Update on Clover, and a question....

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ShanNClover

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Good morning everyone. Well, I brought Clover home from the vet yesterday. He is STILL not eating on his own. And I have a very hard time force feeding him. I did buy a new glucose meter (yay!) so I was able to check his bg last night, and now this morning. At 7:15 last night, it was 517! So, I gave him 3units. He didn't eat much though. I tested again at 11:15, and it was at 50. So, I force fed him about 10ml of food. I didn't want to give him sugar or anything bc he wasn't acting weird and I didn't want his sugar to spike back up. This morning, (7:00 am) his bg was 101.

Ok, so my question is this, I'm confused as to why we are supposed to test, shoot (or not shoot), feed. Using today's bg would mean that I don't shoot right? But then what if him eating raises his bg alot? It almost would make more sense to feed, test, shoot wouldn't it? Anyone that could answer that, I would really appreciate it. I just want to do everything right. Thanks again!
 
ShanNClover said:
Ok, so my question is this, I'm confused as to why we are supposed to test, shoot (or not shoot), feed. Using today's bg would mean that I don't shoot right? But then what if him eating raises his bg alot? It almost would make more sense to feed, test, shoot wouldn't it? Anyone that could answer that, I would really appreciate it. I just want to do everything right. Thanks again!
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The test, feed, shoot (not test, shoot, feed) sequence developed for two reasons. First, testing a pre-feeding (or fasting) BG level gets you a level that is unaffected by food. Food may only temporarily raise BG levels. Second, we feed before we shoot because in the olden days, most insulins would drop a cat quick and hard, so having food on board was important to counteract the effect of the insulin. That is still the case these days if one is using a "harsh" insulin like Humulin N or some of the intermediate-acting insulins like Caninsulin and PZIs.

You are using 3U PZI. We don't have any history of his BG levels to look at to give you dosing advice. But my shoot-from-the-hip advice is at you don't want to shoot 3U PZI on a fasting 101. See FAQ 4.4.

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.

Lantus and Levemir users: Because Lantus and Levemir are gentler insulins, you may find that these guidelines are stricter than you need. If you have some data on how your cat responds to insulin, please read Jojo and Jill (Team J)'s guidelines at FDMB (http://www.felinediabetes.com/phorum5/r ... 22,1017956).
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Given the incomplete information you are giving us, if Clover were my cat, not eating, and hitting 500+ yesterday and almost hypo numbers at +4 last night on 3U PZI--->I would wait until he got to or near 180 mg/dl, give him a 1U dose, and test alot during the day. But you may have information about his reaction in this situation that we don't have access to that would cause you to make a different decision. This is, ultimately, your decision.
 
ShanNClover said:
Ok, so my question is this, I'm confused as to why we are supposed to test, shoot (or not shoot), feed. Using today's bg would mean that I don't shoot right? But then what if him eating raises his bg alot? It almost would make more sense to feed, test, shoot wouldn't it? Anyone that could answer that, I would really appreciate it. I just want to do everything right. Thanks again!
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Good morning. First of all, welcome to the vampire club and congrats on having your first successful hometests. Second - do not give any insulin this morning.The order you should use is test, feed then shoot. You want to test first to get an accurate BG reading. Because food causes the BG levels to spike as much as 200 points, you want to have an accurate reading of what the BG is like when there is no food in the system.

Next you want to feed. Since right now your cat is not eating normally, you want to make sure there is food in his system so he does not become hypoglycemic.

Last you shoot. For newbies, we recommend not giving insulin if the BG reading is less than 200.

I also recommend that you lower your insulin dose. 3 units appears to be too much since he dropped to 50 in such a short time. Most cats on FDMB get between .5 and 2 units twice a day unless there are other health issues. I suggest you start over at 1 unit and gradually (over a period of a few weeks) increase it until you find the best dose that works. When you increase only do it by 1/2 unit. You do not change your dose from shot to shot based on single BG reading. With most insulins, when you change doses, you want to keep using that dose for at least one week to give the body time to adjust to it. The only exception is if you start getting low readings like you have this morning. Then you want to lower it and try a week at the lower dose. Most likely you have missed your optimal dose.
 
I agree with everything that has been said. Reduce the dose. Test and find out what the insulin is doing.

You do need to get some food into him. By force feeding, do you mean you are using assisted feeding with a tube? If so, here is the yahoo site with some great info: http://pets.groups.yahoo.com/group/Feli ... d-Feeding/ If you are just trying to get him to eat, here are some tips: http://www.felinecrf.org/persuading_cat_to_eat.htm Lots of people here use FortiFlora. It's a probiotic that stimulates many kitties to eat.

Let us know how things are going this morning.
 
Thanks everyone for your help. I did end up skipping his shot this morning. I was able to get him to eat 15ml of food. By force feeding, I am using a syringe and opening his mouth, and squirting the food into the back of his mouth (I don't want to make him choke). He literally wants NOTHING to do with any food. I've tried a few different kinds, warming them up, I've used cat nip, I've offered turkey, and even tried chicken broth....and he just turns away from all of it. I did get him to eat one treat at about 11:00am, but then offered him another one after his afternoon bg test, and he didn't want it. His afternoon bg wasn't good...it was 422 @ 11:30am.
What do I do when I skip a morning shot bc his bg is low, but then get a reading like that in the afternoon? I know I can't just give him a shot whenever his sugar is high.

