Crossed the Bridge October 8, 2007
Ripple's Memorial
Friday, February 8, 2008
Sunday, February 3, 2008
Introduction to Diabetes--Part I
Hi Annie,
I am writing this "email" here so that I can add nifty links. I don't want to overwhelm you, but I am afraid I will. But I know you soak information up like a sponge, so I'm not holding back. This discussion will be in multiple parts, because I've already spent several hours on this and need to do some other things.
****************
As they say on the Feline Diabetes Message Board, "welcome to the best place you never wanted to be."
First step, I suggest you register in the FDMB and if you want to do more than lurk, introduce yourself and Tiger on the Health Forum. It is a very welcoming and very knowledgeable community.
The first thing to read is this FAQ that resides on the FDMB. It covers many many areas concerning feline diabetes and some tangential issues.
There are four important elements to treating a diabetic cat:
Homesting blood glucose levels. You have the tools, but I know you are concerned about how compliant Tiger may be. I have sent you info before about how to test. What you need to do is establish a place where Tiger will be accessible and comfortable with the testing and treatment. Max and I had a place, the couch. Initially I had to tempt him with treats to get him to come up on the couch, but after a while he would come on up without having to tempt him. With Ennis, I can do the test most anywhere, but he's usually on the bed or couch. Some people use a counter. Some get on the floor with the cat.
The test strips for the One Touch Ultra can be pricey. I shop either E-Bay or Hocks.com. You don't need a scrip for meters or strips. You can get a meter for which the strips cost far less than the One Touch Ultra. Many use the WalMart ReliOn glucometer. I have read that the meter kit costs only $25 and a box of 50 test strips costs just $10. It measures blood glucose (bg) in the range of 20-600 mg/dl and has a memory that retains the last 10 bg tests. The auto shut-off is 1 minute, and it has a non-replaceable battery that lasts for about 4000 tests. U.S. Customer Support: 800-992-3612. The meter is not featured on the WalMart website, and is available only in WalMart pharmacies (not any other store).
You probably got the ultrasoft lancets with your test kit. They are white. You would be better off with the finepoint lancets, the purple ones. They are a slightly larger needle and you can get a better prick with them.
Remember that on the testing, you are probably way more nervous than Tiger is, but he will pick up on your tension. So just relax. Make it a petting session. Coo to him.
Insulin. Sorry to say the Glipizide is not a good choice. We have an article on the diabetic pet wiki that discusses Glipizide.
There are various insulins that are prescribed for cats. The least "liked" by members of the FDMB are Humulin N (a human insulin) and Caninsulin (a veterinary insulin).
Both Humulin N and Caninsulin have a quick onset, can produce a sharp drop in BG, and seldom last a full 12 hours. They are considered "intermediate-acting insulins."
Let me digress and talk about how exogenous (from outside the body) insulin work on a cat. You start the day by testing Tiger's BG level. Depending on that level, you decide whether to give him insulin and how much. This wiki article speaks to what the various ranges of BG levels mean.
So let's say Tiger starts his morning at 312 mg/dl. You give him his shot of insulin at 7am. This time is called AMPS, for morning (AM) pre-shot. In 2 to 4 hours, depending on the insulin you are using and the type and amount of food he has eaten since about 6am, his BG level will start dropping. This is called the "onset" time. It may happen at 9am (two hours since the shot and thus labeled +2) or at 11am (four hours since the shot and thus labeled +4). Let's say that at +4 his BG level is 212mg/dl.
Then you need to know how low Tiger's BG level goes on the insulin. This is referred to as the "peak" or "nadir." Depending again on food and the type of insulin, nadir may be expected between +5 and +9. Let's say you find Tiger's nadir at +7 to be 153.
After nadir, the exogenous insulin starts losing potency. Tiger's blood sugar will rise. Let's say that at +9 he is 198, +11 he is 247, and 7pm (+12) he is 329. +12 is when he will get his PM shot, so the +12 time is referred to as PMPS (PM pre-shot).
