Wynk... Something is up...

[Cara and Wynken (GA)]

I was thinking about writing a post this weekend about how after years of being an exemplary diabetic, Wynken seems to be growing tired of me poking his ears. I got to thinking, though, about how I *used* to test him only very occasionally…

I have been poking him almost every time I spend time with him, now for several months. I had noticed before I left on my trip last week, he almost wouldn't hold still for the blood testing. This is so unlike him! Since I returned late Friday afternoon he has also been pretty averse to me getting blood out of his ear. He barely allows it, anymore.

However, this didn't seem like a huge or insurmountable problem… So I decided not to make a post about it. I just decided I would have to start giving dried meat treats, or more affection (which has always been his favorite form of reward.)

However, last night something happened that really never happens… He didn't want his meal. I tried adding Fortiflora but he kept sniffing and walked away. He just seemed like he wanted to rest on the bench next to the window and gaze out of it placidly. Then I offered 100% Wellness (he loves that!) and he nibbled... but left it mostly alone. I had already shot 2u insulin ( because that's what I always do as soon as I set the plate down and he starts eating… ) so I checked him a couple times. He was high...

99.999% of the time he begins eating as the plate lands, and walks away only when the plate is clean, or if he does walk away he comes back and finishes it within about 20 minutes, tops! I am certain about this because that's about how much time I allow before I go back in and let his sister out of her enclosure, where she eats by herself now.

I was SO sure (hoping!) that it was a passing thing...and that this morning he would eat.

However, he remained completely uninterested. So I took the regular food away and offered him tuna and shrimp fancy feast. He's never had that, but I bought it because it was zero carb. And I thought it might come in handy someday. So he began to eat that with some amount of gusto (whew!) and I shot 2u. About 30 seconds later he stopped eating it and went to look out the window again.

In between the regular food (that he didn't eat) and the fancy feast, I gave him 1/4 of a Pepcid AC in case he's nauseated. This is also something he's never had before, but I use it with my kidney failure kitty.

Needless to say I will be running home at lunch to check on his blood sugar. This is just so incredibly unusual. I don't know how anyone is managing that has a cat with unpredictable appetite. I'm thinking of Carol & Murphy...

I am scared.

 

[Sue and Oliver (GA)]

I hope the Pepcid does the trick. There are just so many things that can throw them off their food, including just grumpiness, having tasted a little something off, a small tummy upset.... If it continues through the night, maybe a quick trip to the vet tomorrow?

 

[DianeM &Shadow]

Oh, boy. That is very upsetting. Perhaps, if you haven't, it's time for a vet check? I went through something similar years ago with Asia. I think part of his refusal was that he was feeling crappy with his renal situation worsening etc. He also had a UTI and a touch of pancreatitis. At any rate, it will be interesting to see what his lunchtime number is!

 

[Sparkle]

Oh Wynk, please feel better so your bean can feel better too.

 

[Cara and Wynken (GA)]

Well, he's right around 250 at lunch… So that probably is because he didn't eat very much this morning and I still gave his insulin. Pretty far from hypo, although I'll try to get home early just in case.

Dr Gilor from OSU called just as I was pulling up to the house here at lunch and let me know that he does not have acromegaly. YAY!!! His results were only 44. Which is low.

He feels we've ruled out any major cause for Wynken to be acting weird on prozinc. So he's going to call the Levemir prescription in for me. He insists on me using the pen to give exactly one unit for one week. And then do a curve. So I will do that until I feel I can't do it any longer… LOL! I suppose it is possible that Wynk will have optimal dose at some integer increment of units ?

We talked more about the accuracy of using syringes and he's going to send me a study that shows how inaccurate it is. I will pass that along or post it when I get it. Not that I expect it to change what anyone is doing… But it might be interesting!

I have to go back to work, and I decided to not offer him any food since he's in the 200s, but I did give him a handful of dried origin treats. It's basically just freeze dried meat. And he was very interested and ate them all up! So maybe we're OK.

 

[Cara and Wynken (GA)]

Oh! And for @Carol & Murphy : I did ask him to remind me about why we chose Levemir . And he said it would have the most consistent response in the cat. Including exactly when the low would occur in any cycle. He said that at a given dose, the cat's BG would behave predictably day after day as long as nothing else varied too much.

