*** WARNING: Lengthy Post ***
Hi Ash,
Did the senior panel include a B12/folate check? As I'm sure you already know diabetics may develop neuropathy because the high sugar levels affect the nervous system. Severe neuropathy causes weakness (e.g. walking flat-footed or on hocks). However, it is my thought that some cats may have sub-clinical Diabetic neuropathy can be treated with oral B12 (methylcobalamin) supplements (Zobaline or Vitacost are diabetic-friendly). I've seen a number of cats here over the last year who developed inappropriate elimination problems. Various things helped different cats:
* better-regulated blood glucose levels
* B12 supplementation
* addressing of electrolyte imbalances (potassium in particular seems to have a role in hindquarter weakness - needs veterinary input).
Our vet said it was suppost to last 12 hrs and because Tigger has been difficult to figure out he wanted to be able to get support if needed and wouldn't be able to do that with Lantus as it is made for Humans.
[Emphasis mine]
Piffle.
I know I've only seen your comments on this thread upon which to offer preliminary thoughts, but I get the impression that your vet isn't a feline diabetes guru!
It's good that he recognises gaps in his knowledge for which he would like to consult with a specialist were he to prescribe Lantus, but Tigger is not well and I think it's poor form for him to withhold a treatment that may help your cat based on such a weak argument. Here is the published, peer-reviewed Roomp/Rand study into the management of diabetic cats using long-acting insulins (including Lantus). It includes comprehensive, evidence-based dosing guidelines for Lantus. I very much recommend you take a copy to your vets and discuss it with him. It is a bona fide scientifically tested protocol so it can't be dismissed on grounds of lack of provenance. You yourself are well familiar with using Lantus and have successfully aided your other kitty into remission through its use. Try to negotiate with your vet based on the protocol document and your own expertise.
With regard to Vetsulin treatment in the interim, I think it would help you to further persuade your vet to switch to Lantus if you can provide him with solid data showing how poorly-regulated Tigger is. (The 14-16mmol/L preshot readings you quote above strongly point to Tigger's sugar levels exceeding the renal threshold for at least part of every cycle. (Are you using a human glucometer or a pet-calibrated one by the way? If it's a human meter then Tigger's 'true' blood glucose levels will be even higher.
Here's what I would do if Tigger was my cat:
1. Set up one of FDMB's spreadsheets to start recording daily blood glucose levels. Here's how to set one up. You're measuring in mmol/L so you need the World spreadsheet template. (If you get stuck with this, just shout: we can get someone to help you get the spreadsheet going. ) AMPS and PMPS are where you enter your morning and evening preshot results, and also record the dose given. The +1, +2, +3 columns after each PS are the number of hours that have elapsed between the time the dose was given and the time the test was taken. (e.g. if you test 3 hours after AMPS then that test time is (AM)+3; if you test at 7 hours after PMPS you would enter the test result in the +7 column that follows the evening PMPS and dose columns.)
2. I would test at every preshot as normal and whatever time you check for Tigger's nadir, I would also get as many +3 and +7 tests as possible for BOTH morning and evening cycles (+2 and +10 if +3 and +7 aren't possible). These tests will help you to determine the duration of effect of each Vetsulin shot and also give you solid data showing the periods where Tigger's BG levels are not regulated.
3. I would do secondary monitoring of Tigger - food consumption, fluid consumption, and urinary output. (See Glucometer Notes in member
@BJM's signature line in an earlier post for great tips.)
4. I would regularly monitor Tigger's urine for glucose and ketones. (Strips such as Ketodiastix are ideal) and record results in his spreadsheet.
5. I would make daily observations of Tigger's clinical signs (mood, lethargy, activity level, hair coat condition, body condition, weight loss (a digital baby scales is ideal for home use), inappropriate elimination, signs of weakness/neuropathy, hiding, etc.) and use the Remarks field in the spreadsheet to keep a journal of these for the vet to review. (See the first part of Saoirse's 2014 spreadsheet for the time when she was on Caninsulin (UK brand name for Vetsulin) to give you some ideas.
6. I'd present my findings to the vet with a view to getting an Rx for Lantus. As noted above you know how to work successfully with this insulin. (Sell the idea of working in partnership with the vet to get the right result for Tigger.)
In the UK vets are required by law to prescribe Caninsulin first before any alternative insulins may be tried. One has to build a case to show that Caninsulin isn't working in order to secure an Rx for a different insulin under drug cascade rules. I used the method described above to build Saoirse's case and our vet was able to prescribe Lantus for her. She's now a diet-controlled diabetic. Maybe something similar might help you build a case for Tigger.
Hope some of the above is helpful to you, and I hope you'll be able to secure the treatment Tigger needs to return him to wellness.
Mogs
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