Major Wilson News

Wilson has found a home! He's been adopted by a very experienced FDM caregiver and is settling in (in a spastic, Wilson-like way) to his new household. There are a lot of other cats in the household but I think it will work out ... Wilson was actually good with the two original cats here; it was the constant addition and subtraction of foster cats that really pushed his buttons. His new mom and dad love him, and understand that he is a very sweet loving cat who may be a few sandwiches short of a picnic :)

He actually went to his new home a few weeks ago but I was too nervous to post in case he was sent back ... ! I was luckier than I ever thought I'd be in finding someone that not only will accept a cat with a health issue but also actually understands that cats have, um, "personalities" and aren't the happy-cheery sure-whatever types that dogs are.

So here's to Wilson and his new family!

Hanging in there

He is still swinging between the 100s up to 300s (ugh) but I have decided to hold steady on a dose of 2 units until things calm down. I think that changing the lantus dose so frequently isn't helping matters, esp since overlap seems to be a factor here. So I'm going to try to stick at 2 for a few days and see where we end up.

In other news, Mr Wilson got on the bed this morning (waaay too early) and parked himself a few inches from my face, purring like a motor, and I of course jumped up and quickly tested him in case he was too low again. He wasn't, and instead was just getting an early start on his morning beg-a-thon for breakfast. What a stinker!

+12 = 124

Gave him a fat 1/2 unit. I'm off tomorrow so I can spend all night staring at him if I must. But I really think this afternoon's dip was because of his exercise.

WTF Wilson?

Ok so he has had three numerical episodes of hypoglycemia in the past two weeks. Two were mildly symptomatic -- only symptom was hunger/begging for food. This current one is without symptoms. But let me start at the beginning. First a few notes:
*I have tested this meter (the Elite) extensively against the lab machines at work. It is remarkably accurate.
*All using the same box of strips.
*This is all using the same cartridge of insulin.
*Food is all the same flavor from the same exact case.
*My usual dose was 2 or 2.5u. I'd give the higher dose if the PS was higher because in my long history with lantus it seems that it will not drop higher PS's unless you bump it slightly. (This is only my experience with this cat and shouldn't wantonly be applied to others.) I've also had luck adjusting lantus doses up or down 0.5u without a problem, despite the typical protocol requiring it to be the exact same every day.



As noted in previous posts, Wilson has been having pretty predictable pre-shots. He was getting 2 units BID. I hadn't done a curve in a long while though and I was getting a bad feeling that maybe his nadir was, well, not really a nadir. I did a curve on 10/13:
AMPS 258
+2.5 296
+4.5 258
+6.5 239
+8.5 225

At this point I gave him his two units early.

Ok, his BG is not going anywhere at this dose. Started 2.5 units bid.

10/14
AMPS 232 gave 2.5u
PMPS 143 gave 2.5u

10/15
AMPS 202 gave 2.5u
PMPS 248 gave 2.5u

Now for our first hypo:

10/16
AMPS 184 gave 2.5u
PMPS @ +13 56

Huh? Yep, 56. Now I was at work for 11 hours that day so I'm not positive if he ran around or not, but in my experience he is not very active. He is miserable around the dog, doesn't like the foster cat and rarely plays with the other cats. I fed him, he ate an entire can of food (6oz)

+14 45

Another HUH? He went down. Now on the meter 56 and 45 aren't that far apart-- you could do two tests on the same drop of blood and get a 3-5 point difference. I don't know if this was a true dip (indicating pancreatic function?) or basically another 56.

I gave another can of food, he ate some and by now he's eaten probably about 8-9oz total of a low-carb food. I gave him a few feline greenies, too. He seemed a little hungry at first but now is back to his usual behavior (lunging at the dog, etc.) so I took a shower, walked the dog, etc. It's now past midnight.

+16.5 48

Ok, I will just pull my hair out and give up. He won't budge even after nearly two cans of food, and a few handfuls of greenies. I give in and put out several bowls of kitten dry food since the other cats will snarf as much as they can too. He eats the dry food eagerly like the typical kibble junkie. I fall asleep on the couch for a few hours.

10/17
AMPS = +22.5 = 404

Awesome. I have to go to work; I give him 1 unit.

PMPS = 418 gave 2u

10/18
AMPS = +9 = 308 gave another 2u. Remember, this wasn't budging him a few days ago.
PMPS = 144 gave fat 1u (1.25 or so)

He eats his dinner, about 6 oz of canned food. Later on, Wilson starts being unusually lovey-dovey and cuddly. I'm about to go to bed, so I test him for the fun of it.

