Poncho diagnosed diabetic 1/15

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christoph

christoph

Member Since 2015
Hello. Poncho is 14 1/2 neutered male Tabby I've had since I rescued his litter at 3 weeks old. His food has been mostly premium dry food with a spoonful of wet x2 daily and he has been a grazing cat. I took Poncho in due to little appetite and rapid weight loss and the sniffles. I noticed this right after my oldest cat, who he was close to, died of old age Jan 1.....and like an idiot I thought he was grieving. He was diagnosed diabetic with possible pancreatitis. Since diagnosis his appetite was a problem but was immediately switched to canned food. Starting out he was put on IV fluids for 1 1/2 days and sent home with Prozinc @ 1 1/2 units x 2 daily. Unfortunately I was never made aware that a certain food he had a taste for was never sent home with him and I struggled to feed him for 4 days until I had to get him back in due to me not being able to get his appetite up and he was very lethargic. During those 4 days I talked to 2 other vets there who were on duty and they just advised warming his food or sprinkle cheese on it and either don't give him insulin or give him 1 unit depending on the BG reading (using Relion Confirm)......no mention of the food the original vet wanted him to go home with. During this time Poncho never vomited but they said his initial bloodwork before the IV treatment showed trace ketones. Anyway they did an ultrasound 1/20 and his pancreas was inflamed and he had some lipidosis so put him back on IV and 3 day pain injections for 4 days and I visited 3-5 hours per day to keep his stress down and he seemed to eat better with me feeding him. During this time mucous formed from his left eye and I was told it was probably due to stress. Saturday at 2:30 he was sent home. I still had to struggle with the appetite issue and his BG was always between 350 and high 400s with a couple @ 155 and 167 (before I found this site). This went on for 10 days with his appetite picking up well but then I noticed on the 7th day he would be hungry but walk away after sniffing his food. He also started to show some nasal stuffiness and the left eye was showing mucous and sensitivity. I figured he couldn't smell his food (Friskies chicken, turkey pate) so bought some seafood flavor......he sniffed and ate well. I had to wait 3 days to see the vet again for some antibiotics and glucose curve. The night before I took him for his 1st curve his BG was379. The next morning before I took him it was 60 so I rushed him in. They said he was hypo and had an upper respiratory infection and proceeded to do a curve after force feeding......no success. They said said my meter was way off up and down compared to theirs and they were stumped due to erratic and low readings. Sent him home again and said no insulin and would try the curve 1st thing the next morning. He ate fine that night and before I took him in next day. When I picked him up the vet said she had the same problems. His morning preshot BG was 379 and afterward next test was 166 then next it had dropped to 37. She said he needs to see a specialist or consider euthanasia. I said I'd prefer to let the antibiotic take out the upper resp. infection and then see what happens. She said no more insulin and to come back after the 10 days of antibiotics to try a curve again unless he crashes again then I guess that's it. I think his pancreas is trying a come back but the infection a a big monkey wrench. Anyway I might drive Poncho 250 miles back to his old vet in St Louis who treated his sister for diabetes successfully. I'm waiting for him to call me back. Does anyone here have any ideas on this.....it's stressful and confusing as heck. Thank you. Chris


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Welcome to FDMB,

It seems your on the right track. Its always tough trying to treat different things because they all play there own part. First things first is to get rid of that infection, infection raises bg. Your vet is saying the numbers are off because they use a pet specific (most likely) meter. A lot of vets seem to be against human meters. This is a difficult thing because of the ketones. If it wasnt for the ketones, IMO i'd say give the antibotics a few days to do its thing and find a food that he'll eat thats low carb and no dry food. Stress, infection and diet can drastically raise bg. You may also want to try to do a curve at home, theres really no need to take him to the vet to do a curve. All it does is stress him out and raise his bg (especially if their trying to force feed him) not to mention cost you more money. As to the appetite, you can ask your vet for fortiflora (you can also buy it online as well), it can help or you can try something like bonito flakes or even tuna juice.

Hopefully someone with DKA experience will pop in soon to give some advice about dosing.
 
Hi and welcome

Have you seen the IDEXX article on managing pancreatitis.

https://www.idexx.com/files/small-a...pec-fpl-treatment-for-feline-pancreatitis.pdf

One of the supportive meds that I have found the most useful is not an appetite stimulant as mentioned in the article but an anti nausea medication such as ondansetron or cerenia. An appetite stimulant can also be given but you also need to address the nausea. Could you just phone and ask for the vet to prescribe it without having to go back in.

