Warren - 5/29/2000 - 7/1/2016 rest in peace my furry friend

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I haven't yet as I'm almost certain this is not behavioral, but it's on my just in case backup plan. It seems to be priced pretty competitively though.
 
It's a little high, but usually when it works, people are able to gradually switch out the Cat Attract and start adding in their old litter.

His numbers today look much better too....sure hope he doesn't bounce from going so low, but it sure wouldn't surprise me
 
I second the "cat attract". Our older female cat was peeing daily for months on a few spots on the throw rugs. No physical issues, so vet said it might be behavior. Blocked off her "favorite areas" and added the cat attract, and it was magical. She hasn't had an accident since. Older cats lose their sense of smell and get confused I think.

Worth every penny! Amazon has it for cheaper than local places.
 
I meant to write a positive update earlier today but I didn't get around to it. Unfortunately now I can't. Warren is just wrapping up his second week of clavimox, he also has a Feliway collar now and cat attract litter. His diabetes still isn't regulated but overall the trends have definitely been improving. I've been letting him out of the bathroom during the day for the past few days and he was doing well. I left him out overnight last night and also no issue. However today he peed in the kitchen again (once again 5 feet away from the litter box with the cat attract). I think I will have to go the cytocentesis route to see if he has an infection that the clavimox hasn't addressed.
 
Can you move the litterbox over to where he is peeing and see if he goes in it or just picks another spot beside it to pee? If he goes in it, you can get him accustomed to using it there where he wants to pee, the very slowly start to move it back to where you want it. A poorly placed litter box is better than him going on the floor (I have 2 boxes in my dining room 'cause that is where they wanted to pee).

There is also a Dr Elseys for Seniors. Its like a pulverized crystal. It is more costly that the attract even, but seemed to lure my senior peer into the box more.
 
You have to take your victories where you can get them sometimes.....not peeing on the floor for several days was better than doing it several times a day!

Hopefully you'll figure out what's going on soon and he'll be back to doing his business where he should. I agree that it might be worth having the litter box in the way for a little while so it's right where he's peeing and then scooting it back a little at a time
 
Tomorrow will be 7 days Warren has been off clavimox, so the plan is to have a cysto done tomorrow with a culture and sensitivity. He's been living in the bathroom the past week other than when he's willing to sit on my lap in the evening while I watch some TV.

His blood sugar has improved but not regulated.

I feel bad for the guy, he is so excited when one of us comes to use the bathroom. At least he has a window to sit in. Hopefully we learn something useful from the results.
 
His numbers definitely look more consistent on the spreadsheet - I don't see any black in the last 2 weeks, which is always good! :)

I really hope you're able to get some useful information from the culture and sensitivity tests - hopefully then he can get out of the bathroom a bit more.

The one thing I do see is that it looks as though he's bouncing on some cycles and with only pre-shot tests to work from, it's difficult to know if he might be dropping low sometimes which might be causing the bouncing (I'm looking at 6/10, 6/12 and 6/14 where he was fairly low at one of his preshot tests for the day and wondering how low he might have gone mid-cycle). Is there any way you can get some mid-cycle tests to get an idea of where he's getting to at his lowest point?
 
It's true, no black is GREAT news. He sometimes bounces when I give him one unit. It's a challenge because .75 (Approx) doesn't seem to be enough, but 1.0 can push him too low. There was only a single instance where less than 1 unit pushed him low and perhaps I made a dosage error (which is easy enough to do as the difference in the syringe between 0.75 and 1.0 is less than 1mm). As you rightly point out though, some of those readings could have been even lower as his nadir is usually around the 9 hour mark and the measurements are taken at around 12 hours.

As the protocols outlined here weren't working after many weeks, I developed my own protocol and it seems to be working better. It looks something like this.
If his AMPS/PMPS is:
>275 - 1 unit
100-275 - 0.75
50-100 - 0.5
<50 - wait

Actually I just made that up. When comparing it to the spreadsheet, I'm more aggressive. I should nail that down to a set of consistent rules, but that's the general idea. The nadir takes so long for Warren (7-9 hours), I'm not worried about shooting him when he's low.