+4.5 = 30

Here we go again. I can't stay up most of the night again so I bust out the kitten dry food immediately. He wolfs it as expected.

+5.75 = 37

You have got to be kidding me. He inhaled carb-y dry food like a champ a little over an hour ago. I give him some more treats and encourage him to eat more. He eats just a little more, it seems like I am annoying him. No signs except his previous cuddliness. As before, his behavior is normal.

+6.25 = 43

I put out some canned food & dry food and go to bed. I've been up for 20 hrs by now. [NB: I don't encourage other people to fall asleep while their cat's BG is 43.]

I wake up a few hours later, probably around +9, he looks good and runs under the couch when I stumble over to test him. He's had it with me and my little pin pricks and beeping meter and swats at me when I reach for him. Typical Wilson. I go back to bed.

I get up at about +13 to go to the bathroom. He looks good, and vigorously attacks the dog when he walks into the living room.

10/19
AMPS = +26 = 365 gave 1.5 unit. I'll be home all day today to watch.
+3 = 301
+7 = 303
+10 = 341
PMPS= 296 gave another 1.5u

10/20
AMPS 314 gave 2u. Will be at home today again.
PMPS 168 gave 1u because I have no idea what's going on here.
+2.5 160 (spot check)

10/21
AMPS 242 gave 1.5u
PMPS 329 gave 2u

10/22
AMPS 320 gave fat 2u
PMPS 96 gave about 1 drop of insulin (0.25?) after he ate

10/23
AMPS 315 fat 2u
PMPS 257 gave 2u
+1.5 231 (spot check before I fell asleep)

10/24
AMPS 235 2u
PMPS 259 2u

10/25--today
AMPS 217 2u

+4 62, I think. The strip was slow to fill--I am not sure I had enough blood, and the meter reads falsely low when this happens. He is not amenable to a retest so I give him a few grenies and will just keep an eye on him.

+6 29
I tested to confirm that the 4+ was a mess up (which it probably wasn't) and because he had been unusually active today -- major case of the zoomies. I just fed him although he is not ravenous. He ate about 1/2 can of food, washed his face, smacked one of the other cats, and is now snoozing in his basket by the window.

Will keep you posted.

A big huge screaming fight

Wilson just had a big huge screaming fight with the foster cat. The foster cat is confined most of the time but is out for short periods of time. For the most part, I can referee and everything is ok -- tense at times but ok. No one got hurt this time around, probably because the fight lasted about two seconds. My dog helped break it up because he immediately gave a few loud woofs, scaring everyone.

Now the poor foster cat is back in the bathroom.

Depressing

I have been thinking about posting for the past few days but the whole situation over here has me feeling pretty down. Wilson is very unhappy here and I don't see any way to change things for the better. He does NOT like to live with dogs, he does NOT like the coming and going of new cats all the time (I do cat rescue). He's stressed, unhappy, tense, and I don't see any way to remedy this since he is not exactly an adoptable cat.

He's definitely dog aggressive and will actually burst out from under a chair, or jump up from the couch, etc., just to run after the dog and slash at his rear legs. The dog gives him a wide berth but Wilson is constantly on the offensive. This isn't cool for all of the obvious reasons but topping it off is the fact that my dog is getting older and was recently diagnosed with liver failure. Awesome, right? After Wilson gets all hot and bothered about the existence of the dog, he will occasionally pick a smack-fight with one of the other cats. There are two other cats that live here, and I have one extra right now who is looking for a home. Wilson is aggressive towards this extra cat as well.

So what to do? Try to find a home for a grumpy (but often loving) diabetic cat....

Wilson is holding steady

And there is (therefore) not much to report. I actually haven't even written his numbers down though they are stored in his BG meter. He is on 2-3 units a day and I consistently get pre-shots in the 200s. We've had little wobbles in his numbers--a few days of numbers in the 300-400 range led me to take him to work for a urine culture--but it is actually quite consistent as long as there are no illegal activities undertaken like ripping open the dog's dry food bag or scarfing down some unattended pasta (why, Wilson, why???).

I should copy down his numbers at some point ... it's on my to-do list...

Insulin needs are lessening ...

But true to the caveat in the Rand protocol, if you back off too much at first you will mess up the process.


8/5
7:21a 105, 2u
8:25p 83, 1.75u
8/6
6:54a 133, 2u
7:57p 127, 1.5u
8/7
8:19a 306, 2.5u
9:48p 234, 2.5u

Major annoyance

I just realized now that my Elite has the wrong date and time setting. Sigh.