 

[Carol & Murphy (GA)]

Cara - thank you so much for the information
Today was eventful as Murphy dropped to 82 - he is so unpredictable I never know, all things almost exactly the same, whether he will drop to a green, blue, yellow or pink
Oh Cara, how I feel for you and the food issue. It's terrifying. I guess you would tell us if there is anything out of the ordinary with him - he had a full lab workup at OSU, correct? Check for ketones? Is he dehydrated? UTI probably always a possibility In the absence of that, I would do what you are doing - pepcid, and then offer a wide variety of food. Maybe offer something different -with Murphy's issues, I offer the full gamut - different variety of kibble including Young Again, Evo, Epigen 90, Waggers (a semi-moist no starch food @Merlin found) and then a few different varieties of canned. Sometimes he won't eat anything except for the less favored food (the prescription diabetic diets) I don't shoot him until he has finished as much as he is going to eat on his initial eating (he rarely finishes anything at first pass- usually just a few tablespoons at a time) and for me, I now have a low threshold for giving him an appetite stimulant due to his GI pathology
If i were you, I'd begin offering something different and I know that this is hard to hear right now - as you are about to change insulin, but lay off testing so much for a while A few months ago, Murphy was like that - wouldn't tolerate ear pokes at all and mad at me all the time - I backed off testing big time between doses. Now he is fine again Looking back, he was probably not feeling so well with pancreatitis and IBD issues. Please keep us updated

 

[Jill & Alex (GA)]

We talked more about the accuracy of using syringes and he's going to send me a study that shows how inaccurate it is. I will pass that along or post it when I get it. Not that I expect it to change what anyone is doing… But it might be interesting!

Your vet is right about the pen being more accurate for measuring whole unit doses. Syringes... any syringes, even u-40 syringes... are known for their imperfections. We've seen them to be "off" by as much as 0.5 unit. Using the pen to dose is all well and good when the dose is given in increments of whole units. Trouble is we adjust doses in increments of 0.25 units. The pen can't do that... so we opt to use syringes.

These days, many use calipers for consistency when dosing. Others, like me have simply eyeballed doses. You can see from Alex's spreadsheets, eyeballing doses worked for us. She was mostly tightly regulated when not bothered by health issues.

I did ask him to remind me about why we chose Levemir . And he said it would have the most consistent response in the cat. Including exactly when the low would occur in any cycle. He said that at a given dose, the cat's BG would behave predictably day after day as long as nothing else varied too much.

That's how Lev is supposed to work, but in reality, it simply another one of those ECID things. Alex did great on Lev from 2009 til she passed from cancer in 2014, but that's not always the case. One never knows how their cat will respond until they try it.

I've always said, "the best insulin is the one that works for YOUR cat."
Good luck! Wishing you all the best!

 

[Carol & Murphy (GA)]

Your vet is right about the pen being more accurate for measuring whole unit doses. Syringes... any syringes, even u-40 syringes... are known for their imperfections. We've seen them to be "off" by as much as 0.5 unit. Using the pen to dose is all well and good when the dose is given in increments of whole units. Trouble is we adjust doses in increments of 0.25 units. The pen can't do that... so we opt to use syringes.

These days, many use calipers for consistency when dosing. Others, like me have simply eyeballed doses. You can see from Alex's spreadsheets, eyeballing doses worked for us. She was mostly tightly regulated when not bothered by health issues.


That's how Lev is supposed to work, but in reality, it simply another one of those ECID things. Alex did great on Lev from 2009 til she passed from cancer in 2014, but that's not always the case. One never knows how their cat will respond until they try it.

I've always said, "the best insulin is the one that works for YOUR cat."
Good luck! Wishing you all the best!

@Jill & Alex (GA) - thanks Jill (I'm following along with Cara since I will probably switch from Prozinc next week)

 

[Olive & Paula]

Cara, I hear you. Smokey started walking away from his food a week ago. Then he vomited a few times and dropped really really low. Stinky you know what and very gassy. Took him to vet. All lab work negative including pancreatic blood test although it's 26 since December on a range of 8-26. They say it's normal. Gave him cerenia for 4 days. It helped. No vomiting, not gassy of stinky. He scheduled for ultrasound Wednesday.

Today was first day without cerenia. He is not himself. Walked away from his food. His head is down and he's burping.

I hope your little one feels better soon and you find the problem.

 

[Carol & Murphy (GA)]

Cara, I hear you. Smokey started walking away from his food a week ago. Then he vomited a few times and dropped really really low. Stinky you know what and very gassy. Took him to vet. All lab work negative including pancreatic blood test although it's 26 since December on a range of 8-26. They say it's normal. Gave him cerenia for 4 days. It helped. No vomiting, not gassy of stinky. He scheduled for ultrasound Wednesday.

Today was first day without cerenia. He is not himself. Walked away from his food. His head is down and he's burping.

I hope your little one feels better soon and you find the problem.

Daily cerenia has really helped Murphy - I do 5 days on and 1 day off. Have you tried pepcid as well?

