Diagnosed 2 months ago-still out of control

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Shiframb

Shiframb

Member Since 2017
Hello, my name is Margaret. I have a 12 year old male cat, Austin, who was diagnosed with diabetes Jan 4, 2017. I suspected he had diabetes when he had sudden onset of ravenous appetite, weight loss, and tested on my glucometer at 457. Confirmatory testing, including a "senior" panel, at the vets revealed he does have diabetes. Austin was started on Lantus at 1 unit twice a day, and since then has progressed to 3 units (I upped the dosage myself to 4 units for the last 2 doses) and has had absolutely no response. All his sugars have been in the 400s. His last BS, 6 hours after a dose, was 527! I have been treating my diabetic dog successfully for nearly a year-he is on Vetsulin. I am a nurse with decades of experience. I have done more than 1 glucose curve on Austin and am very discouraged to see little to no response, and he continues to lose weight. My vet has tested for a UTI as it could have been a reason for the lack of response, but that is not the issue. I have switched from his Taste of the Wild dry food to wet food the vet suggested a month ago. I am in tears as I feel my cat thinks I am starving him. I am close to retirement and have limited funds. I asked my vet if we could try a dose of another insulin-like my dog's Vetsulin, just to see if it gets any response. She is suggesting that my cat could have some GI issue, that requires expensive testing. Any others out there who may have similar experiences and can offer me some advice? I am getting desperate.
 
From my post in the Welcome forum

Welcome.
Good insulins are the human Lantus and Levemir and the pet insulins ProZinc and BCP PZI. For those two human insulin it is best to get the 5 pack of 3 ml disposable pens via a 10 ml vial. Although per ml the vial is less expensive most cats will not use up a 10 ml vial before the insulin goes bad/becomes ineffective. The human insulin N/NPH is sometimes prescribed but only lasts 8-10 hours. Same for the pet insulin Vetsulin/Caninisulin.
Most of us here test our cat's blood glucose at home using a human meter. We test before each shot and periodically between shots. We record our reading and other info in a spreadsheet. See:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Here is a link to home testing blood sugar
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
Can you post the results from the latest curve you performed?
 
You should definitely be able to find some help here! My boy was diagnosed 5 days after Austin so we're still "newer". When I was researching, I found information on insulin resistance, which are also stickys on the forum here. Austin may be a high dose kitty. Not suggesting anything specific, just trying to share some information I came across. Here's the sticky: Acromegaly and Other High Dose Conditions
 
Hello and welcome to you and Austin. It's great that you are home testing! What are what are you feeding? Some of the vet prescribed foods are high in carbs and we want to keep it at less than 10. Also if you will set up our spreadsheet it will help you, your vet and us to really see what's going on.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
If you have trouble, just ask and someone will help you with it.
 
The last full curve I did was 2/26/17. Austin was on 3 units Lantus BID. I work 3pm-midnight, so his feedings and insulin are 12:30am and 12:30pm.

Before meal and insulin 497
2 hours post prandial 485
4 hours pp 456
6 hours pp 437
8 hours pp 468
10 hours pp 479

Before becoming diabetic, Austin has always been between 10.5 and 11 pounds. Last weight check 2/28, he was 9.3 pounds. He has always been fed Taste of the Wild-a grain free dry food. Since diagnosis, he has been on Fancy Feast Classic, as the vet suggested. 3 cans per day. No treats.
Random blood sugars in between feedings have all been in the 400s. Never lower. Today, when I tested at 6 hours after insulin, the glucose was 527.
 
Margaret, I know it's emotionally hard having a cat that has always trusted you give you the "You're starving me" face. You're a nurse, look at this mathematically. From a high of 11 pounds to 9.3 is only a 15% loss. I'm not saying you should not be concerned but my two boys have bounced back from worse than that, most of us have. Your background and the amazing knowledge base here will really help you. You are in the right place, keep the faith and we'll all make Austin a happy and healthy cat again. Nurses know miracles don't happen overnight, promise us you'll keep coming here.
 
The Fancy Feast Classic is a good low carb food. The Spreadsheet really will help us see what's going on. We usually increase doses by .25u every 6 or so cycles. Do you test pre shot every time? He may just need more insulin, the spreadsheet and more data will tell us the best way to proceed. Check out the yellow stickies at the top of the page in the Lantus forum. I don't know human diabetes or dog, but cats are a bit different.
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
 
My vet is advising an endoscopic exam of some sort that will include biopsies of his GI tract. She has not given me an estimate of the cost of this yet, but indicates it is expensive. She feels Austin's lack of response could be due to some GI disease-one cause being lymphoma in the intestines, which would mean chemotherapy. She also suggested a sono of his abdomen, but did say that it in itself would not be diagnostic. His liver enzymes from the tests done when he was diagnosed show no sign of liver disease. He has no vomiting or diarrhea. He is just ravenous and thin. I am not sure I can pay for chemo, and surgical testing. What I thought was going to be a rather straightforward thing to control, like my dog's diabetes, is turning out to involve much more. Between my dog and cat, this has pretty much wiped out my savings (except for retirement) over the past year, and now with expensive testing in the future, I am having to use my credit card, not something I can do as I approach retirement and a fixed income.
 
