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Voula

Voula

Member Since 2014
We have been at 2.75f units of lantus for 10 cycles now. I reduced the dose from 3 units to 2.75 units as we had a reading of 2.3/41 but we needed to then increase the dose from 2.75 units so I decided to try 2.75f units. Lucy had a dental with two teeth extracted six days ago so my feeling is we should stay on 2.75f for a while yet to see what happens as Lucy's gums heal from the tooth extractions. The vet agreed we should stay at 2.75f a while yet. Lucy has healed really well from the dental work and did great with a quick and smooth recovery from the anesthetic too.
My previous post:
http://www.felinediabetes.com/FDMB/threads/17-1-15-lucy-pmps-275-6-175-9-175-11-232-pmps-254.131569/
 
Hi Voula and Lucy!!

Do you have a follow up appointment for the vet to check out her mouth?

We don't want to hang onto a dose TOO long that's not working, but if she's still having problems with her mouth, it might not be a bad idea
 
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Chris & China said:
Hi Voula and Lucy!!

Do you have a follow up appointment for the vet to check out her mouth?

We don't want to hang onto a dose TOO long that's not working, but if she's still having problems with her mouth, it might not be a bad idea
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Hi Chris. We saw the vet today and the only issue after the dental is a little bruising but the vet said everything is good now. I guess the concern is if 3 units caused too low glucose levels would going back to 3 units again be wise? Then again the glucose levels are too high at the moment.
 
Just becasue 3u was a little much before doesn't necessarily mean it will be too much now, I don't think I'd be waiting any longer to increase but let's see what others have to say.

Serryn
 
Serryn is totally correct...that was my concern too

If the vet says she's pretty well healed up, I think I wouldn't wait too much longer to go ahead and increase

Cat's insulin needs can (and do) change, so you just follow the protocol according to the numbers you're getting
 
Chris & China said:
Serryn is totally correct...that was my concern too

If the vet says she's pretty well healed up, I think I wouldn't wait too much longer to go ahead and increase

Cat's insulin needs can (and do) change, so you just follow the protocol according to the numbers you're getting
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Thank you Chris.
 
I was thinking that maybe Lucy's possible arthritis may be affecting her blood glucose levels too. The vet thinks Lucy may have arthritis and that I should think about giving Lucy some medication for that. But she has only offered metacam and I am very anxious about that despite the fact that a recent study done by an Australian feline vet shows it is safe for long term treatment in appropriate doses. The vet said that vets here haven't seen the problems from metacam that vets in the U.S. have seen because vets here give smaller doses. I don't know. I wonder what else there is to try before metacam.
 
I agree with the others, time for an increase. You don't want to hold a dose for longer than 6 cycles if she's only seeing yellow nadirs. From the protocol:
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
Click to expand...

My Neko has arthritis too. There are several things you can do before going to Metacam. Before trying pain control, there are options for helping the joints that have arthritis. Fish oil (for Omega-3) is an anti-inflammatory and you can add that to each of her PM and AM meals. Not sure what types are available in Oz, but I've used both salmon oil and now I'm using something that contains herring and sardine oils. They are available in pet food stores here. Glucosamine chondroitin can also help. Here I can get it in Cosequin (available from the vet) or you probably get something at pet food stores too. Hyaluronic acid is another additive I'm using, specifically Hyaflex. Yet another medicine that I've seen others from Australia use is Cartrophen. Neko's getting an injection once a month for that. It does have a loading period where injections are more frequent. That's also something you get from the vet. It's specifically for dogs (and horses) but also used for cats. I get syringes preloaded from the vet and inject them myself. In the US, they use a very similar medicine call Adequan - it's not available in Canada, don't know about Australia.

Finally, once you've exhausted the above options, pain control is next. Neko is on a maintenance dose of buprenorphine, given twice daily. I get a vial with chicken flavour from the compounding pharmacy. They use Metacam in Canada too, some vets are less eager than others to try it. Even Neko's vet who is fairly conventional doesn't have it on her list of drugs to try. Her suggestions in order were bupe, gabapentin, then tramadol. I recently looked at the FDA list of complaints for veterinary drugs for felines and noticed half of them were for Metacam.
 