 

[Cara and Wynken (GA)]

Cara, I hear you. Smokey started walking away from his food a week ago. Then he vomited a few times and dropped really really low. Stinky you know what and very gassy. Took him to vet. All lab work negative including pancreatic blood test although it's 26 since December on a range of 8-26. They say it's normal. Gave him cerenia for 4 days. It helped. No vomiting, not gassy of stinky. He scheduled for ultrasound Wednesday.

Today was first day without cerenia. He is not himself. Walked away from his food. His head is down and he's burping.

I hope your little one feels better soon and you find the problem.

Thank you! He ate with a bit more appetite tonite, so I shot, and he walked away from the plate. Wynken!!!

I sure hate to hear about Smokey... Sounds like tummy upset for sure. Glad you will be getting the ultrasound, and hope that you get to the bottom of it. Like Carol, I recommend Pepcid. Has sure helped 2 of my other kitties. The burping may indicate gastric acid, and Pepcid helps with that. You may want to ask your vet.... Has to be the 10mg AC, and not stronger (not 20mg) and not Pepcid complete, either. 1/4 tablet. Good luck!

 

[Carol & Murphy (GA)]

Also, raise the food dishes off the floor - I use big rolls of duck tape to put the dishes on - raises them about 2 inches off the floor - that helps a lot

 

[Carol & Murphy (GA)]

Thank you! He ate with a bit more appetite tonite, so I shot, and he walked away from the plate. Wynken!!!

I sure hate to hear about Smokey... Sounds like tummy upset for sure. Glad you will be getting the ultrasound, and hope that you get to the bottom of it. Like Carol, I recommend Pepcid. Has sure helped 2 of my other kitties. The burping may indicate gastric acid, and Pepcid helps with that. You may want to ask your vet.... Has to be the 10mg AC, and not stronger (not 20mg) and not Pepcid complete, either. 1/4 tablet. Good luck!

Cara - when Murphy does this, I bring his food to where ever he is every 20-30 minutes - he will frequently eat tiny amounts each time and it all adds up also do the sleep trick - if he is sleeping, I put the bowl of food right by his nose and gently wake him up - frequently he will eat a little before he even wakes up and realizes he doesn't like the food Good luck to us all - giving insulin to a cat that doesn't eat well is truly a great stressor

 

[Cara and Wynken (GA)]

I've always said, "the best insulin is the one that works for YOUR cat."
Good luck! Wishing you all the best!

Thank you! Since he is been on pro zinc for almost 4 years (other than a brief early Remission) I am a little nervous about switching. Especially to the pen. I am certain that I will start to use syringes when I want to go in between whole unit doses. I'm just trying to learn all I can from Dr. Gilor since he specializes in feline diabetic research.

The more I find out about insulin, and cat diabetes, and dosing.... I have started to really wonder why they don't make a really nice dilute form of insulin, perhaps like u10. That way we could be incredibly accurate with the syringes that we have.

I spent a great deal of my life doing human pharmaceutical stuff, including preparing chemotherapy and parenteral preparations even for neonates. So I'm trained in making preparations that have the exact milligram strength needed. It is incredibly apparent to me that for these small animals a dilute insulin that was accurately prepared would be the answer to most of our problems!

 

[Carol & Murphy (GA)]

Thank you! Since he is been on pro zinc for almost 4 years (other than a brief early Remission) I am a little nervous about switching. Especially to the pen. I am certain that I will start to use syringes when I want to go in between whole unit doses. I'm just trying to learn all I can from Dr. Gilor since he specializes in feline diabetic research.

The more I find out about insulin, and cat diabetes, and dosing.... I have started to really wonder why they don't make a really nice dilute form of insulin, perhaps like u10. That way we could be incredibly accurate with the syringes that we have.

I spent a great deal of my life doing human pharmaceutical stuff, including preparing chemotherapy and parenteral preparations even for neonates. So I'm trained in making preparations that have the exact milligram strength needed. It is incredibly apparent to me that for these small animals a dilute insulin that was accurately prepared would be the answer to most of our problems!

Sounds like a great idea for a start up company!!! With feline diabetes (and probably canine as well) on the rise, sounds like a good business plan

 

[Jill & Alex (GA)]

The more I find out about insulin, and cat diabetes, and dosing.... I have started to really wonder why they don't make a really nice dilute form of insulin, perhaps like u10. That way we could be incredibly accurate with the syringes that we have.

I spent a great deal of my life doing human pharmaceutical stuff, including preparing chemotherapy and parenteral preparations even for neonates. So I'm trained in making preparations that have the exact milligram strength needed. It is incredibly apparent to me that for these small animals a dilute insulin that was accurately prepared would be the answer to most of our problems!