Last night his BG was 86 @ +12 (dinnertime). I tested again and it was 104 @ +15. So I left it alone... Since I took it 3 hrs after his meal, I wanted to see what would happen without insulin.

This morning, of course, his BG was 310. Gave 3u.
This evening 195, gave 2.5u

I just heard from two other lantus users that their cats also got a duration that was over 12 hrs but less than 24. . . .

The week in review

Not that the week is over yet, but whatever.

For the meter comparison thing that I'm doing, I had been keeping my Elite at work so Monday I still used the mini:
7/30/07
7:00am 72
8:00am 162, 2u
8:25pm 130, 2u
10:38pm 146

7/31
7:23am 215
8:51am 257, 3u
Brought home my elite from work:
9:40pm 249 (by Elite), 3u

8/1
5:43am 233 (Elite)
8:30am, didn't retest, shot 3u
8:31pm 59 (Elite)
10:17pm 72 (Elite)
1:00am 162 by mini b/c the Elite is apparently out of batteries (aargh), 1.5u

8/2/07
9:27am 206, 2.25u
Got more batteries for the Elite. Actually have just stolen them from my old Contour whose inaccuracy makes it worthless (to me)


stay tuned.

Lantus has apparently settled (or something)

The following numbers and my insulin-amount decisions may make me look crazy. Whatever my decisions or results were, I STRONGLY and VEHEMENTLY advise against using them as a guide to how to treat any other diabetic cat. Got it? Ok here goes:

7/26
8:27am 52! FED, ate well
9:00am 65 FED MORE, ate well (he always eats well)
9:24am 87, 2u
Yup, I gave him 2u at that number. It's dangerous to do that so I strongly advise against it. However there was someone that was going to be home all day with him and feed him and observe him.
8:14pm 304, 3u
Ah, the effects of gluttony and/or mild rebound. He was fed only low-carb (less than 9%) wet food but he did have quite a bit of it. And he got four little greenies.

7/27
6:11am 236, 3u
4:49pm 245, 3u
Shooting early was a stupid thing to do, esp. given the events the previous day. Lesson learned:
12:00am 50! FED, ate marvelously
12:31am 63 FED, ate well
1:00am 75 Left food out and went to sleep

7/28
5:30am 119
10:15am 204, 2.75u Trying to get him back towards his 8am/8pm schedule
5:24pm 188
10:20pm 156, 2.75u
12:45am 164

7/29
8:00am 244, 2.5u
8:16pm 157, 2.5u

Notes for this week are a lessening of his pu and I also note that I just can't afford all of the OTU strips. Since his ears have learned to bleed better and my tests at work continue to show the Elite to be the most accurate, I am switching back.

UPdate

Ok, I can't figure out why it's so hard to write new entries; the letters don't appear on the screen immediately, I type away but the text doesn't follow it, the words appear in chunks. This is really, really annoying but I tried all of the little things I know that could have fixed it and none of them work so I hereby blame it on blogspot. I knew I should have started this blog on wordpress.com :( Oh well.

Ok, last number I mentioned was the 7/19 shot where the +8 was 287 (ick). I said was going to try to keep at two you before moving up, but I was unable to resist and did 3U that night. These numbers are all with the OTU mini which I was using because I couldn't get enough blood sometimes for my favorite meter, the Elite XL. I am also using a new cartridge of Lantus.

Here are my updated numbers:
7/19
8:33am 274, 2u
+8 = 287
8:41pm 254, 3u
[I know, I should have done just a half unit increase but I couldn't help myself; I felt like he was going to fall into DKA if he was really spending all that time in the high 200s!]

7/20
8am 166, 3u
7:30pm 250, 3u

7/21
8:48am 282, 3u
7:45pm 232, 3u

My notes for that past week: mild pu, behaviorally +++ -- playful, affectionate, etc.

7/22
7:55am 248, 3u
7:45pm 270, 3u

In my limited experience, Lantus takes a bit of time at the same dosage to show progress so I am holding steady here.