If anyone has any other suggestions on how to get him to eat...please let me know...I'll try anything!! Thanks again!
 
ShanNClover said:
... If anyone has any other suggestions on how to get him to eat...please let me know...I'll try anything!! Thanks again!
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To help with appetite, any of these alone or in combination may be helpful:

Engage in a bit of play before feeding (normal behavior for a cat in the wild is hunt, catch, eat, groom, sleep!)

An occasional pinch of catnip will perk up some cats and get some playfullness.

Warm up food to make it smellier (closer to freshly killed prey temp).

Higher fat foods may be smellier and thus more appetizing.

Raw foods, such as sliced up or ground chicken (be sure of no added seasonings or broths), warmed (but not cooked)

Canned AD, as a supplement, assists some cats.

Talk with the vet about an appetite stimulant.
 
You need to get him to eat. High numbers and not eating and no insulin is a recipe for disaster. Was he eating before he was diabetic? If so, I would feed him whatever he was eating before, even if it is the deadly dry. He may be feeling especially crummy if he went from the 500s to double digits and then back high again. That certainly can affect appetite. Have you tried the FortiFlora? That is magic for some kitties.

You also need to be testing for ketones. Here's the info: http://www.felinediabetes.com/ketones.htm

You haven't posted in several hours. What is happening now?
 
ShanNClover said:
His afternoon bg wasn't good...it was 422 @ 11:30am.
What do I do when I skip a morning shot bc his bg is low, but then get a reading like that in the afternoon? I know I can't just give him a shot whenever his sugar is high.

If anyone has any other suggestions on how to get him to eat...please let me know...I'll try anything!! Thanks again!
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The spike you saw for the afternoon reading is normal when you end up skipping a dose due to a low BG. Don't get too upset with it. You will find it will come down after the next couple shots to a range you are expecting. When the BG drops too low, the body will try to protect itself and produce extra glucose. We still suggest you lower the next dose back to one unit.

Try sprinkling parmesean cheese on top of the food. Also, as Sue suggested, if he was eating something else before he was diagnosed, give it to him. The important thing is to get him to eat.
 
If he is too low at shot time you can test again in 30mins etc and see if you can shoot then...also you need to give tiny doses so that you aren't getting such huge swings....
 
I tested Clover again at his normal shot/feeding time (7:00ish pm), the meter read Hi...which on the meter I have, means his sugar is over 600. I fed him 15ml of food, and then gave him 3u of insulin. I just re-check his bg at 11:30pm and it was 107. Yay! :) However, he is still not eating on his own. I have literally tried everything! The only thing he has eaten is a few treats. He was diagnosed with diabetes in February, and has been on insulin since then, and this is the first time I've had this problem. As of right now, I plan on getting a hold of my vet (or possibly a different vet) on Monday to figure out how to get him to eat. I have to get him to eat, I can't force feed him everyday like this. It also makes me nervous that something else is wrong with him and that's why he's not eating. Again thank you all for all of your help, and I'll keep you posted!
 
Sorry but did you not read my post? Last time you gave 3 it was too much and your cat is rebounding! You are reacting to a trebound number and putting your cat on a rollercoaster...
 
We are really concerned that you are giving Clover a lot of insulin on an almost empty stomach and seeing some low numbers. We are concerned about potential hypo.

To a person, we have all suggested you reduce the dose to one unit at least until Clover is eating. Then you can adjust up, if you need to.

Go get some FortiFlora. You can find it usually at the vet at PetSmart. Continue with your syringe feeding. See if he will eat off your finger - sometimes that works. Make a vet appointment for Monday and ask for a appetite stimulant and maybe a feeding tube.

This whole scenario has led to other cats dying. They have to eat if they are diabetic. and while they aren't eating very much, you need to be very careful with their insulin doses.
 
Jen- I did read your last post, however, since his sugar was so high, and since I was able to get Clover to eat more, I figured 3u would be ok. And since when I re-checked at 11:30, 4 1/2 hours later, it was at 107, I'm assuming it wasn't too much that time. I did end up reducing his dose this morning. His bg was 293, i got him to eat about the same amount of food as last night (15ish ml), plus a few treats that he ate on his own, and then gave 2 1/2 units of insulin. I retested 4 1/2 hours later, and his bg was 113. This evening, I reduced even more. His bg was 260 at 6:30, didn't get him to eat quite as much as earlier, and reduced his insulin to just under 2 units. I'm going to call the vet tomorrow because I am now concerned about the fact that Clover has not had a bowel movement since he's been home (since fri. afternoon). Granted, he is not eating a lot, but I would think he would have gone at least once by now. I'm now worried about some kind of blockage. He is starting to eat a little more on his own, but not what he needs to, that's why I'm still force feeding him. I'll keep you all posted, and thanks again! :)
 
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