I have plotted the above imaginary curve and it is here. The downward and then upward movement of the BG level is why it is called "a curve." However, until Tiger gets properly regulated, his curve may be flat or even inverted!! There is a good wiki article on curves.
So back to insulins. There are a couple commonly used insulins that are considered long-lasting. There are two types of Protamine Zinc insulins (PZI) being used. Both are veterinary insulins. Idexx's PZI Vet is available through vets and in some online places. BCP PZI is cheaper than PZI Vet, and is only available through mail order, with a vet's scrip. Your vet can get you a free sample of BCP PZI using this form.
I used BCP PZI on Max. As you might remember, he got regulated and then into remission on this insulin, although it was more his diet change that helped him.
There are also two often used, long-lasting human insulins. Lantus and Levemir. These insulins tend to have a longer duration than the PZIs. Because of that, the cats on these insulins often experience overlap from one dose to the other. As a result, their curves can be very flat as the PM dose starts working just as the AM dose is starting to lose potency. Here is a graph of one of Max's curves when he was getting really well regulated. You can see how flat the curve was.
Ennis is on Levemir. PZI stopped working on him. Cats can respond differently to different insulins. I am very happy with the Levemir. Ennis stays under renal threshold all or most of the day.
I can recommend PZI and Levemir because I have used them. Lantus would be my third choice, and I would reject both Humulin N and Caninsulin.
There is one last type of insulin you should be aware of. Humulin R. This is a short-acting insulin. It is not appropriate as a basal insulin, although I have seen a few vets recommend it that way. That really is a bad idea. I use Humulin R on Ennis from time to time when I need a bolus insulin to bring down a really high BG level. Humulin R is also used by vets in an urgent or emergency situation to rapidly reduce BG levels. Some people also used Humulin N as a bolus insulin.
Both Humulin N and R are sold at human pharmacies without a scrip. All the other insulins I talked about need a vet's scrip.
****************************************
I'll continue later with the other 2 elements: food and urine testing. Take care Annie!!
I am writing this "email" here so that I can add nifty links. I don't want to overwhelm you, but I am afraid I will. But I know you soak information up like a sponge, so I'm not holding back. This discussion will be in multiple parts, because I've already spent several hours on this and need to do some other things.
****************
As they say on the Feline Diabetes Message Board, "welcome to the best place you never wanted to be."
First step, I suggest you register in the FDMB and if you want to do more than lurk, introduce yourself and Tiger on the Health Forum. It is a very welcoming and very knowledgeable community.
The first thing to read is this FAQ that resides on the FDMB. It covers many many areas concerning feline diabetes and some tangential issues.
There are four important elements to treating a diabetic cat:
Homesting blood glucose levels. You have the tools, but I know you are concerned about how compliant Tiger may be. I have sent you info before about how to test. What you need to do is establish a place where Tiger will be accessible and comfortable with the testing and treatment. Max and I had a place, the couch. Initially I had to tempt him with treats to get him to come up on the couch, but after a while he would come on up without having to tempt him. With Ennis, I can do the test most anywhere, but he's usually on the bed or couch. Some people use a counter. Some get on the floor with the cat.
The test strips for the One Touch Ultra can be pricey. I shop either E-Bay or Hocks.com. You don't need a scrip for meters or strips. You can get a meter for which the strips cost far less than the One Touch Ultra. Many use the WalMart ReliOn glucometer. I have read that the meter kit costs only $25 and a box of 50 test strips costs just $10. It measures blood glucose (bg) in the range of 20-600 mg/dl and has a memory that retains the last 10 bg tests. The auto shut-off is 1 minute, and it has a non-replaceable battery that lasts for about 4000 tests. U.S. Customer Support: 800-992-3612. The meter is not featured on the WalMart website, and is available only in WalMart pharmacies (not any other store).