7/23
7:25am 239, 3u
8:25pm 265, 3u

7/24
8:40am 250, 3u
8:57pm 179, 3u

7/25
7:57am 254, 3u
7:30pm 210, 3u

Made some changes, got some better numbers

Although my nerd-scientist self would have prefered to make one change at a time to calculate its effect, my scared-of-DKA self kicked me in the ass and forced me to implement a whole new plan in order to get him out of the danger zone he was in with those 400s. So I made three changes:
1--restricted feeding and treats. I was using a lot of treats in attempts to get him used to the testing/shooting process; now, the food reward is his own post-test meal. He is fed a fixed amount, twice a day, and eats it all within a half hour. I *had* been giving him large amounts of food to both offset the food-thievery of his feline housemates and to have some extra on hand in case he went low, BG-wise, since I have worked crazy hours in the past month or so.
2--opened a new vial of lantus in case my current bottle was crapped out. It doesn't appear to be, visualy, but even so.
3--changed from a sliding scale to a fixed 2u dose. It's conservative in case the first two changes make a huge difference, and also to address the possibility tht the former craziness was caused by rebound.

Results so far??
Tuesday 7/17 8am 292, 2u from fresh Lantus bottle
9:44pm (late because of work) 426, 2u
Wednesday 7/18 8:22am 253, 2u
8pm 219, 2u
Thursday 7/19 8:33am 274, 2u
+8 = 287

It is so very tempting to move up to 3u but I will hang in there for a few days at least. I also plan to get a urine reading if at all possible.

One other note: I am using the OTU mini now. Again, I like the Elite the best and it is the most accurate IMO but since Wilson is somewhat resistant to testing and it requires the most blood (2x the amt of the mini, and 3x the amt of the contour), I have switched to the mini to save some angst and time.

Quick numbers update from the past week

Again, fluctuations in times of shots are due to work.

7/9/07
7am 266, 3.5u
7:40pm 141, 2u

7/10/07
8am 501, 4.5u
10:20pm 226, 3.5u

7/11/07
8:25am 273, 3.5u
8pm 443, 4.5u

7/12/07
7:30am 389, 4u
9pm 424, 4.5u

7/13/07

8am 228, 3.5u
6pm 318, 4u

7/14/07
7:20am 436, 4.5u
7pm 244, 3.5u

7/15/07
7:40am 286, 3.5u
8pm 403, 4u

7/16/07
7am 254, 3.5u
8:30pm 265, 3.5u
+3 390!!!!!!
+4 399!!!!!!

7/17/07
8am 292.
Pulling hair out now, dunno what to do.

Back after a forced hiatus

Ugh, computer was messed up and then internet was down completely. The worrds are coming up super slow as I'm typing, so this doesn't bode so well either. AARGH. hang in there, I have stuff to report, I'm still trying to fix this thing. If not, that tremendous CRASH noise you hear will be my computer hitting the sidewalk outside.

Starting a TR protocol

I've decided to start Dr. Rand's tight regulation protocol for Lantus. It's written out here. More info to come later.


PS Wilson is so CUTE! Check out the gianormous paws!

Diabetes accessories that I like

First, the most accurate meter I've tried is the Ascencia/Bayer Elite XL. But it takes a ton of blood, hence me trying out the Contour. We'll see how that goes.

Other stuff: the little lancet devices that come as part of the meter kits usualy work pretty well. The one that comes with the mini is quite compact and uncomplicated and I like it. I also use the microlet lancet thing that comes with Bayer meters. I haven't found any differences in the lancets themselves so I usually buy the cheapest ones.

The best place online to order from, price-wise, is usually Hocks.com. The best urine strips are the Keto-Diastix which measure urine glucose and ketones. The syringes I like to use for my U-100 insulin (all insulins are U-100 except for PZI and Vetsulin, both of which are animal-specific insulins) are the short-needled, 3/10cc syringes with half unit markings. Since most cats receive just a few units of insulin at a time, these syringes are worth getting because they make those small measurements a little easier.

For testing the ear, I use these cheap cotton squares. I fold one and put it on the other side of the ear so that I don't poke myself accidentally and also because it gives me something to press the ear against. The cheapo brand that I use isn't good enough to use for removing makeup or anything but it is perfect for ear testing.

Another thing I do is put my insulin bottles in pill vials like this:


so that I can't drop and break them. I wrap the bottle in one or two of the aforementioned cotton squares:

Pre-shot BGs in the 300s

Sigh. I am pretty sure that the main problem here is that I am not shooting on a regular schedule. That should straighten out, though, since my work schedule has changed.

This morning I gave him his shot late, at +15 rather than +12, and he was OVER 500. So I have to work well within the overlap in order to keep him at good numbers. I feel really bad that I have been doing such a lousy job.

