Update on Jack

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KigerKat

KigerKat

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Today, he is at the vet for his 12 hour blood glucose curve. We still haven't received the blood glucose monitor from my stepsister, so I'm thinking we probably will be purchasing one tonight.

I stopped in to visit him while I was running errands. We are very lucky that our vet is less than a mile away, so popping in has never been a problem. He was sooooo happy to see me, but sad when I left. I'm thinking I probably shouldn't have stopped by, but I wanted to see how he was doing and just couldn't wait until 7 tonight!

The vet tech told me that he has been testing in the 300's, so that part is not good. The part that IS good is that he was originally in the 400's, so we have been able to bring it down a little with his 1 unit/bid. I know he will probably be on a higher dose of insulin this evening, so now we'll really need to watch for any hypo episodes. I've got my Karo syrup and q-tips ready to go, just in case!

The other two kitties have been loving their new wet food dinner and are now on a 50/50 mix, so Jack has had some access to carbs this past week which could also explain why his blood sugar is still high.

And our Bengal's sensitive tummy has not had any issues with the food change, so that's good, too!
 
It is good that his glucose is lower, but I suspect that once he comes home and you can begin testing, you should see a significant drop in his BG levels. Vet stress can significantly raise a cat's BG level as much as 100 or more. If they are dosing him base on his readings at their office, be prepared to reduce the insulin when he gets home or he may possibly become hypoglycemic.
 
Lisa and Witn (GA) said:
It is good that his glucose is lower, but I suspect that once he comes home and you can begin testing, you should see a significant drop in his BG levels. Vet stress can significantly raise a cat's BG level as much as 100 or more. If they are dosing him base on his readings at their office, be prepared to reduce the insulin when he gets home or he may possibly become hypoglycemic.
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This is why we're going to be buying a glucose meter tonight. I didn't sleep well the first couple of nights when he was on insulin, and I doubt I'll sleep well with him being on a higher dose. Like I said earlier, they should be on 100% wet food by Thursday, and I know that will have a lot of impact, so I really want to be able to test him on our own and make sure he's doing well.

He's still pretty tired and lethargic, so I'm thinking his BG is probably higher than it needs to be. Either that, or he might be developing neuropathy. I haven't read too much about that here, because I don't want to overwhelm myself again, but I do plan on asking the vet about it tonight. It just breaks my heart when I get out his favorite toy (a long strip of brightly colored fabric on a stick) and he shows absolutely no interest at all. He normally drags that thing around and drops it at my feet, but not in the past few weeks. :cry: But there have been two nights when the toy mysteriously moved from one room to another, and he's the ONLY cat that will drag it around, so maybe there's still hope!
 
The vet wasn't there when we picked him up on Monday, but I spoke with him yesterday afternoon. He said Jack's curve looked good, but his BG levels were still pretty high. He increased the insulin dosage to 3 units/bid. We started this last night, and already Jack's energy level has increased! He really hasn't been "normal" for a couple of weeks, and now I feel like I've got my good buddy back! He was finally playing with his favorite toy today, even jumping up in the air to catch it and rolling around on his back. He also hasn't spent the entire day under the bed. Even though he naps for about 23.5 hours out of the day, he at least took his naps out in the living room so he could hang out with me. :-D
 
Glucose meter came yesterday!! My stepsister sent us an AlphaTrek system, which is one of the few my vet recommends. I've tried to check his glucose levels a few times today, and I obviously need help!

First, I tried his paw two times. The first stick didn't give me any blood and the second stick gave me the tiniest drop, which was not enough for the meter. I gave him a break and tried again a couple of hours later. Nothing.

Gave him another break, and then gave his ear a try. I think I poked right through it! There was waaayyy too much blood for the meter. He shook his ear and blood went everywhere. I put the testing strip next to the pool of blood on his ear and as soon as it beeped, I quickly folded a paper towel over his ear and gently applied some pressure to stop the bleeding. He was such a trooper! I don't think he even noticed what was going on!! I'm so blessed to have such a cooperative kitty!!

