorus binders, but they are not without their side effects.

Whatever you do, do not go back to dry food. Not only will it be higher in carbs/sugars, but it is very hard on kidney cats who need every ounce of moisture they can get. The other good news with the m/d is it is so that Sarah does not turn up her nose at the Royal Canin, and I can mix all of her meds in there without pilling.

Treats: I give Sarah a very small chunk of skinless chicken breast as a treat, and she goes nuts for it. I cut up a chicken breast and place about six tiny cubes in a snack size zip lock. I do this for as many chucks that I have, place one bag in the fridge and the rest in the freezer. When I am down to three chunks, I remove a bag from the freezer and place it in the refrigerator for the future. Due to the kidneys, no more than two chunks a day so you don’t overdo the protein.

Next, I know it’s another expense, but it is very important that you get kitty’s blood pressure checked. A mobile vet is your best bet, because a trip to the vet always raises the value. If your cat has high blood pressure (which is very common with CKD), it is important to start meds asap. Not dealing with it can cause blindness and/or heart muscle damage. It can also cause glaucoma.

Your kitty’s creatinine value is indeed high. It could be a sign of high protein in the diet and/or dehydration. You can test yourself by making a skin tent by pulling up kitty’s scruff about the shoulders. If it goes back down slowly, check the gums for moisture. If not wet, kitty is dehydrated and probably would benefit from subcutaneous fluids. Yes, I know, another thing to worry about, but it will save your cat’s life in the long-run. Adding water to the wet food will indeed help, but with a creatinine that high, if I were you, I would talk to my vet about sub-q’s asap.

Other things to keep a close eye on: potassium levels. Too low will cause kitty to walk on the back hocks. Too high will do the same. Yes, I know, ugh. Also diabetic neuropathy will cause the same behavior and a very weak back end.

Hang in there. I know this is all so overwhelming, especially with multiple issues.

If you want to email me privately, please do so. I am now on the Sunshine Coast, and if it will help you, I’d be happy to talk with you by phone.

Hugs, DZ and Sarah
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Wow, that was all a little overwhelming. I never received Grady's phosphorous number or his Urea/BUN values. They just told me his glucose level (324), his creatinine level (278) and that his sodium and chloride levels were low. It was over the phone at my place of work so I was just frantically writing things down as they were thrown at me. His scruff does go down after being pulled up and his gums look wet. He was at the vet last weekend giving a urine sample for a culture, which came back negative, and they didn't mention anything about him looking dehydrated. Before the diagnosis he was on a higher protein diet, both wet and dry, trying to get him away from the crappy kinds of food. Now he only eats the wet food that is 5% or less in carbs and less than 250 in phosphorous. He absolutely hates water added to his food. Doesn't matter if it's straight from the tap or distilled, he just walks away. I've read so many negative things about Hills Prescription Diet foods I've steered well clear of them. Not only does Grady not like them, along with Royal Canin, they are quite expensive and only available at the vet's. The vet did recommend getting his blood pressure taken, so I might get that taken care of next weekend. Now next I have to find a way to tell the vet I didn't follow her dosage instructions (1.5 units) when they ask for his numbers. Thanks for all the great advice and support!

Last reading 241 at AMPS +11. Looks like I won't be shooting low tonight.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Just show the vet your spreadsheet and bring the meter with you. If your vet is good he will see the dose and be happy with the readings.. Although most vets don't like under 200 though but their goal isn't remission..
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

Jumped up to 1 unit this morning. All seemed to go well.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

250 AMPS to 313 at +5 at new 1 unit dosage. Don't know why the spike in numbers. The injection definitely took this morning (no fur shot). I think my wife may have fed him shortly before I got home for lunch, but it would've only been the BFF Tuna & Salmon.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I am thinking he could be bouncing off a middle of the night low. If it is a bounce he will come back down.But it also means he may have gone green last night drat it and we missed it.

Did you get a chance to look at the other board?

Wendy
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I have migrated over there and posted a couple of times. One thing that's been nagging me is food scheduling. I'm really at a loss as to when I should be feeding Grady in relation to when I'm taking meter readings and giving him his insulin. Right now it's kind of all over the place with the exception of shot time, where he does not get food two hours prior but immediately following. Other than that there's no specific feeding times. Is there something I should be doing regarding feeding times and ear poking times?
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

With a depot insulin like Lantus, test, feed, & shoot at AM & PM preshot tests, within about 15 minutes

Unless dealing with a possible hypo, pick up food at +10 so there are 2 hours food free before your pre-shot tests.

Mini-meals may be done, or freezing some and putting out to be nibbled as it thaws, or using a timed feeder help reduce the impact of food on glucose levels. If your cat will graze, you may put out all the food at one time - it won't hurt him.

Test around bedtime to see if anything looks like it needs attention before you go to bed. Sometimes you'll get a surprising drop and need to stay up and monitor.

Test around nadir - 5-7 hours post shot - when possible, as that is when the lowest values will often happen

A full curve - testing every 2 hours from pre-shot to pre-shot - is helpful in observing the full response to Lantus.

A mini-curve - testing every 3 hours from pre-shot to pre-shot - is also helpful when you don't as much data.

Whenever <50, its test, feed 2 teaspoons gravy, 30 min wait, repeat, until numbers are safe.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

I've just been reading some of the posts on here about how and where to inject the insulin and it seems a little different from what the vet tech showed us. She demonstrated by pinching the skin between the shoulder blades and exposing skin between the thumb and forefinger, then insert the needle, draw back slightly to make sure there's no blood, and inject. Now I'm reading that a possibly better location for absorption of the insulin is along the flank. And from the videos I've been watching, I'm supposed to be making a tent and injecting into the front wall rather than between my fingers. Also, lumps in the form of scar tissue may form around the scruff after too many injections. I haven't been able to find any flank injection videos, but I might give this a try at the next shot.
 
Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

You are using the bd ultra fine ii 5/16" syringes?

You don't need to aspirate (pull back to check for blood) since the needle is so short and you are ensuring your are shooting into skin with that technique (or tenting). Just pull the skin up to form a tent, or pinch it like you have been doing and inject at a shallow angle to the body. The goal really is to inject under the skin.

You can certainly use the scruff but many of us rotate sites to avoid scar tissue etc.. So I do scruff and upper and lower flanks on each side. See here http://www.bd.com/ca/diabetes/english/page.aspx?cat=14501&id=14874
 
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