? Poorly puss

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Sootyca

Sootyca

Member Since 2016
Sky changed her insulin before Christmas. When she started province (the new insulin) she was a little lethargic from it and had a couple of runny poos.

She has had her dose increased as her numbers are still high. She has had runny poos since then, barely ate today (no injection) and has been sick everywhere.

Anyone know if it could be linked to her insulin change?
 
Sootyca said:
Sky changed her insulin before Christmas. When she started province (the new insulin) she was a little lethargic from it and had a couple of runny poos.

She has had her dose increased as her numbers are still high. She has had runny poos since then, barely ate today (no injection) and has been sick everywhere.

Anyone know if it could be linked to her insulin change?
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I don't know whether the ProZinc is the culprit but if it was my kitty I'd be taking her to the vet ASAP. Diarrhea, vomiting, no food and no insulin put a diabetic kitty in danger of serious complications like diabetic ketoacidosis and/or hepatic lipidosis.
 
I agree that it's time for a vet visit-- the runny poos are one thing, but not eating and vomiting when on insulin can be dangerous. With such high numbers and those symptoms, plus not being able to inject this morning due to vomiting, I'd be worried-- have you been testing for ketones?

Looking at Sky's spreadsheet, it seems that numbers have been rising and running high for the last month or so-- have you gotten a full vet work-up during that time? Cats can have insulins that don't "agree with" them, but the symptoms Sky is having make me think it's likely that there's some other underlying health issue. One strong possibility with those symptoms is pancreatitis. It often goes hand-in-hand with feline diabetes and can make them feel very poorly (and cause BG numbers to go up). Your vet can evaluate Sky and do either an in-house yes-no test (fast but not perfectly informative) or send out for a test giving a quantitative idea of the severity of any inflammation present. Treatment is mostly managing symptoms (chiefly pain and nausea), but it can make a world of difference in how they feel and how they respond to insulin.
 
Sorry, should have emphasized: pancreatitis seems likely, but it's the possibility of ketones that is the immediate worry. If you can't get to the vet today, you should definitely test for ketones if you have not already. Anything greater than a "trace" needs immediate vet attention to try to head off a worsening of the situation into something like DKA.
 
Thanks for your help. She's booked in tomorrow first thing. She is alert, wants company and is bright (and has been washing me which is her favourite pastime!). She hasn't been sick since this morning but neither has she eaten, or shown any interest in food. She hasn't been to the loo yet so I can't test her for ketones - strips are on stand by ready as soon as she does. She had a full blood profile taken at the beginning of December and there were no problems then.

Her problems started after the vets thought she was in remission on caninsulin. She was only off it for 2-3 days but since then she has been hard to get back regulated, not helped by me going away for a week so she could only be injected once a day. When I got back she hadn't gotten any worse (number wise). We switched to prozinc as whilst she was off the caninsulin she was much livelier and brighter - hadn't realised how subdued she had been. Since she has been on prozinc she is happy in herself but her numbers are not controlled.

Have only tested a couple of times for ketones (and not since on prozinc) and it's been fine.

They will keep her in tomorrow if she doesn't eat to try and get her a bit more under control but I think we will have to go back to caninsulin and live with the side effects of it.
 
If you need to switch again I suggest you try Levemir or Lantus (not Caninsulin, because what you describe is common in cats with whom that insulin disagrees).


Mogs
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We're staying on prozinc at the moment - well when I can inject her again we are! She ate a small amount of human tuna this morning which isn't ideal but was the only thing she would touch. She is still quite bright and responsive but has a slight temperature and has probably got more runny poo to come! She is being treated for a low level infection and has been given anti sickness and diarohea drugs with another appt booked in for tomorrow. If she eats properly in the meantime she doesn't need to go back. The high numbers she has been getting is possibly due to the infection driving them up.

If she doesn't improve today we will have to rethink.

she has eaten more tuna when she got home - just need to go and get her some cat tuna instead :) She still hasn't urinated to test for ketones (well she did a little overnight but wasn't able to test that!) the vet says it's unlikely but is happy for me to test (not that she has any say in it!) - just have to wait for sky to perform. Hopefully now she has had a little more food then she will urinate for us. Can't believe my life at the moment revolves around the toileting of a cat!!!!
 
I suggest asking the vet to run a test for pancreatitis (ref the disinterest in food, diarrhoea, etc.). Has Sky shown any nausea symptoms?

Also I suggest asking the vet whether Sky might only need a *tiny* dose of a long-acting insulin like Lantus or Levemir. Been looking at Sky's spreadsheet and her BGs seem to go higher when she gets more insulin. (Note: if a positive pancreatitis test result is obtained, this may also drive up BG levels.)

From Sky's spreadsheet data I think there may have been times when she was getting too much Caninsulin and her BG levels were rebounding as a consequence.


Mogs
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if numbers are in the 300-400 range I would definately shoot something to prevent ketones. Also, the body cannot fight infection well with all that sugar in the blood and no energy to the cells. Sugar in the blood feeds bacteria like crazy. If you do shoot, be prepared to test and interviene if BS starts to go too low. Often the cortisol output when someone is sick will keep sugars way up, and kitty will burn fat to compensate.
 
She'll be going back in tomorrow, if not to the emergency later. The vet did warn me there was fluid that would come out so I was prepared. lol. No urine and no eating yet. her bloods are 398. The only problem if I did inject is that I'm not convinced that the prozinc is any good for her and if it is something in that making her unwell I would be making her worse. She had runny poos (not full blown diarohea) when she started on it for a day or so and again when it was increased.

She is more lethargic now but is still responsive and wants to be with people (me) but I hope the vet tomorrow has some idea of what to do for her as she hasn't responded to today's treatment.
 