His BG level was 54. I know this is slightly below normal. He had his 3 units of Lantus at 8AM, so according to his curve, this is the time of day it would be the lowest. I have him some Wellness jerky treats after our bloody test, so hopefully that will perk things up a bit.

Does anyone have any tips for our next test? I don't want to bleed the poor guy out!
 
Did you poke with the lancet clicker device or "free-hand"?

I use the clicker device to maintain consistency -- it has "depth settings" for the poke -- for Tiggy, depth 4 works best -- poking but not going through the ear usually. Also - I aim for the edge of the ear -- if you poke too far in, you hit the vein and get a gusher. There is a rim about a millimeter wide -- easiest to see if you use a flashlight
 
Phoebe_Tiggy_NortonGA said:
Did you poke with the lancet clicker device or "free-hand"?

I use the clicker device to maintain consistency -- it has "depth settings" for the poke -- for Tiggy, depth 4 works best -- poking but not going through the ear usually. Also - I aim for the edge of the ear -- if you poke too far in, you hit the vein and get a gusher. There is a rim about a millimeter wide -- easiest to see if you use a flashlight
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I was using the clicker, but I discovered I was using it wrong. It had a clear cap and I didn't see the hole at the end of the cap, so I didn't know I was supposed to put the cap back on after inserting the lancet. I feel so bad that I was using it wrong on my buddy!!

When hubby got home, we tested him again after his dinner, and his BG was at 50. We decided not to give him his insulin tonight and we'll check it again in the morning. Fingers crossed that he's doing well!!

I'm very fortunate to have such a cooperative kitty. It still took us about 7 tries to test his blood tonight! My stepsister told me to use a depth of 1 if we're testing the ear, but it wasn't giving us anything. We finally had some luck when we tried depth 2.
 
Welcome to the Vampire Club! Fantastic that you got a reading. 50 is low for a kitty on insulin, especially if it has been a while since you gave insulin. If he hasn't had insulin, it is a normal non diabetic number. Glad you didn't give insulin. If you hadn't gotten a number and given insulin when he was that low, it could have been very dangerous to your Jack.

We generally urge newbies not to give insulin unless the number is 200 or higher.

What insulin and what dose?
 
[quote="Sue and Oliver (GA)What insulin and what dose?[/quote]

He is on Lantus, at 3 units/bid. This morning, on an empty tummy, his BG was 196. He'll probably be above 200 after his breakfast, so we'll definitely give him some this morning.

Our vet doesn't really want us to micromanage his BG and check it all the time, but I'm really glad we were practicing yesterday and saw what his reading was before his evening dose. I would hate for something to happen to him while we were sleeping and couldn't do anything to help!

He did have a big appetite yesterday, too. I guess that had to do with the fact that his BG was so low most of the day.

We're doing our curve tomorrow and we'll email the results to the vet once we're finished. Maybe he'll have us back down a bit on the dosage. I hope this means Jack is headed in the right direction for a remission!!
 
This is a high starting dose. Our idea is that you start with a low dose and increase slowly. It is easier to add more insulin; it is dangerous if they get too much.

I would urge you not to give 3 units today, even if he is over 200. If I am understanding correctly, you skipped insulin last night? In that case, you still have a very low number after 24 hours with no insulin.
 
Sue and Oliver (GA) said:
This is a high starting dose. Our idea is that you start with a low dose and increase slowly. It is easier to add more insulin; it is dangerous if they get too much.

I would urge you not to give 3 units today, even if he is over 200. If I am understanding correctly, you skipped insulin last night? In that case, you still have a very low number after 24 hours with no insulin.
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He was originally on 1 unit/bid until his curve at the vet this past Monday. The vet increased his dosage to 3 because he was testing in the 300's and 400's all day, with his lowest being about 250. He did explain to me about the "white coat syndrome", which is why he is in favor of home testing, but we didn't have the meter at the time.

We did give him 3 units already, but we'll keep a close eye on him today. We still have some kibble, so I might give him a little bit of that around lunch time, which is when the Lantus will be affecting his BG the most. We'll check again tonight before his dose and consider skipping if it's low like it was last night.

It only took us about 3 tries to get the drop of blood this morning, so I hope we're getting better at it!