A very few of our early Levemir users did dilute Lev. Unfortunately, their efforts were lost in cyberspace when we lost the contents of 2 FDMB message boards. I don't know of any other Lev users who have diluted their insulin since then, but in 2013, Roomp and Rand published the management of diabetic cats.pdf. They brought up diluting both Ls, but specifically Levemir:

Some additional although somewhat outdated information/help from the Pet Diabetes Wiki: Diluting Insulin.

Diluting in the bottle/vial isn't recommended, but smaller amounts of diluted insulin have been known to keep for a few days - a week. This might be something you'd be interested in exploring since you have the expertise required.

 

[Olive & Paula]

Also, raise the food dishes off the floor - I use big rolls of duck tape to put the dishes on - raises them about 2 inches off the floor - that helps a lot

Hubby made a table for Smokey so his is raised. Being a big cat I didn't like that he had to bend over so far. Had the table for a year. I use piece of wax paper for tablecloth. Hehe.

 

[Olive & Paula]

Thank you! He ate with a bit more appetite tonite, so I shot, and he walked away from the plate. Wynken!!!

I sure hate to hear about Smokey... Sounds like tummy upset for sure. Glad you will be getting the ultrasound, and hope that you get to the bottom of it. Like Carol, I recommend Pepcid. Has sure helped 2 of my other kitties. The burping may indicate gastric acid, and Pepcid helps with that. You may want to ask your vet.... Has to be the 10mg AC, and not stronger (not 20mg) and not Pepcid complete, either. 1/4 tablet. Good luck!

That's what Smokey did. Started to eat so I shot then he walked away. Threw up and bottomed out.

Here's to both babes they feel better soon.

 

[Sparkle]

Don't ask me why, but Sparkle will only eat if I start him by spoon, Then I put the spoon in the bowl, put him and his bowl on the floor and he goes right to eating. It takes him a LONG time to eat, but he doesn't walk away, thank goodness. Sometimes I shoot soon after he has started eating, sometimes I wait till he gets more on board. I have to remeber to go get the spoon out of the bowl because sometimes it slips and he can't eat around it. I need him to get all the food in he wants since he only seems to want to eat at shot time.

 

[Cara and Wynken (GA)]

Diluting in the bottle/vial isn't recommended, but smaller amounts of diluted insulin have been known to keep for a few days - a week. This might be something you'd be interested in exploring since you have the expertise required.

Jill, Thanks for including those links and references. I had done a little Google search on my own, and came across most of that, as well as some forums that are similar to ours but about human children needing insulin in smaller doses.

I'm going to just continue to WISH that there was a commercially prepared available dilute insulin... There are just too many factors with potency, efficacy and sterility to really contemplate doing this, in light of the manufacturers recommendations. Although it *is* tempting, I will not attempt it!

 

[Cara and Wynken (GA)]

Don't ask me why, but Sparkle will only eat if I start him by spoon, Then I put the spoon in the bowl, put him and his bowl on the floor and he goes right to eating.

Isn't it funny how they train us to do odd things? I have strange little routines with most of my cats that I can't explain the origin of. And it sounds like that's what happened with you and Sparkle. He just taught you what works.

 

[Rachel]

How's Wynk doing today?

 

[Cara and Wynken (GA)]

How's Wynk doing today?

. Rachel, thanks for asking.
Wynk is NOT eating.

His BG was high (almost 500) and he was moving around ok, nonchalant. I offered 3 different breakfasts. Nothing.

 

[Bobbie And Bubba]

Hi Cara, I am just catching up and so sorry to hear about Wynken not eating. I sure hope that changes for you. I think once you start on Lev and see how it goes, you will be comfortable to switch to U100 syringes when you need to give a dose other than one unit. Sending appy vines to Wynken.

Here are some ideas to get a cat not to eat. I think it was Merlin's list.
1. Here are some ideas.
1) Chicken Broth or Beef Broth (no sugar added); could be made from bouillon cubes
2) Tuna or tuna broth/juice
3) Parmesan cheese sprinkled on food
4) Bonita Flakes sprinkled on food (get from Asian Market or possibly some local food stores)
5) Pepcid AC 1/4 tablet - may have to crush and syringe feed; wait 20 minutes and try feeding again
6) Boiled chicken shredded or pureed
7) Baked/broiled/boiled Salmon, White fish, etc.
8) Warm up regular food in microwave (just a bit to make more aromatic)
9) Florti-Flora sprinkled on food (get from vet)
10) Plenty of exercise prior to meal time (chasing a string, etc.)
11) Last resort to eat give Medium or the high carb, wet food

 

[Cara and Wynken (GA)]

Thanks Bobbie! I have tried some of those. We are going to the vet at 3. I want his liver enzymes checked. This reminds me of when other kitties wouldn't eat and they had hepatic issues.