Wilson and I got in a huge argument last night

:(
He's been high for the past two days and it seems to make him a bit grouchy. He became very irritated when I started our ear-pokey routine and despite treats (he looooooves treats) and happy talk we ended up having a wrestle. I wasn't willing to wait to give him his shot because not only was I super tired but he seems to really skyrocket if his shot is delayed and with all these high numbers I'm afraid of him developing ketones. So we argued, I got a 344 and gave 3u Lantus and 1u R.

Amazingly, this morning he's been a real snugglebear ... of course, I haven't attempted to test him yet, but I'm hopeful that he is feeling much better and will be much less naughty. *fingers crossed*

+9 BG=395 (Elite), 3u Lantus, 2u R

Because I am tired of this hyperglycemia, and I'll be home all day, I didn't wait till +12 and I am giving a bigger dose of R.

The BG was 379 on the Contour2 and 440 on the Mini.

I think Wilson has been such a grouchy little SOB because he feels crappy when he's so high. Hopefully this will push him back into sweetiepie territory. Already, he seems to be a bit brighter today.

AM BG=425 (Elite), 3u Lantus, 1u R

It was 425 on the Elite, 451 on the Contour2, and 531 on the Mini. When it gets to be this high, I don't know if those differences actually matter :(

Yup, last night was a total fur shot

Even though I don't see how it happened. I took a BG when I got up this morning at +10 (from the shot-that-should-have-been) and it was 575 on the Elite :( UGH. It was 529 on the Contour2 (I have a more recent model that I have started testing) and HI on the Mini.

I gave him 1u R and 3u of Lantus. I tested again 5.5 hours later and got 240 on the Elite. I gave 1/2u R. I'll test again at midnight, 12hrs after the first R booster.

In other news, I have used the lancet device that comes with the Mini and I kinda like it.

Meter comparison/review

I am going to chuck the Ascensia Contour. The Ascensia Elite XL that I have is awesome, and incredibly accurate. I have tested it dozens of times against the lab machines through work and it is reliably accurate. Unfortunately, it requires a much larger blood sample than the Contour. The OTU requires a sample that is in-between sizes. Since the Contour is a Bayer meter as well, I thought that it would be just as good and have the additional benefit of requiring a mere speck of blood. Not so, it sucks. It seems to read somewhat accurately at really high numbers (300s) but anything under 150, it reads a good 30-50 points lower than the OTU and Elite. I can't say this is true of all Contours or if I have a bum one. I may just get another one and test that one since I'd like to think that Bayer kept up the quality somewhat with their meters!

So, here is my BG reading comparisons. These are all within the past week from animals at work. Most animals were not diabetic and these are all using venous blood. When possible, I compared the BG meters to one of our lab machines called an i-Stat, using it as a gold standard. It measures blood electrolytes, blood gases, and pH. I tested an OTU-2 (the newest version), OTU Mini, Elite, and Contour. Results:
OTU-2/Mini/Elite/Contour/i-Stat
54/59/60/35/X
74/76/75/44/84
76/79/81/X/X
75/78/81/X/93
X/121/108/83/X
143/155/139/116/154
211/229/200/179/X

I actually have a re-designed Contour, a more recent model than the one I was testing, so I am going to bust that one out and continue testing. I'll keep you posted ...

AM BG=331 on OTU mini, gave 3u, FUR SHOT??

Okay, I'm upping the dose because I am tired of seeing pre-shot numbers in the 300s. I was trying to stick to his vet's advice but I'm getting stressed about this. Wilson was also real stinker tonight about his test & his shot :( I'd like to do a curve tomorrow but don't know if I should ... some more behavior mod may be in order first. On the other hand, I REALLY need to know what is going on with his BG during the day. Is the lantus is keeping him in euglycemic or near euglycemic range for the vast majority of the day?

Dammit, I may have given a fur shot. I would swear that I didn't--I drew back before shooting and didn't pull back any air so I know I was under the skin, and he didn't move so I dont' think it was yanked out at the last minute, but I just pet him and there was a teensy wet spot on his back and it smells like insulin. Aaarrgh. Did I mention that he has been a real punk about being tested? I am not sure what to do. I wish I didn't have two other household wolverine-cats who stuff themselves with his food, so that I could at least give him another token dose before bed and just leave lots of food out in case he feels low.

How annoying :(

Re-tested 2 hrs later, 237/225, 2.5u

6/19 +10=446 (!). Gave 2.5u
6/20 AM BG=163/143, gave 2u
6/20 PM BG=351/393, gave 2.5u
6/21 AM BG=337 on the OTU mini I just got. Wilson was not being a good boy and I was unable to get more blood so I went with this. Gave 2.5u.
6/21 PM BG=371, gave 2.5u

AM BG=119/113 when tested at +12

WTF? I don't know what to do with this guy. If I skip, he ends up hitting 400-something. I will wait until I am right about to go to bed and retest :(

AM BG=212 (Contour only), 2.5u

Once again I didn't get enough blood for both.