I'm also looking at replacing the glucose meter as even when he hit 42 the other day (and may have been lower earlier), he was 100% perfectly normal. I wouldn't expect that.

We're headed out on vacation in a couple of weeks, and whomever we find to care for him while we're gone won't be doing any testing, so I'll pre-measure out a bunch of 0.75 doses for the week we're away.
 
We don't recommend pre-filling syringes.....what you might want to do instead is fill a syringe to where you want the dose to be with some kind of colored liquid so your petsitter has something to compare to

It's also way too soon to decide on a vacation dose...these kitties can really surprise us in a short period of time!

I see you're making up your own dosing scale too. Lantus really doesn't work well on a sliding scale. It needs to be a consistent dose, and if you'll get at least 1 test in mid-cycle during the day (if you can) and ALWAYS a "before bed" test at night, it'll really help us to help advise you on when to increase the dose.

If you absolutely can't get mid-cycle tests during the week, it's even more important for you to get more tests on weekends so we really see what the dose is doing for Warren

The protocols we use here are already very aggressive but if they're followed, they're also very safe and more importantly, they work well. I know it SEEMS that when his numbers are higher, you should give a higher dose, but if you don't understand why they're higher, that can be very dangerous...and it's also just not how Lantus works

If Warren were my kitty, I'd give him .75 every 12 hours, and get at least the 4 tests in we like to see (the 2 pre-shot tests, and the mid-cycle and before bed test) and hold that dose for at least 6 cycles and then let's see where he's at.

The people here really have a lot of experience "reading" spreadsheets, so please let us help you to help Warren
 
Thanks Chris, it's been a challenge. I've gotten a lot of inconsistent dosing advice from people looking at the chart from these forums and there have been a few occasions where dose changes were recommended so I followed that recommendation. But then found I needed to change back. Earlier in the chart you'll see there was a pretty consistent period of 0.75 with much more frequent readings taken. But I also have a problem with measuring 0.75, there is no way to accurately do it which is a bit of a frustration for me since it makes it impossible to give a consistent dose. I can get mid-day readings (I work from home), but I just didn't want to keep prodding his ears any more than necessary and nobody that was helping me was asking for those readings even though I was offering to take them.

And I certainly wouldn't trust someone else to measure my cat's dose when even I have difficulty at measuring. I'd hate an inexperienced person to come to my house, shoot my cat in the AM, accidentally give him a few units and nobody would be around to check on him for 12 hours. I guess I could check with the vet when I'm there tomorrow and see if any vet-tech's want to make a few extra $$. Boarding is cost prohibitive, so pre-measure for a sitter or possibly a vet-tech are my options. Or no insulin for a week, but IMO that's not a real option. What is the issue with pre-filling? WebMD doesn't seem to have an issue with it for humans. http://www.webmd.com/diabetes/tc/storing-insulin-and-prefilling-syringes-topic-overview
 
Lantus has a proven protocol that we use here called "Tight Regulation Protocol". If you have Warren on low carb food (the Fancy Feasts) and can get at least those 4 tests in every day, if you follow the protocol, you'll start to see results, but every cat is different so we can't say at what point Warren will really start to show a lot of progress. We can only tell you that the protocol works!

It's important that you post daily (if you can) and let those people with experience help to advise you. I see some days where he went low, and then bounced, so you have to learn when that's happening and when you just have to ignore those high numbers and when he really needs a dose increase.

Doses can really change quickly, especially when you finally hit that "breakthrough" dose and they can start coming back down the dose ladder very quickly...that's why it's way too soon to think about what he might need a few weeks from now.

The manufactures of Lantus say it's not recommended to pre-fill syringes
Aventis Pharmaceuticals does not recommend prefilling syringes with Lantus and storing for any period longer than needed for application. In addition BD states the following (9): “BD does not recommend that any of our syringes be prefilled more than a few minutes in advance of the injection. There are no conclusive studies to determine the safety or risks associated with this practice.
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Warren I have same problem and will try stuff like cat attract litter .
My Foxie was fantastic for 15 years so i now its not her fault
My Husband love her as much as I do so my situation is much easier,but I'm exhausted .
We do not restrict her movements
I think that may add to your cat stress
I hope things improve for us all
It's not easy for sure
 
Thanks for the references above. Waiting for his cysto results. Hopefully Monday. I've gone back to a .75 dose 100% of the time again. Ill try to get in those 4 reading a day after my hand heals (surgery today).
 
