My Boy Yogi help please :)

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Hazel

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Hi i posted in the new user section last night and i have just spent my morning at work creating a spreadsheet can someone please have a look and give me some advise.

He has started on the PZI insulin and i know i havent done a very big curve since being on this new insulin, its just difficult while im at work i will aim to get one this week,

He isnt improving, he has gone from 10 kilos down to 6.5 kilos

I cant feed him wet food as it has always given him diarrhea this has always happened

He is drinking heavily and urinating alot,

He is very perky and has a good appetite,

Thank you
 
Hi, welcome to the group! Your boy is running high :(. I had just a short time working with my kitties on insulin before they went into remission that I really don't know what might be going on. I do know that dry food is not recommended. They are too high in carbs and is moisture depleted. I thought my cats couldn't do canned and my vet pretty much told me the same and had me feeding the prescription diet.

Here is a great link that discuses the diet for cats. There is a section that helps an owner switch. http://www.catinfo.org

Also, have you been checking for ketones in his urine? The urine sticks are next to the meters at the store.

You might also post in the PRoZinc forum, there are lots of members there that can help you.

@Sue and Oliver (GA)
 
Hi Hazel. What's your kitty's name? What are you feeding him? Have you tried to transition to canned food slowly, or did you just switch? Sometimes a sudden change can cause diarrhea whereas a slow, gradual transition can allow their digestive system to adjust. You might also try adding some probiotics to his food. The ProZinc forum may be the best place to post for dosing advice.
 
thank you for replying,before he was diagnosed with diabetes, i have tried to feed him wet meat, i have tried raw meat, cooked chicken, i have tried posh wet meat and it just upsets his stomach and he gets diarrhea,

I can cope with the diarrhea however he has a disabled foot he has 4 legs but only uses 3 so when he has diarrhea he gets it all over his foot, currently i am showering him a few times a day,

Hi bloods are running high and i dont know if to up him, if he is on too much, i cant get him right
 
Hi, i am giving him a diabetic dry biscuit, i have posted on that forum now as well so i hope they can help


thank you :)
 
For members reading this thread, Hazel posted her introduction in the Welcome section on the following thread:

http://www.felinediabetes.com/FDMB/threads/my-poorly-boy-i-need-help.155997/

I've tried to condense the key points into a potted clinical history for Yogi below (timeline's a bit iffy here and there plus it's difficult to align posted info with BG data in spreadsheet):

* Home BG measurements are on Alphatrak. Rest are vet readings (presumably on a pet-calibrated meter?).

* Yogi lives in the UK. He is a Maine Coone - weight has dropped from 10kg to 6.5kg since start of insulin therapy (!). Weight loss is continuing.

* Vet first consulted when Yogi started snoring loudly. Vet administered steroid (cortisone). In following week Yogi started making unusual vocalisations and displayed polyuria symptoms.

* Vet consulted about polyuria symptoms. Initial vet BG reading 13mmol/L [possibly influenced by steroids - ETA: and possibly by vet stress?]. Back home for a few days then back to vet where BG reading was 27mmol/L.

* Insulin treatment started: Caninsulin - dose 2IU BID Caninsulin. Home Alphatrak readings rose to high 30s.

* 1 week after start of treatment vet raised dose to 3IU BID Caninsulin. Numbers remained in high 30s.

* Dose further increased to 4IU BID Caninsulin by vet. Tests in range 30-36mmol/L.

* Dose dropped by Hazel to 2IU BID Caninsulin (timeline, number of cycles for which dose reduction was held, and subsequent effect on BG levels is unclear).

* Switched to Hypurin Bovine PZI insulin. Starting dose: 3IU BID. Still in 30s 1 week later. Dose increased to 4IU BID on 10 April 2016. Still no improvement. Dose reduced to 2IU BID.

* Lowest BG in 5 weeks and best clinical signs since start of insulin treatment was 21mmol/L (Alphatrak) after a possible fur shot in a previous cycle (!).

* To date, Yogi has tested negative for ketones (thank heavens! :) ).

* Yogi has had blood work done to test for Cushings, hyperthyroidism, EPI. [? - not sure whether TLI for exocrine pancreatic insufficiency only or whether Spec fPL also done for pancreatitis.] Cushings, hyper-T and EPI ruled out.

* General clinical signs: perky, good appetite, drinking/peeing a lot (PU/PD - with some inappropriate elimination). Yogi has major problems with diarrhoea [unclear whether this started before or after start of insulin treatment, nor is it clear whether Yogi is getting diarrhoea when eating dry food]. Wet food triggers diarrhoea in Yogi. Distressing level of weight loss is continuing.

--------------------

@Hazel - is this a fair summary of events to date? If I've got anything wrong can you provide corrections/clarifications please so that we can all get a clear understanding of what has been happening with Yogi's treatment (so that we might make better suggestions for you).



Mogs
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Hi again, Hazel. :)

I then think i gave him a fur shot i wasnt sure i had given him is insulin correctly so i dont think he had the full 4 units at night, i got up the next day and his BG was 36, i tested him throughout the day and he stayed around 30 mmol, just before his shot at night i tested him again as he seemed so much better and he was down to 21 mmol,
Click to expand...

This would make me look at whether Yogi is showing signs of rebound hyperglycaemia. Based on the assumption that there was a fur shot, then that would have been the only period since start of treatment where Yogi got little or no insulin and it produced the best BG reading and improvement in his clinical signs that you've seen since all of this started.