PM BG 154/212, 2u Lantus

AM BG=247/228, 2.5u

For the first time the Elite is testing higher than the Contour.

This is +13 from the last shot.

Update of other stuff

I mentioned some time ago that Mr. Wilson was sometimes a real PITA about getting his test and shots. He doesn't bite or scratch but sometimes he'll growl and/or try to get away. It's odd, he doesn't do this all of the time but I haven't figured out what the triggers are. One big downside to this is that I can't rely on anyone else to test him because his behavior is somewhat intimidating. Personally, I have known enough cats to know he's a BS'er and have no problem with this but I know most normal ppl would. Esp. given his recent history of DKA, I need to be SURE that he is going to get the test and shot as needed.

Sooo, my original plan was clicker training. I have the iClick thingy and am experienced in clicker training dogs. I really love it, it's actually kinda fun and worked very, very well with my dog. He learned stuff faster and retained it longer.

For the shots and testing I was using some classic conditioning. Meter beeps=feline greenie, test=feline greenie, shot=feline greenie. Wilson LOVES feline greenies. Initially I was using the clicker but then gave up on it mostly due to coordination issues plus the fact that after almost a week it had not worked well enough to be worth the juggling effort. I am absolutely all for training cats with clickers, but clicking while holding a cat still for a test or poke is not too easy.

So where are we now? We are still at the point of occasional grumbles but overall tolerance. I still don't trust that he's easy enough for just anyone to handle, though.

Major update, BG numbers

Sorry for my week-long hiatus. I am having serious internet connection difficulties :(

This past week was marked by craziness both in numbers and timing. I worked a double shift and then 3 evening shifts, then a day shift, so feeding times and shot times were all messed up. I haven't bothered doing a curve yet because I don't think there is any info to be gained from it since I basically haven't much idea about what's going on in terms of duration and overlap.

As a reminder, the insulin used is Lantus unless otherwise specified. Since that one instance mentioned in my last post of not being able to get the BG, numbers and amounts have been:

Saturday 6/9 PM BG=236, gave 3u
Sunday 6/10 AM BG=234, gave 3u

Then there was a little road bump

Sunday 6/10 PM BG=81. ????
This was +12hrs from the last shot. I waited as long as I could before work and retested: BG was 93. I didn't want him to go without insulin for another 12 hrs while I was at work but I was not comfortable shooting him at that low number. So I hauled his heavy furred self into work with me. His vet was working that day and took the opportunity to check him out and re-do bloodwork. Drumroll please .... EVERYTHING WAS NORMAL. Normal liver values, kidney values, CBC, everything looked terrific. No ketones or glucose in his urine.

Because his urine didn't have any glucose and I'd gotten that low number, his vet recommended that I decrease the lantus. He assured me that trace glucose in the urine was not going to harm the kidneys, at least not quickly enough to be recognized in a feline lifespan. So I decided to pull back. BG that night at work at +16hrs since last shot was 236 and I gave him 2.5u.

I was in a bit of a pickle later because I needed to stay on a 1-2am, 1-2pm schedule and had given him the last shot at +16 which was 6PM. I decided to hold off and wait till 12pm the next day to shoot. This is the beginning of the timing weirdness so I'll start putting in the numbers as +---hrs since the last shot. That means that every time insulin is given, the counting starts at zero. The irregularity of the timing is due to my work.

6/11 +18=436. Gave 1/2 unit R (again, I don't recommend doing this) and 3u lantus. I'm scared of ketones.
6/11 +3=264. This was a spotcheck since I'd given R.
6/12 +12=494, ugh. Another 1/2u R and 3u Lantus. NB: don't wait till +18 to shoot.
6/12 +12=328, 3u
6/12 +11 (I wanted to go to bed early)=83. WTF? Aargh. Set alarm for two hours later.
6/13 +13=236, 2.5u
6/13 +8=318, 2u. I had to leave for work and couldn't wait till +12.
6/13 +15=310, 1.5u because of next day's shooting schedule
6/14 +8=348, 1.5u

Now I admittedly was totally goofy with my timing, but wanted to be sure that all the jumping was due to my being a bad cat-mom and not because my meter was wonky. I'd had it since my last diabetic kitty, it's an Ascencia Elite XL. I also have a Contour meter so hereafter I'm using both to try to get a read on what's going on. So there are now two BG readings, the first is Elite, the second is the Contour.
6/14 +12=341/401, 2.5u
6/15 +12=342/395, 2.5u
6/15 +16=317/338, 2.5u

The Contour needs much less blood than the Elite, so Saturday afternoon I was only able to get a speck out of him and used the Contour only. 6/16 +13=296 on Contour. Gave 2.5u.