If she's got more lethargic it might be better to take her to the ER, especially as she hasn't been peeing.

(((Sky)))


Mogs
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I second the ER visit tonight then. Going a couple days without insulin with sugars that high can lead to DKA/lipidosis which can be $$$ to treat. It can happen in a matter of -hours-, but if caught and treated early it could save you lots of time and money as well as make sure your car remains healthy. It's worth the extra trip and expense of the ER vet. Ask them for lantus or levemir. Ususally the human recombinant insulins have less potential for immune reaction in cats, so it's funny that the prozinc might be causing her symptoms. It could be unrelated to the insulin, like constipation, infection, or pancreatitis. Sometimes, uncontrolled high BS can worsen pancreatitis flares. Worth getting it tested when you go.
 
Thanks everyone, she is better today - not right but much better. She had a tiny bit of food before the vet trip and half a can of applaws for lunch - which she was asking for. Had a new vet who was very clued up - said we were doing right with the testing and as such he has no problem with me injecting on empty stomach as I will monitor her bloods and react accordingly. He also suggested lantus - but as it isn't registered for use in the UK he has to check that it can be obtained through Cascade (or something like that).

He has taken bloods for pancreatitis as that hasn't been tested (thanks for suggesting it) but he is of my initial thought - that it is the prozinc.

There is a logic behind the thought:

  • Last year she was on metacam which didn't agree with her - everyone said it would be 24 hours to get out of her system - it was well over 48 hours before she improved.
  • When she initially stopped the Caninsulin and went on no insulin as they thought she was going into remission it was 48 hours that her numbers spiked but she was then more her old self.
  • She started Prozinc and started with loose poo (not diarohhea) within 24 hours of it. This latest bout of sickness/poo/non eating is within 24 hours of increasing her dosage.
  • 48 hours without prozinc and she is much brighter, seeking more interaction and wanting food (not eating much but it's progress).

Our thoughts are that she has a slow metabolism for medication - so when she gets medication for anything her body clings onto it. This could explain why she was not quite herself on the Caninsulin - that it was building up in her system and the accumulation was just making her feel unwell. I know it's not supposed to work like that but every cat is individual and everything that I've seen and know of her suggests that this is the case.

Whether it is right or not, she is back on Caninsulin - at least that way her numbers are controlled more. She hasn't had any yet - that will be tonight so she is back on her 12/12 schedule at the right time. Will find out the pancreatitis results hopefully on Monday and will rely on the vet for the lantus.

hopefully she will keep today's food in her - she has lost 150g in 24 hours but given how little she has eaten then it isn't a surprise!

Karen
 
Sootyca said:
He also suggested lantus - but as it isn't registered for use in the UK he has to check that it can be obtained through Cascade (or something like that).
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At time of posting, in the UK vets have to treat first with Caninsulin or Prozinc because they are the only two insulins currently licensed for treatment of feline diabetics. If the first one prescribed doesn't suit the cat then legally the vet must try the other one next. It is only when both Caninsulin and Prozinc have been tried that a vet may legally prescribe an unlicensed insulin under drug cascade rules. Sky has been treated with both insulins now and you have accumulated a body of evidence (BG data and history of clinical signs) which demonstrate that neither of the licensed insulins are right for her needs. Therefore your vet can now legally prescribe Lantus under the cascade if required.

[ETA: Not sure whether Levemir (insulin detemir) could be another option under cascade; might be worth enquiring because a lot of cats on L&L seem to be happier and brighter after switching to Lev from Lantus.]


Mogs
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Sootyca said:
Our thoughts are that she has a slow metabolism for medication - so when she gets medication for anything her body clings onto it. This could explain why she was not quite herself on the Caninsulin - that it was building up in her system and the accumulation was just making her feel unwell. I know it's not supposed to work like that but every cat is individual and everything that I've seen and know of her suggests that this is the case.
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I can really relate to this from dealing with Saoirse's med-sensitivity. If anything it was the opposite problem to Sky's in that she metabolised insulin really quickly (nadired early on both Caninsulin and Lantus) and she only needed very small doses of any medications prescribed for her (if she could tolerate them at all).

Has the vet done tests for liver and kidney function for Sky?

I'm so glad to hear Sky is feeling brighter and getting her appetite back. Keeping fingers and paws crossed for a negative pancreatitis result.

(((Sky)))


Mogs
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Thanks - he obviously knows more of what he is talking about than the other vet (as nice as she is!). I think that the problem with my vets is they have had a lot of changes and all the vets are now new - and they probably are used to dealing with people who don't/won't/can't home test and just do as they are told. To have someone who makes an effort to research and understand things and take control was probably a bit of a shock but I think they now trust me to know what I'm doing (well, sort of in regards to the bloods and her injections!)

Everything was tested in early December and came back fine - kidneys slightly elevated but nothing too worrying.

If she is supersensitive to medication, like Saoirse, I will really have to keep an eye on her.

I'm just so relieved she is eating again, even if it is only a little bit - she will soon eat more once she gets used to eating again.
 
She is so much better thanks. She started eating yesterday morning properly. Hasn't been sick. Poo was mixed so could just have had runny left in her system.

Back on caninsulin and had an immediate effect on her numbers. I know it's early days but so far looking promising. Bloods not yet back.

The only thing I will have to take into consideration is that if her body does hold onto her medication I may have to not dose her every so often to try and help her not have too much in her system. Unless the lantus is an option and a better one.

She is very bright at moment as well so happy all round :)
 
What an encouraging update, Karen! I'm so pleased Sky's eating and feeling brighter. (((Sky)))

Big difference in BGs! :cat:


Mogs
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