Ro
robr said:
Thanks for the references above. Waiting for his cysto results. Hopefully Monday. I've gone back to a .75 dose 100% of the time again. Ill try to get in those 4 reading a day after my hand heals (surgery today).[
Rob
Good luck with your hand and Warren
My Foxie seems better,but still pee on the floor.
She knows how lucky she is.
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Glad you got the cystocentesis done. Hopefully that will help get the right antibiotic for warren.

There are a couple of points that I haven't seen anyone address yet.

I think it's helpful to understand how Lantus works. It's a depot insulin, so when you inject, some goes to work immediately and some builds up in the body and slow releases. The size of the depot is related to the size of the dose. When you increase a dose, it can take a few cycles for the depot to build up. When you decrease a dose, the larger depot can take as long as 6 cycles to reduce to match the new smaller dose. During that time, the old size depot can continue to "give" and lower blood sugar.

That's why changing a dose too often, like with a sliding scale, can work against you. To see what the current dose can do, you want the dose and depot to be settled in. Think of it as needing a calm lake to evaluate the dose, and changing the dose too often is like rocking the boat.

Here's a good description of how it works. http://www.diabetesclinic.ca/en/diab/2treat/lantus_vs_levemir.htm

Lantus dosing is based upon how LOW a dose will cause the cat to go. It can be hard to change after you learned on vetsulin, which isnt a depot insulin, but lantus dosing isn't usually adjusted based upon the preshot test, unless it's too low to shoot. With lantus, it's really important to get some midcycle tests in so you know how low he's going. Sometimes high numbers are caused by bouncing from low numbers.

If you could add on 1 more test per day, it would tell a lot about what's going on with him. Doesn't have to be at a particular time, just sometime between the shots. If you imagine the spreadsheet as a jigsaw puzzle, getting a sprinkling of tests throughout the spreadsheet will help reveal more than a stripe down the middle. What you have with preshot tests are sort of like having the edge pieces of the puzzle without anything in the middle.

You commented about the meter and him getting to 40's...Lantus is gentle and he may very well have been in the 40's without hypo symptoms. That's not at all uncommon in the Lantus ISG. You don't want him thete, but i wouldn't assume your meter was wrong.

If he gets another antibiotic you might want to get a probiotic to prevent diarrhea. Most cats like Fortiflora. You just sprinkle it on their food. It's available only from vets or online.

Anyway, I've written you a book, but hopefully some of it will help you help Warren. Keep asking questions! There is a wealth of experience on here and people will keep helping you.

Hang in there!
 
I appreciate people that write books, im generally verbose myself :). thatnks for all the info. warrens #s have gone up the past few days, could be a bounce but usually they last around 24-48 hours. will just keep with .75 for now again and await results of the cysto and plan on more readings when i have 2 hands again
 
So Warren has not had a good past 2 days for some reason with his glucose levels. He didn't see 500s for about a month then the past 2 days ... 500s. It doesn't look like a bounce. Though I don't have nadir readings from the prior days, I don't think his preshot readings were low enough. If you look at his bounce history, all his pre-shot readings are EXTREMELY low. The lowest reading I have just prior is 199. I've also just been giving him 0.75 dose now for the past 11 days.

We let him out of the bathroom about 10 days ago, no peeing in the kitchen until today, but I think that's because his glucose levels are so high.

His cysto was negative BTW. $200 for telling me he doesn't have an infection. Do they still need to do a culture and sensitivity if the results are negative? Just wondering if I paid for a test that they didn't have to do.