Wendy&Neko said:
I agree with the others, time for an increase. You don't want to hold a dose for longer than 6 cycles if she's only seeing yellow nadirs. From the protocol:


My Neko has arthritis too. There are several things you can do before going to Metacam. Before trying pain control, there are options for helping the joints that have arthritis. Fish oil (for Omega-3) is an anti-inflammatory and you can add that to each of her PM and AM meals. Not sure what types are available in Oz, but I've used both salmon oil and now I'm using something that contains herring and sardine oils. They are available in pet food stores here. Glucosamine chondroitin can also help. Here I can get it in Cosequin (available from the vet) or you probably get something at pet food stores too. Hyaluronic acid is another additive I'm using, specifically Hyaflex. Yet another medicine that I've seen others from Australia use is Cartrophen. Neko's getting an injection once a month for that. It does have a loading period where injections are more frequent. That's also something you get from the vet. It's specifically for dogs (and horses) but also used for cats. I get syringes preloaded from the vet and inject them myself. In the US, they use a very similar medicine call Adequan - it's not available in Canada, don't know about Australia.

Finally, once you've exhausted the above options, pain control is next. Neko is on a maintenance dose of buprenorphine, given twice daily. I get a vial with chicken flavour from the compounding pharmacy. They use Metacam in Canada too, some vets are less eager than others to try it. Even Neko's vet who is fairly conventional doesn't have it on her list of drugs to try. Her suggestions in order were bupe, gabapentin, then tramadol. I recently looked at the FDA list of complaints for veterinary drugs for felines and noticed half of them were for Metacam.
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Thank you so much Wendy. That is all very good information. I am fattening up the 2.75f unit if that makes sense because many of the 2.75f units were probably closer to 2.75 units due to a recent pack of syringes where the plunger was harder to move and so I probably gave closer to 2.75 units and maybe even some 2.5f units doses too. I would try to move the plunger and it would go way past the 2.75f units and I lost count of the number of syringes I discarded and so I would get frustrated and sort of make do with the closest I could get to the 2.75f units. So from this morning I am discarding any syringes with plungers that are hard to move and picking ones in which the plunger moves easily and I will order some new packets of syringes too. I am filling the syringe maybe a drop less than 3 units and see how we do with that with the plunger of the syringe just over the 3 units line and I will see what happens with that dose for a few days. I was probably being a little cautious too because of the recent dental work too. I will definitely get the supplements you mentioned and ask the vet about cartrophen too. I guess I would like to make sure that Lucy has arthritis before using cartrophen. Did you have any xrays done? I was thinking earlier I should have asked the dental vet to take some xrays while Lucy was having the dental done. Lucy has also had a couple of soft tissue injuries a few years ago which may still be flaring up at times too. Thank you again.
 
It's a good idea to get X-rays done. I did get them done for a previous cat. And they found even more when they were X-raying his heart. Having said that, I didn't get them for Neko. One of the common symptoms of acromegaly is arthropathy (a type of arthritis) and it's pretty obvious from the way she moves.

For supplements, you might want to try one at a time so you know what's working or not. Give each one a couple of weeks to see if it's having an effect before adding the next. Fish oil/omega-3 is a good one to add anyway.
 
Wendy&Neko said:
It's a good idea to get X-rays done. I did get them done for a previous cat. And they found even more when they were X-raying his heart. Having said that, I didn't get them for Neko. One of the common symptoms of acromegaly is arthropathy (a type of arthritis) and it's pretty obvious from the way she moves.

For supplements, you might want to try one at a time so you know what's working or not. Give each one a couple of weeks to see if it's having an effect before adding the next. Fish oil/omega-3 is a good one to add anyway.
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Thank you Wendy. Okay I will try one supplement at a time.
 
I believe that recent study on low dose metcam only involved 12 cats and was only over a short term. My substitute vet tried to tell me about it too but when I wanted to see a copy of the study she could only produce a one pager on it which said stuff all, to my knowledge it hasnt been published yet.

My first port of call for arthritis (does she seem to have pain - maybe limping or not jumping up on things?) would be a cat specific glucosamine/chrondroiton supplement. Do not use a human blend like you can for droolers. The mix is wrong for cats and suspected of causing diabetes - the prime suspect in Vyktors case.
 