You probably got the ultrasoft lancets with your test kit. They are white. You would be better off with the finepoint lancets, the purple ones. They are a slightly larger needle and you can get a better prick with them.
Remember that on the testing, you are probably way more nervous than Tiger is, but he will pick up on your tension. So just relax. Make it a petting session. Coo to him.
Insulin. Sorry to say the Glipizide is not a good choice. We have an article on the diabetic pet wiki that discusses Glipizide.
There are various insulins that are prescribed for cats. The least "liked" by members of the FDMB are Humulin N (a human insulin) and Caninsulin (a veterinary insulin).
Both Humulin N and Caninsulin have a quick onset, can produce a sharp drop in BG, and seldom last a full 12 hours. They are considered "intermediate-acting insulins."
Let me digress and talk about how exogenous (from outside the body) insulin work on a cat. You start the day by testing Tiger's BG level. Depending on that level, you decide whether to give him insulin and how much. This wiki article speaks to what the various ranges of BG levels mean.
So let's say Tiger starts his morning at 312 mg/dl. You give him his shot of insulin at 7am. This time is called AMPS, for morning (AM) pre-shot. In 2 to 4 hours, depending on the insulin you are using and the type and amount of food he has eaten since about 6am, his BG level will start dropping. This is called the "onset" time. It may happen at 9am (two hours since the shot and thus labeled +2) or at 11am (four hours since the shot and thus labeled +4). Let's say that at +4 his BG level is 212mg/dl.
Then you need to know how low Tiger's BG level goes on the insulin. This is referred to as the "peak" or "nadir." Depending again on food and the type of insulin, nadir may be expected between +5 and +9. Let's say you find Tiger's nadir at +7 to be 153.
After nadir, the exogenous insulin starts losing potency. Tiger's blood sugar will rise. Let's say that at +9 he is 198, +11 he is 247, and 7pm (+12) he is 329. +12 is when he will get his PM shot, so the +12 time is referred to as PMPS (PM pre-shot).
I have plotted the above imaginary curve and it is here. The downward and then upward movement of the BG level is why it is called "a curve." However, until Tiger gets properly regulated, his curve may be flat or even inverted!! There is a good wiki article on curves.
So back to insulins. There are a couple commonly used insulins that are considered long-lasting. There are two types of Protamine Zinc insulins (PZI) being used. Both are veterinary insulins. Idexx's PZI Vet is available through vets and in some online places. BCP PZI is cheaper than PZI Vet, and is only available through mail order, with a vet's scrip. Your vet can get you a free sample of BCP PZI using this form.
I used BCP PZI on Max. As you might remember, he got regulated and then into remission on this insulin, although it was more his diet change that helped him.
There are also two often used, long-lasting human insulins. Lantus and Levemir. These insulins tend to have a longer duration than the PZIs. Because of that, the cats on these insulins often experience overlap from one dose to the other. As a result, their curves can be very flat as the PM dose starts working just as the AM dose is starting to lose potency. Here is a graph of one of Max's curves when he was getting really well regulated. You can see how flat the curve was.
Ennis is on Levemir. PZI stopped working on him. Cats can respond differently to different insulins. I am very happy with the Levemir. Ennis stays under renal threshold all or most of the day.
I can recommend PZI and Levemir because I have used them. Lantus would be my third choice, and I would reject both Humulin N and Caninsulin.
There is one last type of insulin you should be aware of. Humulin R. This is a short-acting insulin. It is not appropriate as a basal insulin, although I have seen a few vets recommend it that way. That really is a bad idea. I use Humulin R on Ennis from time to time when I need a bolus insulin to bring down a really high BG level. Humulin R is also used by vets in an urgent or emergency situation to rapidly reduce BG levels. Some people also used Humulin N as a bolus insulin.
Both Humulin N and R are sold at human pharmacies without a scrip. All the other insulins I talked about need a vet's scrip.
****************************************
I'll continue later with the other 2 elements: food and urine testing. Take care Annie!!