So I came home at lunch to check him (384 at +6) and I'm just going to work from home til his appt at 3. Guess what... I put down a new food (Weruva Fowl Ball) and he's eating.

A lot.

I gave him 1/4 Pepcid this morning. So maybe that helped?

 

[Cara and Wynken (GA)]

We are at the vet. He is SUCH a good boy... In the car and in the exam room. Nothing noted during a pretty thorough physical exam (including checking his anal glands! She said she always checks that in kitties that aren't eating, since one time that was a causal factor (kitty felt full back there and didn't want to eat - I had never heard of this!). At OSU 8 days ago they did not do full bloodwork, just sent the acromegaly test off and took urine to make sure the UTI had resolved. Then of course the X-rays and ultrasound. So the only thing left to check today are liver, kidney and pancreas values. They can do these in house so we are waiting....

 

[Cara and Wynken (GA)]

All of his liver, kidney, electrolytes and even the pancreas "snap" test were ok. I guess I'm really happy we've ruled out a lot of things. She said to keep giving the Pepcid, only 1/4 tab per day, since it appears that may have helped today.

Mystified. I told Wynken in the car on the way home that there is officially nothing wrong with him... So he needs to eat normally, starting tonight. He's deaf though, so we'll see what he does.

 

[Sue and Oliver (GA)]

Well, that is all good news, but frustrated not knowing why he is off his food.

 

[Cara and Wynken (GA)]

He didn't listen.... He only ate about an ounce to maybe 1.5 oz at 1pm when I got home ( he and Blynken shared a 3 oz can). I want him to be hungry. She certainly is! (When did she start eating off her paw?). I tried to post a video of Blynken eating but it doesn't work....

 

[Carol & Murphy (GA)]

Oh dear - something in the air - now Murphy won't eat tonight - I haven't had this issue in at least 7-10 days - it is so scary -well, I popped a zolfram (anti- nausea) and cyproheptadine (appy stimulant) so I hope it starts to work soon - so Cara, welcome to my stress - I still think you should try novel foods - something he has not had before - are you warming the wet food for a few seconds to increase the aroma? Could he be dehydrated?

 

[Cara and Wynken (GA)]

Oh dear - something in the air - now Murphy won't eat tonight - I haven't had this issue in at least 7-10 days - it is so scary -well, I popped a zolfram (anti- nausea) and cyproheptadine (appy stimulant) so I hope it starts to work soon - so Cara, welcome to my stress - I still think you should try novel foods - something he has not had before - are you warming the wet food for a few seconds to increase the aroma? Could he be dehydrated?

Carol, I am so sorry that this a shared trouble! Eat, boys! Eat!!
I can't give another Pepcid since I gave one this morning. I do have Zofran on hand - as I use it for 2 other kitties... And was considering it. Is that what you use (generic name is ondansetron)?

If he still isn't eating in the morning I will consider the only appetite stimulant I have on hand (mirtazipine). I find that 1/8 tab works pretty well in most cats.

Yes to the novel foods and warming them. He has nibbled some... Maybe a Tbsp... Will keep trying. He seems "done" tho.

 

[Carol & Murphy (GA)]

Carol, I am so sorry that this a shared trouble! Eat, boys! Eat!!
I can't give another Pepcid since I gave one this morning. I do have Zofran on hand - as I use it for 2 other kitties... And was considering it. Is that what you use (generic name is ondansetron)?

If he still isn't eating in the morning I will consider the only appetite stimulant I have on hand (mirtazipine). I find that 1/8 tab works pretty well in most cats.

Yes to the novel foods and warming them. He has nibbled some... Maybe a Tbsp... Will keep trying. He seems "done" tho.

I thought pepcid was bid ? Yes, zofran is ondansetron - does he seem nauseated? If not, I might try the mirtazipine although I prefer cyproheptadine
I have special 1 mg tablets of mirtazipine I get from Cat Hospital - last time I tried the 1/8 tab, I think it's difficult to cut the pill accurately and Murphy started acting weird. Plus I read that you should use mirtazipine and zolfran together with caution due to danger of serotonin syndrome but I would like some confirmation about that. If he is not eating soon, I would give an appy stimulant if he doesn't seem nauseated - if he seems nauseated, give 1/4 zolfran. The other thing I do in these situations is offer him food every 20-30 minutes