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 :)