Anyone have a BG chart they would like to share or know of a place where I can go to find one?
 
Here is the template. It is working fine for some, but not so well for others so be sure to ask if you have trouble. You need to be signed into Goggle to access it. https://docs.google.com/previewtemplate ... blic&pli=1 Choose "Use this template". It does take a while to load.

I am glad you will be around to keep an eye on him today. The objective is to get 2 doses that you can give 12 hours apart - that is how the insulin works best. If you give too much in the morning and then have to skip the shot in the evening, the insulin is gone and then you need to start all over. Particularly with Lantus which builds up a shed: viewtopic.php?f=9&t=150 The forum for Lantus users has some great info that will help you. viewforum.php?f=9 How to dose, how to store, how it works best in cats, etc. Raising the dose from one unit to 3 units may have been too large an increase. We suggest increasing by only .25 units at a time. And yes, your vet is right about the numbers being higher at the vet. Some cats are 100 points higher - that would have meant Jack was really in the 200s - a nice range for a beginning diabetic. So glad you are testing at home!
 
After discussing it with my husband, we decided to call the vet. He had us take Jack's BG 6 hours after this morning's insulin and call him back. Test shows it was 44. Vet said no insulin tonight or tomorrow morning and to make sure Jack has plenty of food in front of him all day today.

We are supposed to call him again tomorrow evening after testing him to see what he says about the results before giving him any more insulin.

Jack seems okay right now, just tired and hungry. I just gave him an entire 15.5 oz. can of cat food, and he seems to be eating it pretty well. He's not acting hypoglycemic (other than being hungry), so I'm assuming we're okay.

The vet also said there was no need to do a curve tomorrow, since we'll be changing his dosage soon anyway.
 
Lantus can go lower than the +6 number. I would suggest that you test him every 30 minutes or so for awhile to make sure he goes no lower. 44 is in the hypo range. Giving him food is good, but if he goes lower, you might want to intervene with higher carb food or even honey. I would just want to make sure he starts up and doesn't go down any further.

Did you print off the hypo information on the top of this page?
 
Sue asked me to stop by since I tend to spend my time over on the Lantus Board.

I think there are a couple of things that are going on.

First, I completely ignore my vet when she tells me I test too much. I'd urge you to do the same. Vets seem to have the idea that we're torturing our cats. Our cats, on the other hand, seem to figure out that testing = treats/food. I suspect if you were to ask the people here, they'd tell you that not only do their cats cooperate, they will jump to their test spot and purr.

Many cats have considerably higher numbers when they are tested at the vet's office. It's the same with people who experience "white coat hypertension." Instead of high blood pressure, our diabetic cats' blood glucose levels spike. As a result, the dose recommendations based on a curve at the vet's office are way too high. A jump from 1.0 to 3.0u is too much. In all likelihood, your vet has recommended that you speed right past what would be a good dose for Jack. We use a dosing protocol on the Lantus board that has been published in one of the leading veterinary journals. Doses are typically increased in 0.25u amounts. This allows you to safely increase without risking hypoglycemia. I've linked the info on the protocol we use. In that link is another link to the formal version of the protocol from the University of Queensland. You may want to share that with your vet.

It also sounds like Jack had not fully transitioned to canned food when your vet was testing. Many cats' numbers drop significantly once dry food is no longer part of their diet.

Feeding Jack 15 oz. of food is a bit much. When a cat is running in low numbers, you don't want to over feed. You run the risk of scarf-and-barf. Low BG causes a cat to be hungry and they will eat -- a lot. If they overeat, they vomit and you're back to square one.

Instead, if you have a high carb food on hand (something that has gravy -- roasted, sliced, or marinated Fancy Feast varieties, for example), you can give a teaspoon or so of the gravy. Alternatively, adding a few drops of Karo or maple syrup or honey to Jack's regular food will bump up the numbers. You then need to re-test in 15 - 20 min. to make sure you have him out of what could be dangerous territory. This is a post we use on Lantus about managing low numbers.

I really think Jack needs to be on a lower dose of insulin. If this were my cat, I'd go back to the 1.0u since he's now on a far better diet and you're seeing lower numbers. You may want to work his dose up much more gradually.