We are off on vacation starting mid next week, so we'll have a period of no readings while the cat sitter takes over.
 
robr said:
His cysto was negative BTW. $200 for telling me he doesn't have an infection. Do they still need to do a culture and sensitivity if the results are negative?
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Just what did they do for the $200? That much should cover obtaining the urine sample, doing a dipstick test, looking a the urine setemeint under a microscope and sending the urine to a lab for a culture and sensitivity test.
 
Larry and Kitties said:
Just what did they do for the $200? That much should cover obtaining the urine sample, doing a dipstick test, looking a the urine setemeint under a microscope and sending the urine to a lab for a culture and sensitivity test.
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I was wondering exactly the same thing as Larry! :eek::eek: I just had a the same thing done for my Tiger yesterday, including C & S, my bill was $140! I would want to see a bill breakdown if I were you!
 
It was $200 for the cysto, office visit, etc. I guess my question was, do they first do a test to determine if there is bacteria, and if bacteria is found, THEN do the culture and sensitivity? They told me the C&S was a much more expensive test than the previous testing I had done (which was test for bacteria from a sample I brought, but no C&S). Ie, did I pay for testing that isn't done once it is determined there was no need after seeing no bacteria present.

Anyway, I'm not that worried about it at this point, but just curious.

In other news....... My wife is losing it because Warren peed in the kitchen again. She believes (and I can't entirely disagree) than the Lantus simply isn't working out. It's been 2+ months and he isn't even close to showing signs of regulation. I switched to Lantus because the vetsulin (which used to work before he went into remission) was no longer working after his relapse, but it turned out he had a UTI working against him which we didn't know at the time. While we're on vacation, she wants him locked in the bathroom 24/7 as our cat sitter should not have to deal with cleaning up pee. She wants me to switch him back to the vetsulin immediately and see how that goes so we have enough data before our vacation to decide which insulin to use.
 
That seems reasonable with a C&S. Frequently bacteria is not found is not found in the sample and thus is a UTI is really suspected then a C&S is in order. It also depends upn what else the vet's analysis of the urine showed? Do you have a copy of the results?
 
Any thoughts before I transition him back to vetsulin? Or the best way to go about that transition? Given there is a depot for Lantus, I imagine I'd want to start with a low dose at first.
 
I don't know that I would switch back to Vetsulin. It looks to me like Warren may be dropping low and then bouncing. If you look at 6/25, he started off at 199 at AMPS but by PMPS he was up in the 500s. With no mid-cycle data, we can't be sure of course but that looks to me like he might have dropped into green and then bounced. As bounces can last up to 6 cycles, it's quite possible that he's still bouncing now. If there's any way you can get some mid-cycle tests in, that would really help to figure out what's going on with him. It wouldn't surprise me too much if he'd earned a reduction somewhere between 6/16 and 6/21 as he had some fairly low pre-shots in there...if those were rising numbers, then it's quite possible he might have been under 50 at mid-cycle. And as too much insulin can look like not enough, maybe what he really needs right now is a slightly smaller dose of Lantus to flatten those cycles out. As his accidents only seem to happen when he's in the 500s, flattening the cycles might well help in getting him to use the litter box instead of the floor.
 
I get my stitches out Monday but will try to get some more #s and stay with the Lantus. Just getting exhausted from fighting my wife. She's lost all patience with trying to work Warren through this and I can't take much more of the stress.
 
Would she be prepared to talk to any of us on here? Whether by joining the site herself or by using your login? That way maybe we could talk her through the different types of insulin and why, for most cats, Lantus is a better choice than Vetsulin.

I completely understand why you haven't been able to get mid-cycle tests with stitches. Hopefully you'll be feeling better soon and will be able to get a few more numbers for us all to look at so we can try and help you more. :)
 
Hi Rob I wish I had great advice for you about Warren but I don't. I feel for you in your situation with your wife. Of course, I have no idea about your relationship but I can understand how stressful it must be to basically be asked to choose between them.