I am not sure that leaving off the insulin is the best thing if he has ketones? But perhaps I misread that.

When was his last insulin shot ? What is his reading now? Did the vet not suggest lowering the dose rather than just stopping?
 
Hi Chris, and welcome to FDMB.

It sounds like you and Poncho are having a tough time of it. (Big (((hug))) to you).

Are you monitoring Poncho's pee for ketones at home? (Sorry if I missed that bit). You can get Ketostix or Ketodiastix (or equivalent) from a pharmacy. They are to be dipped into fresh pee. (Oh, what we do for our kitties....:rolleyes:)
Here's a page of pics and info about how to do that:
http://www.sugarpet.net/urine.html

Regarding the steep blood glucose drops after insulin, it may just be that the insulin dose was too high for him. Some cats only need small doses.

Keeping fingers and paws crossed that things improve soon for your boy. Please keep us updated.

Best wishes,

Eliz
 
That low number post-shot automatically earns a dose reduction of at least 0.25 units. You'll have to eyeball it as no syringes measure quarter units.
 
Thank you all for your prompt helpful replies. Before I took Poncho home last night he was given cerenia and a B12 shot. The last few days his appetite has been much better since I started giving him fish flavored pate instead of chicken (no dry food for 2 weeks now). I think the smell cut through his sinus issue. He hasn't had any issue with vomiting and his BMs have been normal (solid). The vet made no mention of home testing for ketones. I'll ask about that tomorrow. I did get a call back from my old vet and he said to continue with the antibiotics as prescribed and give sub cutaneous fluids (the other vet is going to have that ready to pick up tomorrow) and in a couple days test his BG again. He thinks he might be transient with the diabetes. This infection is complicating things and if need be my old vet said to make the drive and he'll check him out. He is sneezing less and his eye is better tonight. I'll update as we go. Thanks again......great site!
 
You can test with urine test strips; you don't need the vet's permission. You get them at the pharmacy; they may be behind the counter.
It is helpful to make sure there are no ketones. They form as a by-product of fat breakdown for calories. Too many ketones may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat, complication of diabetes.
See my signature link Secondary Monitoring Tools for other assessments which may be helpful too.
 
Glad to see that Poncho got a B12 injection. It is very much worth following the IDEXX recommendations to have a course of B12. They really help with pancreatitis.
 
Pancreatitis can interfere with normal GI absorption which results in less vitamin B-12 being absorbed. That is why a B-12 injection helps; it by-passes the GI tract and goes right into the body.
 
Tomorrow I'll pick up the test strips for ketones and get started on that. When I pick up the fluid bags/needles I'll get the BG numbers from the curve attempts and comparison numbers with their meter and my Relion so I can start testing again with some reference as a guide. I hope I didn't buy a "lemon" meter. I don't like the idea of stopping the insulin if it's needed and if I get a high BG reading the vet will have to ok at least .25 unit I would think. Unfortunately she wont be there so one of the other vets will have to ok resuming insulin. Seems like a "catch 22". For 2 weeks I've been giving 1 1/2 units and only until Tues and Wed was there a sharp post shot BG drop. I hope his next BG is in the normal or low/safe range. Thanks BJM for the very informative links.
 
First thing this morning I noticed Poncho straining in the litter box to go so I called the vet clinic and they said to come get the fluids right away and after fluids and syringe feeding ad critical care he should loosen up. I don't think it is urinary since he went last night a good amount but last BM was Wed night. I'm having them fax all lab work and vet notes to my old vet in St Louis and asked his office to have him review it all and if he thinks he can work with Poncho I'll get him there Monday am. I just have to get him out of the current mess and I want to still test his BG but they said his BG on my meter was up to 100 points higher AND lower than the reading on their meter, so I guess I can still test but will have to consider that the reading could be 100 pts either way and if its lets say 400 I could safely give him .25 - .5 units? I still have to get the ketone test strips later today. Any thoughts? 5pm: Ok got the test strips. My old vet asked me to have the clinic do a BG on Poncho to see where his level is after 2 days and they seemed not to want to do anything else for him.....see a specialist or euthanize him is their view. Probably has a little to do with the fact I'm low income on a disability pension and they don't think they'll ever get paid.....which is wrong. I syringe fed earlier and gave fluids. He did leave a marble sized piece of poop but threw up a little of the ad food I had just given him. I got some MiraLax so will put some in his syringe feeding food. I called the clinic again and they'll do a BG in the morning (reluctantly) and then call my old vet's clinic and hopefully another vet will be able to guide me since Sat is his day off.....great timing! Starting to feel hopeless about this.
 