Hi Serryn. I think Lucy has some discomfort with walking because of the way she walks and she doesn't jump up on things like she used to. She still can jump but she seems not to do it as often. Do you know of any cat specific glucosamine/chondroiton supplements as I have been trying to find some. The study I read involved 38 cats over four years and was a retrospective study conducted by an Australian feline vet. The link to his report is at the end of this message. He concludes by saying no significant conclusions involving such a small number of cats can be made along with some other limitations of the study but his study showed that elderly cats were given meloxicam/metacam for a long period of time with few adverse effects and no obvious effect on renal function compared to renal function of cats of similar age who had not been given meloxicam/metacam. I emailed him a while ago and he seems genuinely passionate about helping older cats manage chronic pain. The other argument that our vet made is that in the U.S. the prescribed dose is too high and that the pharmaceutical company in order to make a profit has cited this dose and that vets here use 60% of the dose used in the U.S. I don't know with all the negative stories on the internet it makes me very anxious to use this medication. On the other hand I can see that Lucy's walking is getting worse and I don't want her to be in pain. She could also have diabetic neuropathy as I think now she may have had mild undiagnosed diabetes for some time before she was diagnosed with diabetes. I would like to try alternatives to medications first so I will buy some supplements and start with those and see how we do. I also have buprenorphine to try too which might be worth a try to see if Lucy's walking improves with it. I will speak to our vet again too. Thank you again.
http://samedicine.anzcvs.org.au/sam...ti-inflammatories in cats - richard gowan.pdf
 
My thinking is to start with the least problematic approach and go from there. Cosequin, if available in your area, is available in the US on Amazon. It is not prescription. Serryn may know of a glucosamine and chondroitin source in Australia. Omega-3 is also good providing that Lucy is not allergic to fish. Check with Ella/Rusty for an alternative to a fish oil product.

If you are concerned about neuropathy, methyl B-12 will help. Here, we use Zobaline with is available on the internet and is a form of this vitamin that's formulated for diabetic cats.

If none of the supplements seem to be helping, then it may be time to consider prescription alternatives.
 
Thank you Sienne. That is what I will be doing. So with the fish oil do I buy one for people and give a smaller dose? There is an omega supplement that is for cats but it is flax seed oil and I have read that fish oil is best. There is a joint support powder but it says it is for dogs. http://www.vetsallnatural.com.au/index.php?option=com_virtuemart&Itemid=127
I will have to order the zobaline online as methyl-B12 seems difficult to find here in Australia. It seems cosequin is available but the bottle says for dogs. I will have to find out if it is okay for cats too. http://www.ceva.com.au/Products/Products-list/COSEQUIN-R-DS-Capsules
Thank you again.
 
Here is another product available in Australia and in the description it says not to use human formulations as the incorrect ratio of glucosamine and chondroitin has been suspected of causing feline diabetes. I am posting the links to products I find for other Australians too.
http://www.jointguard.com.au/cat-section.php
 
Some difficulty standing and walking may be seen with diabetic neuropathy and with electrolyte disturbances which may happen with diabetes. Since you're still working on regulation, those issues may be happening.

Methylcobalamin (methyl-B-12 vitamin) can help with the former; you want one that is safe for cats, with no added sweeteners. Tests identifying any of the later result in treatment with the necessary mineral supplement, such as potassium.
 
BJM said:
Some difficulty standing and walking may be seen with diabetic neuropathy and with electrolyte disturbances which may happen with diabetes. Since you're still working on regulation, those issues may be happening.

Methylcobalamin (methyl-B-12 vitamin) can help with the former; you want one that is safe for cats, with no added sweeteners. Tests identifying any of the later result in treatment with the necessary mineral supplement, such as potassium.
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Thank you BJM. When Lucy was first diagnosed with diabetes she had low potassium and I gave her potassium supplements and the last two blood tests in the past month and last week showed normal potassium levels so we know that is not the cause now. When we first started on potassium supplements I thought her back legs did improve a bit but the symptoms remain so I will order some zobaline and try that too. Thank you again.
 
Zobaline can make a huge difference in some cats.

As to your question about the fish oil - you prick the capsule with a pin or skewer, then squirt the fish oil out onto the food. I don't know what the dosage would be on it, but i do think fish oil would be better for cats than flax seed oil. not research-based, just opinion, but cats are carnivores so i would lean towards meat of any kind over a plant.
 
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