I'm trying to stick to the 2.5u because of his vet's recommendation. I did manage to sneak in two urine readings and they were both positive for glucose (low) and neg for ketones (yay).

Couldn't get a BG this AM

Dunno why, but I must have poked him a bazillion times. I gave 3u anyway because he has been so consistent and certainly eats well :)

PM BG=263, 3u Lantus

Wilson is still a little attached to being in the bathroom. He ventures out but then hisses and high-tails it when he sees the other cats or the dog. You have to admit, though, he does look really cute in a sink....

AM BG=174, 3u Lantus

Yay! I am so glad to see a number under 200. Since it's been almost a week since he started his 2u BID of Lantus, I'm increasing to 3 units and will see where that takes us.

PM BG=229, 3u Lantus

Booster shot given

At +8 (eight hours after last shot), his BG=248. Because of his recent DKA, I'm concerned about him staying above 200 all the time. I gave him 1/4 unit of "R" insulin. This is NOT a practice that I advocate or recommend for everyone. Regular insulin is short-acting and strong and can do a lot of harm very quickly.

AM BG=380, 2u Lantus

UGH that is waaaaay too high for me, for him. The Lantus protocol I read said to not use a sliding scale but it's tempting.

I am leaving the bathroom door open more and more. He still hisses at the other cats, and at the dog, but he is also starting to meow when left alone with the door closed. I think Wilson has just had a lot to deal with lately so I am still betting on his being able to integrate completely.

AM BG=210, 2u Lantus

Not bad! And we are making some progess on integrating him into the household. Yesterday I had the door to the bathroom open for a while. Wilson was curled up in his new favorite spot--the sink--and roommate's cat came in to sniff around. He hissed a bit but roommate's cat ended up lying down on the tile and they both relaxed in there for a while. This morning we had a bit of a row, though, when roommate's cat came into the bathroom while Wilson was on the floor too. He hissed and gave a swat but it was a little half-arsed.

I did some reading up on Lantus on VIN (Vet-only info site) and the recent recommendations posted there is to NOT alter doses in the first week; the authors warn that you sometimes get some higher-number days at first but this "breaks" and you may get notably lower BGs after that first settling time. This Friday I'll run a curve on him and may go from there; I would like to get his pre-shot BGs to below 200. Since i haven't been able to do spot-checks, even, I'm loathe to mess with anything right now; I don't know how low he is going, but I can't back off because of his recent ketosis. I haven't been able to get a urine strip reading since I haven't been home and haven't been able to catch him urinating. Tomorrow I'll put Nosorb in, I guess, since I need to get some urine info.

I've started to clicker train him in order to get him more comfortable with the testing and shot process. So far the only thing that he is crazy for is dry food ... or Feline Greenies, I guess, but those are even bigger. I have to figure out a lower-carb treat to work with.

BG @ 1am = 204, gave 1 unit lantus

Afternoon BG=317 :( Gave just over 2u Lantus--there was an air bubble that I couldn't get out so I tried to compensate. I'm bummed about the 300+ number.

Shooting early

I worked during the day on Sunday (I got him Saturday night) and he had been on an 8am-8pm schedule anyway so that's what I did yesterday. This morning I got up and shot at 7:30am since I was supposed to work during the day today but at the very last minute things were changed around and I don't have to leave to go in until 3pm. So, I can either not shoot till 1am, when I'll get home, or I can test and shoot at 3pm. Because of his recent DKA I'm not comfortable letting it slide till 1am. But because I don't really know him I'm a little uncomfortable shooting 4-5hrs early.

Soooo, my thought is that I will shoot a reduced dose, maybe one unit, at 3pm and then test and probably shoot another unit at 1am. I'll leave a good amt of canned food out for him in case he gets hungry/low, and I'll leave out the hypo instructions just-in-case, although I don't seriously think there is a risk there.

BG @ 3pm, before I left, was 146. Gave 1 unit Lantus.