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You are doing fine. Don't lose hope. We can help you also.

Were they using an alphatrak meter? These are feline specific ones and do read different from the human ones we use here but that isn't a problem. I think they have gotten a little confused or confused you

You are using a relion confirm aren't you? They are usually fine. Perhaps others using it can comment on whether they have found their readings off but I haven't heard mention of it. Meters are only meant to be a guide rather than complete accuracy but you did the right thing, a quick drop is entirely possible if the dose is too high.

If you want to take a reading in the morning when you would normally give a shot or whenever you want then post here asking for advice on dosage. I am sure we can help. I do think that if he high then a small dose might be advisable as long as you are able to monitor and have the high carb gravy, honey or karo to cope with a low. The trouble with taking him to the vet is that his blood glucose will go up anyway. What is he reading now?

Have you read the prozinc protocol? Their suggested starting dose is 0.5 to 1 unit. I just wonder if your starting dose was too high.
http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

If you want advise once you take a reading then I think you should change the title of your original post by going back to the top and editing the thread. Change it to prozinc dose advice now required or something similar but I agree with you if in the 400 or even lower then I would give the 0.5 dose.

The miralax should help him go. It might take a day or two. I used to give 1/8 teaspoon per day or even twice a day in food or water.
 
You are questioning your meter, so you may find my signature link Glucometer Notes enlightening. It includes feline-specific reference numbers for human glucometers. You may want to share it with your vet.
 
Yes, phlika29, I'm using the Relion Confirm. He hasn't had insulin since Wed when they tried the 2nd curve with no success. When I took him home that night the vet said no more insulin.....she had given him 1 unit when the drop occurred. They started him off with 1 1/2 units twice daily, which he's been getting for over 2 weeks until last Monday night when Tues morning BG was 60 on the Relion after 379 the night before pre-shot @ 1 1/2 units. I'll post the chart on his BG and injections since his stay in ICU. I just syringe fed him with the ad and 1/8 tsp Miralax and 1/4 tsp or less olive oil. Right now I'm waiting for him to pee so I can test for keytones. Should I do a BG test tonight or wait for morning here....I agree taking him to the clinic will be too stressful, hence inaccurate even with their meter (don't know what brand) and not feeling that welcomed since they threw the towel in. He's had a stressful day and I still have to syringe feed him again, unless he eats enough on his own, so his BG will probably be elevated due to that, however I would like to get a reading and insulin in him if needed. I'll edit my title after I test BG and keytones. Thanks for your help and encouragement.
 
I would do a test tonight and one tomorrow. The more info the better at this point. Just make a note of when he last ate in relation to the reading. If you could list them all out that would be useful. List the tests, the dose and whether he was at home or at the vets.

You want a dose that just helps support his pancreas without it dropping too low. He needs to be eating and drinking as well. If you have to assist him with that so be it. My one concern is that the cerenia injection will wear off soon and if he is still feeling sick he may stop eating. Carefully syringing water into him will help a little (or sub q's) and help ward off ketones but you ideally want to continue with an anti nausea medication. Can you get so e tablets off the vet to see you over the weekend without having to take him back in?

If the ketones show anything over trace amounts you will need to take him back to the vets as it can become dangerous very quickly. As I mentioned before to help ward ketones off you need to ensure a cat has enough water, food and if required insulin (hence the need to continue to monitor blood glucose).

Just be careful with the olive oil. Some cats with pancreatitis can be fat sensitive. I would just stick to miralax from now on.
 
christoph said:
... they seemed not to want to do anything else for him.....see a specialist or euthanize him is their view. Probably has a little to do with the fact I'm low income on a disability pension and they don't think they'll ever get paid.....which is wrong. ...
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Hi Christoph,

I am so sorry that these particular vets are behaving that way towards you. I've been in a similar predicament and it's horrible for you and Poncho to be treated like that. I think it's awful the way some people automatically assume the wrong thing, and where they are so focused on dollar signs they lose sight of compassion.

(((Christoph)))

Starting to feel hopeless about this.
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Thankfully you've found FDMB, and there are some very knowledgeable people here who will help you and also there is so much you can learn here to help your kitty. In spite of the questionable response you're getting from your current vets, you're not alone with this, OK? :)

Re anti-nausea support, Sarah's advice is spot on.
.
 