Not sure how long you have been married, or what your relationship is like (and none of my business!) but in many relationships, what seems like the obvious issue actually has something else behind it. I'm wondering if she might feel a bit threatened by all the attention you are focusing on Warren. Stranger things have happened. Did she just tolerate Warren before he got sick, or did she have any affection for him? Who does the cleaning up when he eliminates where he shouldn't? I'm sure the stress in the household only makes it worse for Warren, perhaps creating a vicious circle, or at least contributing to it.

I'm sure your wife must love you and have some regard for your feelings for Warren, and surely she must understand on some level that if she pressures you to have him put to sleep against your wishes it may have long-term consequences to your relationship; likewise, I'm sure she's feeling like you are picking Warren over her. Resentment will build in either scenario. Perhaps you can soften her position - not sure what your fights are like, or what is said, but perhaps you could disarm her. If you haven't already, tell her how much you love her, how much you need her support in this and what it means to you, that it's not forever, and how much you appreciate her on your side. That of course she is more important in the grand scheme of things, but for right now, you need to do this and ask, would she help you? Might work to lessen the tension. Just a thought!
 
Thanks for the advice. Warren was also her baby until we had children (they are now 9 and 10). Once we had kids, Warren no longer held that place in her heart. We have four cats, she loves three of them, but not so much Warren. Meanwhile, Warren is my baby. We used to be a foster home for the local shelter and have had Warren since he was 2 weeks old. He lives in my lap, the other cats don't give a rats ass about me.... I love them, but I'd trade them all in to keep Warren :). She wants the house to remain how it always was before Warren's recent issues. Clean, everything in it's place and she wants the litter box we've put in the bathroom downstairs gone. We also don't have tons of extra $$, so the $$ I've spent on Warren (probably close to $1000 at this point) she sees as taking money away from the kids and family. Logically she is correct. Emotionally, I don't care because diabetes is 100% treatable. There is no reason I shouldn't be able to get him regulated and restore things back to normal. But the 'chaos' has been ongoing now for 3 months (1 month of vetsulin and 2 months of lantus) and she doesn't want to keep going indefinitely. I've tried to explain to her what's going on, what bounces are, but in her mind she thinks I'm making excuses for him. If I didn't think there was hope things could return to 'normal', then I'd give up, but I don't see any reason at all why things can't be that way. I just don't know how long it's going to take. Which I think frustrates her more than anything. This definitely isn't a who's getting the attention thing. It's a cat litter and pee in the bathroom/washer/dryer area and kitchen thing as well as a $$$ thing.
 
Thanks for the clarification. I just don't know what to say. :nailbiting: I don't know how to un-love a cat and I don't know how another person could ask me to choose between them and my pets. Actually, I do… he was kicked to the curb and my pets are still with me :D. Not feasible in your situation and I feel for you!!!
 
I'm sorry too
My husband is very supportive
Your poor cat is sick and like my Foxie
It's not his fault .
It's too months now and for the first 3 days she went to the litter box
Ask your wife what if she become sick
And pee in her bed.
I don't want to sound inconsiderate but imagine Warren locked up in the bathroom
While you are gone.
I try litter atract and Foxie likes it
Good luck
 
@robr if you have not taken Liliana's advice I strongly suggest it. The cat attract cat litter from Dr Elsey really works to get the cat back in the box. I had a cat that had a really bad UTI and that litter was the saving grace as he was peeing everywhere until I tried it. Now you could still have a issue with the rug going forward as that is one thing I cannot get past with this one kitty. I cannot put a rug in my hall bathroom of any kind as he will to this day pee on it. Not sure why but he does. We took him in out of the street when his owner kicked him to the curb in the middle of winter because they had a kid and he wanted to sleep in the baby's bed. So we do not know if he was confined to a bathroom for a while or what, but I have tried pretty much any material they make bathroom rugs out of and he will pee on them, but only in the hall bathroom as stated. I have the same rugs in my master bath and he has never gone there. Could be Warren now has an association with the kitchen rug. I know it sounds strange but it is at least worth trying, remove the rug and see what happens.
 
Moving him back to .75. He seems to be in the 200-300s most of the time at 0.5. This is so frustrating. He also has diarrhea all the time. Poor guy :(
 
Is the diarrhea a new symptom? What does the vet say?
Giving a teaspoon of plain pumpkin may help give it some form.
 