I do realize it's overwhelming but there is a ton of information in the starred, sticky notes on the Lantus board. Below is an overview of what they contain and links to the stickies.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
 
Thank you so much for all of the detailed information!! The reason our vet doesn't want us to home test too much is because he doesn't want us to obsess over the smallest changes. I can kind of see where he's coming from, but then again, if we weren't practicing last night, then we would not have known how low he was getting. So, I can see the other side, too.

And I had put out a 15 oz. can because we have 2 other cats (one that's an 18 pound Bengal) who get excited about the food, and I was afraid that if I only gave him a spoonful or two that he might lose it to one of the other kitties. They've gotten to be a bit selfish about the new yummy wet food they're eating.

And yes, when Jack went to the vet last Monday for his curve, there was still a little bit of kibble in the mix. They are 100% wet food now, but can definitely see how that could have thrown the numbers off.

He's still doing really well, and he hasn't been eating too much. There's quite a bit of food left, so I probably could have just put out 1/2 a can and been okay. He's sleeping a lot, but we're checking on him often, and when he comes out he will come up to us and rub against us and respond to being petted by purring.

I know we did the right thing last night, but maybe we jumped the gun a bit this morning by giving him his usual dosage. I'm glad my vet is being very responsive and giving us his cell number if anything should go wrong and admitting we need to lower his dosage. This is just further proof that diet has such a strong connection to diabetes. I wish we would have known all of this before.
 
Don't feel bad. No one of us realized it. I feed Science Diet light for years to Oliver, trying to get him to lose weight. When we switched to wet, he gradually lost weight over several months and eventually went into remission. I think the story is that someone associated with the board first made the connection when they fed their cat Thanksgiving turkey and his numbers went down.

Sienne gave you some great resources. Lantus is an insulin that many people have had success with and there have been studies done to establish a protocol that works for many cats.

It is wonderful that your vet is responsive, and open to testing. The most important times to test are before each shot and mid cycle (that 6 hour time). And when you get a low number, it is invaluable to know where they are in terms of blood glucose levels so you can intervene if you need to.

Reading all the information and figuring out how it will work for you is a steep learning curve at first. It was for all of us and we survived - and so did our cats!
 
Thanks, Sue. Everyone here has been so great and helpful! I'm really glad this was the first website that popped up when I googled "feline diabetes" 15 days ago.

Jack is still doing very well, up to 71 BG.

I tried to use the spreadsheet you posted, but I keep getting an error message from Google. I have a gmail account, so I don't know what the problem is.
 
One other thing you can try is to sign on to Google, then google docs, then search for templates, then FDMB spreadsheets. Sometimes that will get you there.

So you are skipping the shot tonight? What does your vet think for tomorrow or does he want you to continue to test and get some data?
 
Nope, that didn't work. I even went to "browse google docs" and search for it, in case there was more than one version. I only came up with 5 results, and this was one of them.

But I had the same trouble with all of them, so it must be a problem with Google. I'll email them for help.

Jack's BG was 164 this morning before his breakfast. No insulin last night or this morning (so we slept in a bit!) and we'll call him tonight after checking his BG before dinner.
 
Okay...that was odd. I went to the main "Google Docs" page, clicked the "Let's Get Started" tab (even though I currently use Google Docs) and now it works. Just as I was posting my question to the help forum, I tried it again so I could quote the error message I was getting, and it worked.

So, maybe if anyone has issues in the future, they might try to go to the Google Docs home page and click the "Let's Get Started" tab at the top.

Thank you!

Now I just need to figure out how to post his spreadsheet in my signature!
 
I think you have the hardest part done. We can't see it, probably because you need to "publish" it. Go back to your copy and make sure it is saved in your favorites. Then go over to the right hand side and pick Share, then publish to the web. When the box comes up, choose start publishing. You should get an URL in the box that has "pub" in the middle. Copy that url and put it in your signature. Then we should be able to see it.

If you already did that, then you might need to go back to your copy. Up by the title, choose "Anyone with the Link".

He is doing great. If you go over to the Lantus forum and post, they can give you ideas about dosage to share with your vet.
 
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