His keytones are very high -80- so I'm taking him to the er.....I'll have to say good bye to him since I don't have the funds anymore esp with the er prices. Any other suggestions before we take off? I'm at a loss.
 
I have so little experience that I have no direct advice to give you. My heart aches for you in such a predicament. (((Christoph and Poncho)))

I do have one bit of advice, though. Post a new thread and choose the prefix 911. Put a title like "Ketones High and Worried about ER Tx Costs - Please Help". Maybe some of the members with experience of ketone problems might be able to offer valuable advice.
 
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I've posted on one of the other boards asking for help, Christoph. I hope that you'll get replies here (or on a 911 thread if you create one). I'm so sorry that I can't do anything more to help you both.

(((Christoph and Poncho)))
.
 
I'll keep him here for more advice.I had just given him fluids and he urinated in the box on top of a sheet of plastic wrap so I dipped a strip and it immediately turned to a high dark color. Bg test was 378
 
What is his current glucose level? - 378 mg/dL about 11 pm Ohio Time
When did you last give insulin and how much?

Depending on his glucose level, you may need to give him some more insulin, along with the fluids you have to help flush out the ketones.


Also, have you got a spreadsheet of his numbers in any format you can share?
 
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I just gave sub q. BG was 378 on Relion Confirm Last insulin was Wed afternoon @ 1 unit which caused a drop to 37. What dose .5?
 
What did it drop from - the total drop for the dose is what I need.

Ah - I snipped that into Notepad
"preshot BG was 379 and afterward next test was 166 then next it had dropped to 37"
- that was a drop of 342 points, if the testing equipment was lab equipment. If it was a hand held glucometer - human or pet - they are allowed to read +/- 20 % from what a lab would get.

Yes, I would give 0.5 units of insulin now.
 
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How is he behaving? Eating, drinking, peeing, pooping, playing, purring, preening/grooming? He is more than a glucose or ketone number.
 
The vet said curve preshot was 379, next BG was 166, 3rd BG was 37 He's lethargic....more than usual.....sleeping.
 
Do you know if it was a lab machine that did the determination, or a form of hand held meter?

That was a drop of 342 points, BUT:
If the testing equipment was lab equipment, I'd think it accurate.
If it was a hand held glucometer - human or pet - they are allowed to read +/-20 % from what a lab would get.
 
I don't know, but when he was in ICU the techs used a hand held meter. They might use lab machine for curves
 
Going to give him .5 injection. I'll be up all night of course to monitor. Shot given 10:45
 
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These are all the tests you've reported. Without specific times, it is a tough to see what is happening.

"his BG was always between 350 and high 400s with a couple @ 155 and 167"
- using glucometer

"The night before I took him for his 1st curve his BG was 379."
- using glucometer

"The next morning before I took him it was 60"
- using glucometer

"His morning pre-shot BG was 379 and afterward next test was 166, then next it had dropped to 37"
- could have been a lab machine OR a glucometer
- This seems to be a curve, and if so, the tests would likely have been 2 hours apart. If so, we can list it like this:
AMPS ~ 379; 1.5 units ProZinc
+2 ~ 166
+4 ~ 37

Tonight: 378 mg/dL about 11 pm, No insulin on board
- using glucometer
 
If the curve they did was based on 1.5 units of ProZinc and that dropped him about 342 mg/dL, 0.5 may drop him in the ballpark of 100 mg/dL, although it doesn't follow the math that exactly.
If you can test about every 2 hours just to see what it does, we'll get a feel for how he responds.
This should help with the glucose and ketones a bit, and may perk him up. Recall how you may have felt after eating way too many carbs, if you every did that - lethargic is a common after effect.
 
Chris

A couple things to consider:

  • If he's not eating and he gets insulin, his BG will drop. It doesn't necessarily mean the dose is too high. However, I have never used PZI and would not begin to offer dosing advice. It's critical to get food into him but you have to treat the nausea first.
  • Diabetic ketoacidosis is very serious and can be a fatal condition. It occurs when there is not enough insulin + infection + not enough food/water. If he's throwing ketones that high, he really needs to be in a good hospital that understands how to diagnose and treat high ketones and possibly DKA.
  • If he also potentially has hepatic lipidosis from a decreased amount of calories, it would be best to also discuss with the vets the possibility of a feeding tube. These cats need lots of fluids, lots of calories, and the right amount of insulin.
Have you ever applied for Care Credit?