AM BG = 260, 2u Lantus

PM BG=280, 2u Lantus

My dear little Wilson seems to have some objects to the insulin injection process. Not the injection itself--he doesn't seem to notice when the needle pierces the skin--but tonight I noticed he got stiff and growly when he smelled the insulin, and he swatted at the capped needle when I showed it to him to see if that was what he was growling at. Weird, huh? Luckily he is much more talk than action so I haven't had any problems, but it does look like some desensitization is in order here. More on that later!

AM BG = 240, 2 units lantus

Wilson's home

He's set up in the bathroom for tonight because I think introducing him to two cats and a dog would be a bit much at the moment! He rode home with me on the subway without a single meow, he was such a good boy! BG=219 so I gave him 2 units of Lantus (based on recorded BGs and insulin dosages from his hospital stay).

Wilson is coming home today

Of course it is about a million degrees out right now so I'm going to wait until it cools off this evening before lugging him home. He's a 14lb (6.3kg) bundle of love, you know.

I'm a believer in wet-food-only diets for cats, and believe that low-carb is best for diabetic cats, so I ran out to the supermarket and bought some cheapo low carb foods for right now until I settle on a good higher-quality-yet-affordable brand. Sometimes petfooddirect.com has coupons for 20% off and that 20% usually covers shipping costs, so I try to stock up then. I get my carb info from statistician Janet & Binky's food charts. The complicating factor, of course, is the freaking pet food recall which seems to cover just about everything... I'm researching prices vs. quality + carb content now...

Tonight's Update

The vet today says he may be able to come home tomorrow. Unfortunately, he had trace ketones in his urine this morning so they want to make sure they have him reasonably controlled on the lantus before releasing him. I just spoke to one of my coworkers and she said that he's becoming something of a naughty cat, fussing and kicking at them when they try to pill him. Can't really blame the guy ... But other than his forceful objections to being medicated, he has been calm and easygoing. I do feel somewhat bad for him in that he must feel so lost--a week in the hospital, getting prodded and poked and feeling miserable, and then not having a familiar home to go to afterward. I wish I could let him know somehow that this is just the beginning of a new luxurious life, and everything will soon be familiar and comfortable again.

I miss him, I'll definitely visit tomorrow!

Introducing Wilson

Wilson is a 6 year old rescued kitty who happens to have diabetes. At time of rescue, he was suffering diabetic ketoacidosis and acute pancreatitis -- a combination that can be deadly. He's still in the ICU but doing much better and may be able to come home (his new home!) this weekend.

When he arrived at the animal ER he was dehydrated and miserable

His health took a turn for the worse the next day, with his labwork showing significant kidney and liver problems. His blood pressure was abnormally low and he needed several rapid infusions of fluids to keep it up, and you can only do that a few times (or else they become overloaded) so he was at the point of needing medication to raise his blood pressure which is a very poor prognositic indicator in cases like this. He was also so dull and out of it that the vet was initially worried about hepatic encephalopathy since some of his liver values had gone up. He hadn't been eating and a temporary feeding tube was placed.

His diagnosis sheet went from DKA to DKA, pancreatitis, and ARF (acute renal failure) because his kidney values were also very elevated (BUN=110, creatinine=5.2). His vet thought that, in addition to DKA, he was suffering an acute, severe pancreatitis which can cause a system-wide inflammatory response hence the evidence of liver and kidney disease. Acute pancreatitis can actually cause death, so its occurrence with his DKA was very bad news. After discussing it, I told his vet that if he had worsened by the morning I would let him go. Before I left work, I sat down with him and told him that I was going to take care of him, he had a home with me, and he would get yummy food and toys and I'd try to make him his own kitty bed and everything. I've actually done this twice before with rescues: told them that I would take care of them and help them and they needed to let me know if they wanted to fight or if they needed to move on.

The next day, blood pressure stayed normal, NO KETONES or excessive urination. A complete and total turnaround! His internal medicine vet called me at 8am in the morning to happily tell me the news. He was alert and HUNGRY. Another good sign, he started to become grouchy when handled too much; not aggressive in the least, but just grumbly when his temp was taken and his IVs were re-wrapped and stuff like that. He started eating on his own but still had some small feedings through it because his vet was worried that he was developing hepatic lipidosis because of the jump in liver values and his previous anorexia. Here he is that night, clearly feeling much better despite all of the tubes and bandages:





This morning, he switched from his short-acting insulin to his long-acting every day insulin, Lantus. As of now, he's scheduled to come home Sunday but I hope to snag him sooner, honestly mostly because his bill is rather heartbreaking and if I can avoid any more charges, I'd sure like to. I spoke to his vet today and there is a good chance he can come home tomorrow :)