Things I would consider:

* Yogi may have had a health issue that elevated BG levels before the steroid was administered.

* How long-acting was the steroid? It could have further driven up his BG levels after the 13-ish reading. (Did your vet run a fructosamine test at all as part of initial diagnostics?)

* It is possible that Yogi may have been pre-diabetic and that the steroid jab pushed him over the brink into becoming symptomatic. It is also possible that Yogi's BG may have been temporarily elevated initially due to the respiratory issue (i.e. not diabetes) - and possibly vet stress when the 13mmol/L reading was taken - and the BG was subsequently driven further upwards due to the steroid treatment. Perhaps he may not have needed very much - if any - insulin at all. (We've seen it here before.) The other, less common, possibility is that Yogi might be a high dose kitty.

* Yogi's BG and clinical signs seem to have got worse with insulin treatment.

* In the case where a cat is being overdosed with insulin it can take several days of administering a reduced dose before any improvement in BG levels may be seen to confirm such a hypothesis.

* If you are currently feeding Yogi the same food he could eat without getting diarrhoea before insulin treatment started but on which he is now suffering from diarrhoea I would look to ask the vet whether insulin overdose might be hammering his digestive system (it would be putting his internal organs under an awful lot of strain).

Re dry food, if you can't get Yogi to eat wet food comfortably, perhaps discuss feeding Purina DM dry food. Carb-wise it's the best of a bad prescription food bunch and may have fewer carbs than his current kibble. It would help if you could let us know which food Yogi is currently eating so that we have an idea of the level of dietary carbs he is eating. If I were in your shoes I would be reluctant to reduce the amount of carbs in my cat's food for the time being until I could establish whether or not it was being overdosed with insulin. (If it is an overdose situation reducing the carbs in the diet would be dangerous; the dose needs to be sorted out first.)

I have used Caninsulin for my cat and, as you rightly observed, it was doing nothing good for Yogi. I've not used hypurin bovine PZI insulin but I know from my reading here that it can be quite long-acting. I'm tagging Juliet (@Dr Schrodinger), Eliz (@Elizabeth and Bertie), and @Marlena who are familiar with Yogi's current insulin type to see whether they might be able to give you some pointers to discuss with the vet so that you can find the right path to help Yogi get better.

In general terms, I do think that there is a definite basis for exploring the possibility of too high a dose of insulin being given here. If you're not already doing so, please test every day before every dose (remove all food for 2 hours prior to testing so that the preshot test won't be food-influenced) and also get mid-cycle tests every day (sometimes a low one day can produce several days' worth of high numbers when a cat's BG 'bounces'). One of the hypurin bovine PZI users should be able to tell you the best times to test. (The optimum time for mid-cycle testing is typically dependent on the action profile of the insulin being used).

It's great that you're already testing for ketones. Keep testing daily. (If a test result shows trace ketones present speak to the vet immediately for advice on how to proceed. Anything higher than trace requires an immediate trip to the vet - day or night - for emergency treatment in order to prevent DKA.)

I hope some of the above thoughts will be helpful to you and your vet. Other members may have different opinions or suggestions for you.



Mogs


EDITED TO ADD:

Another possibility I missed above is that Yogi may be diabetic but that even the initial 2IU dose of Caninsulin may have been too high for him. If that were the case then subsequent dose increases would have just added fuel to the fire.

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Hazel said:
thank you for replying,before he was diagnosed with diabetes, i have tried to feed him wet meat, i have tried raw meat, cooked chicken, i have tried posh wet meat and it just upsets his stomach and he gets diarrhea,

I can cope with the diarrhea however he has a disabled foot he has 4 legs but only uses 3 so when he has diarrhea he gets it all over his foot, currently i am showering him a few times a day,

Hi bloods are running high and i dont know if to up him, if he is on too much, i cant get him right
Click to expand...
When you are changing his food are you gradually changing it by mixing some of his old food with the new? Some cats cannot tolerate a sudden food change and develop diarrhea. You can also try adding canned pumpkin to his food also. The extra fiber can help firm things up. Make sure it is canned pumpkin and not pumpkin pie filling.
 
Just had a look online. Sometimes corticosteroids can trigger pancreatitis. If you're going to the vet it might be worth getting a SNAP fPL test done to check for pancreatitis (yes/no result only). Pancreatitis can cause diarrhoea (and it doesn't do wonders for blood glucose levels either).


Mogs
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so how do i go about lowering it, do i just stop it and start again? do i leave him without it for a few days??
 
@Hazel -

To avoid you needing to post twice in different places and getting confused I suggest that you repost your question about adjusting the dose on your thread in the PZI forum (they'll be able to make the best suggestions about dosing) and then make any subsequent posts on that thread only.

For people following this thread, here's the link to Hazel's thread in the PZI forum so that you can continue to follow Hazel and Yogi's progress. :)

http://www.felinediabetes.com/FDMB/threads/my-boy-yogi-help-please.156032/


Mogs
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Squalliesmom said:
Oops, my bad, I thought she was using Vetsulin or one of the fast-acting insulins! Don't know much about PZI at all.
Click to expand...

I still think there's a possibility that Yogi's starting dose of Caninsulin might have been on the high side for him in the early part of his treatment, Lucy: numbers disimproved if anything when the dose was increased. If an iffy spell on Caninsulin was then used as a basis for decisions about the starting dose of hypurin bovine PZI it is a possibility that Yogi has not yet been given an optimum dose of insulin for his needs.


Mogs
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