I know funds are limited but if you can get some assistance through Care Credit, you could get him to an ER....which is where he needst to be. We've had many cats here survive high ketones, DKA, and hepatic lipodosis. With ketones that high, I'd want him in the hospital getting IV fluids.
 
christoph said:
I'll keep him here for more advice.I had just given him fluids and he urinated in the box on top of a sheet of plastic wrap so I dipped a strip and it immediately turned to a high dark color. Bg test was 378
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Treating any more than TRACE ketones at home is not recommended and is highly discouraged. Amongst other things, Poncho needs an IV treatment that includes electrolytes.
Is there any way you can get him into an ER tonight?

Sometimes a vet will work together with an ER by allowing the caregiver to hospitalize kitty over night at the ER and then releasing kitty to the vet for daytime care... returning again to the ER for treatment over night. This arrangement will help reduce costs.

Tomorrow you could try organizations listed in our Financial Help Links.


KETOACIDOSIS:
DKA cannot be treated at home. Veterinary care for DKA involves intravenous (IV) fluids to flush the animal's system of the ketones and when necessary, to replace depleted electrolytes[19][20][21], such as bicarbonate; intravenous or intramuscular fast-acting insulin to bring the blood glucose levels down[22][23]; measured amounts of glucose or force feeding, sometimes by feeding tube, to force the metabolism back from fat-burning to glucose-burning.

Dehydration becomes involved with ketoacidosis, which can mean that subcutaneous insulin injections are not properly absorbed; when this occurs, intravenous treatment with soluble, short-acting insulin is needed[24],along with rehydrating intravenous fluids[25].

Veterinary care for DKA may involve a hospital stay of five days or more and cost, in the U.S., $2,000 or more. Some animals are DKA prone, and may have multiple episodes of the condition.

Veterinarians have sometimes been known to send pets home from a DKA episode while still displaying ketones in the urine due to owner financial constraints -- this can turn into a fatal mistake. Your chances of fixing the problem yourself are slim. If your cat or dog comes back from the hospital and still has ketones showing on urine testing stix, it's usually best to find the financial means to go right back to the vet's as your pet may need to stay in hospital longer.


Just thinking out loud...
 
And to Jill's and my posts, I'll add one other thing. The vets can give him the appropriate dose of a short acting insulin and they can give it more often than the PZI to help bring and keep the BG down.
 
Ketosis does not automatically mean diabetic ketoacidosis; you will need a vet to determine that with some blood work.

Does his breath smell like vinegar or fruit? Two of 3 types of ketones may be detected by smell.
 
BJM said:
Ketosis does not automatically mean diabetic ketoacidosis; you will need a vet to determine that with some blood work.
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KETOSTIX.JPG

When kitty is throwing "Large" ketones... noted by the caregiver as "high dark color", a vet should be consulted immediately if at all possible, no?


EDITED TO ADD:
In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day.
 
And I said you will need a vet to determine it by blood work.

And previously stated on a different thread (there were about 4 of them) that having the vet determine what the condition was, was the 1st step.
 
Can't do Credit Care. I have no established credit and my disability pension is only $1072 per month before rent etc. My SPCA vet bill so far is over $900 although they are letting me pay it $100 monthly. Time is not on our side for researching grants, etc. I'll pray and check BG every 2 hours and be at the vet clinic when they open and see what they want to do which more than likely euthanize. They had already given me 2 options....a specialist clinic, which I can't afford, or euthanasia. I guess they were right but I thought Poncho was getting better until the curve attempts and I thought the drops were his pancreas starting up.
 
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Poncho has large ketones and is "lethargic....more than usual.....sleeping" and not eating well. That's not good.

I'm not there. I haven't talked to the ER. If you called them to explain Poncho's current condition perhaps they could work details out with you in the morning?
I know, I'm grasping at any hope, but he really needs to be hospitalized if there's any possibility at all...
 
Where are you located (250 miles from the old vet in St Louis is quite a range!)?
 
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Christoph, sorry, but I've got to crash. I'll check back when I wake up.
Hoping this works out for you.
If you're up, start a You Caring fund raiser online and if you have Facebook, share it everywhere. It may help you generate some funds to help with the bills.
 
I've started a You Caring fundraiser but I'm still trying to get it finalized....not computer savvy.....I never knew that type of thing existed. Thank you for that link and help, BJM. I'm in Kansas City, MO.
Critter Mom, Poncho's sleeping and I'm getting ready to check his BG again. I'll be up all night with him.....thanks and I'll keep updating. I'm going to look up an emergency clinic.....but my dealings with them in the past has always made me sick with their greed.
 
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