I'm sorry for your poor kitty,my Foxie is not doing well either.
I'm beginning to think that I'm just pretending that she is better and the reality is that her life is horrible.
Always thirsty and hungry and dirty,she is peeing on the floor again.
If she could talk I bet she will tell me she has had enough .
 
@Liliana Treeman ...before you think on it too much, please start posting daily, get our spreadsheet going and let us help you! There's so much to the sugardance and unless you have someone who's been doing it awhile to guide you, you may not be making the best decisions to help your dear Foxie!

If you'll post daily over in the Lantus forum (I think you're using Lantus, right?) and keep us up to date on how she's doing, we can probably help you improve the quality of her life quite a bit.

Are you home testing? Have you tried creating our spreadsheet? If you have problems with it, let us know! We can help!
 
I'm new to all of this and I can't believe he's jumping from 83 to 500 in 4-5 hours. Is this a case of the 'wrong insulin' for this cat? Wow.
 
That sounds like a bounce, @pevsfreedom ....there are 3 ways that cats can start a bounce
1. their blood glucose goes too low (under 50) so their liver releases stored sugars and hormones to bring it back up FAST...Bounce!!
2. The BG drops too quickly.....Like from 400-150 in 2-3 hours...those fast drops like that can trigger a bounce too
3. Just dropping into a number their body hasn't been living at for awhile.....Their body gets used to living at 300, so when the insulin brings them down to 100, (which still a great number), the liver is eonce again releasing those stored sugars and hormones to bring it back up to where Mr. Liver THINKS it should be.....the more time your cat spends in the "good" numbers, the less Mr Liver is going to freak out and he'll eventually get used to the idea that those lower numbers are safe and he doesn't need to over-react

Make sense?
 
The diarrhea is not new, but the vet said once we get him regulated, it should go away. What's new is he's started pooping just outside his litter box (while he's locked in the bathroom). Prior to this, he's used the litterbox 100% as long as he was locked in the bathroom. Yesterday he also threw up in the window, it was black. He sits in and got it all over himself, the curtains, etc. Maybe there is more going on than just diabetes but none of the tests found anything.

I don't know what to do about his insulin. It looked like 0.5 wasn't working well enough, I was going to go back to 0.75, then started second guessing everything. What if he was bouncing and I didn't catch it (I've been taking more frequent readings as requested by some folk here). But I'm starting to feel like this is a losing battle. I feel like it's my fault I can't regulate him and I must be doing something wrong. But a life living in the bathroom 80% of the time is no life at all for my friend. My vet is out of ideas, I just don't understand because I thought with diabetes, it's something that should always be able to be regulated. I don't think there is much else I can do that I'm not already doing other than switching meds and starting over with a different insulin. But I think maybe that's just me grasping at straws and trying to avoid the worst case. Sitting here crying but I'm exhausted and out of ideas, money and hope.
 
Black vomit, especially with a coffee ground appearance, can be a sign of a GI bleed, such as from an ulcer.

Pooping outside the litter box can be a sign of arthritis - it hurts to go, the pain is associated with the litter box, so it is avoided. A trial of glucosamine could be helpful, or Adequan.

Also, it is possible to have a fecal blockage plus diarrhea. The liquid stool is able to pass, the obstructed area hurts. That may cause litter box avoidance, too.
 
Thanks. The black vomit thing doesn't look good at all. I think I'm done. I don't have the luxury of time, family cooperation or $ to continue. I can't even get the diabetes under control. I really appreciate all the help from this forum and especially you BJM. I've learned a ton, and my other 3 cats will hopefully benefit from never having to deal with diabetes from those lessons.
 
Rob, if you make the decision you are thinking about, my heart breaks for you. You have been doing everything you can. :bighug::bighug::bighug::bighug::bighug:

And don't EVER feel like you have failed Warren! You have done more than most cat parents would even think about.
 
I'm going to run everything by the vet on Tuesday when she's back in the office and make sure there's nothing I'm missing and there's no reasonable course of action. Thanks shiloh.
 
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