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Is he having any symptoms of GI problems? If he's too thin, you can feed him more. until you get his BG under control his body isn't processing the food properly and he needs some extra. Please let us help you get the spreadsheet set up so we can see what's going on. There are some high dose conditions, but it's possible he just has some glucose toxicity and hasn't reached his breakthrough dose yet. @Bobbie And Bubba had to go up over 5u BID to breakthrough and now her kitty is almost completely off insulin. There are lots of folks here that can help you and Austin!
 
Why does this ALWAYS cost so much money? Our local emergency clinic has a big waiting room with lots of coffee tables. The reading material? Payment options!
 
Thank you all. It's been a hard day, getting the 527 glucose today, and my vet wanting to do the GI testing. Even though I didn't think he had a bladder infection, I agreed to the needle aspiration and culture at $200-the results was negative. Austin has no GI symptoms. No vomiting (not even hairballs), and no stool problems. He is just hungry and losing weight. I have been thinking I possibly got a bad vial of Lantus from the Walmart pharmacy (which was $300) and told my vet I wanted to try another insulin-perhaps using the Vetsulin I already have on hand, just to see if there is any response to some insulin, if possible. Not as a permanent treatment. I don't want to tick off the vet, but I want to try that before the surgical route. Since I have read that some cats are on Vetsulin, I know it is worth a shot (OMG- not a pun).

I am old and a paper person. A spreadsheet I could do on paper would be preferable for me. So far, I have been keeping paper notes in a notebook, once I figured out this was not going to be simple.

What drives me crazy is that neither pet was overweight, they were fed high quality grain free food, not given treats or people food, but got diabetes, while my 13 yr old fat indoor cat, is fine.
 
Shiramb said:
My vet is advising an endoscopic exam of some sort that will include biopsies of his GI tract. She has not given me an estimate of the cost of this yet, but indicates it is expensive. She feels Austin's lack of response could be due to some GI disease-one cause being lymphoma in the intestines, which would mean chemotherapy. She also suggested a sono of his abdomen, but did say that it in itself would not be diagnostic. His liver enzymes from the tests done when he was diagnosed show no sign of liver disease. He has no vomiting or diarrhea. He is just ravenous and thin. I am not sure I can pay for chemo, and surgical testing. What I thought control was going to be a rather straightforward thing to control, like my dog's diabetes, is turning out to involve much more. Between my dog and cat, this has pretty much wiped out my savings (except for retirement) over the past year, and now with expensive testing in the future, I am having to use my credit card, not something I can do as I approach retirement and a fixed income.
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Please go with blood tests first! There are a number of things that can cause insulin resistance. A few cats on this board have high-dose conditions like insulin auto-antibodies or acromegaly. Mine has acromegaly and hyperthyroidism, both contributing to insulin resistance. His total T4 was in the high end of the normal range (unexpected for an older cat) and the dx was confirmed by a free T4. These are the tests for IAA and acro that are sent to MSU for processing:

https://animalhealth.msu.edu/Bin/Catalog.exe?Action=Test&NAME=igf-1&Id=1401
https://animalhealth.msu.edu/Bin/Catalog.exe?Action=Test&NAME=insulin&Id=1494

While I no longer work in direct patient care, I can understand how frustrating it is as a nurse to watch your cat's condition fail to improve or even worsen, despite all your knowledge and experience with monitoring and helping people manage these same conditions.
 
Adrian and Chino said:
Please go with blood tests first! There are a number of things that can cause insulin resistance. A few cats on this board have high-dose conditions like insulin auto-antibodies or acromegaly. Mine has acromegaly and hyperthyroidism, both contributing to insulin resistance. His total T4 was in the high end of the normal range (unexpected for an older cat) and the dx was confirmed by a free T4. These are the tests for IAA and acro that are sent to MSU for processing:

https://animalhealth.msu.edu/Bin/Catalog.exe?Action=Test&NAME=igf-1&Id=1401
https://animalhealth.msu.edu/Bin/Catalog.exe?Action=Test&NAME=insulin&Id=1494

While I no longer work in direct patient care, I can understand how frustrating it is as a nurse to watch your cat's condition fail to improve or even worsen, despite all your knowledge and experience with monitoring and helping people manage these same conditions.

What type of food did you switch to? Some of the prescription diabetic cat foods are higher in carbs and with less desirable ingredients than what you might find at a local pet supply store.
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Thank you. Thyroid was ruled out with his blood work when diagnosed-trust me, they did a lot of tests. This vet clinic is nothing, if not thorough. He is on Fancy Feast Classic, as the vet recommended.
 
The Spreadsheet is simple to do. We set it up for you and all you have to do is add the numbers, the SS does the rest. I'm not at all techy and with help from the people here I was able to get mine going. Just ask if you want to try.
I don't know much about lymphoma or other GI problems, but it seems if that was a problem you'd see some signs. Let me tag a couple of others that might know more
@Tricia Cinco(GA) & Harvey , @Wendy&Neko
 
Sharon14 said:
The Spreadsheet is simple to do. We set it up for you and all you have to do is add the numbers, the SS does the rest. I'm not at all techy and with help from the people here I was able to get mine going. Just ask if you want to try.
I don't know much about lymphoma or other GI problems, but it seems if that was a problem you'd see some signs. Let me tag a couple of others that might know more
@Tricia Cinco(GA) & Harvey , @Wendy&Neko
Click to expand...

Thank you Sharon. That was my feeling. Wouldn't he show signs of some GI symptoms? He doesn't act sick. Eyes still bright, affectionate, no problems jumping and getting around. Very patient with my glucose testing-just like he is at the vets. They always love to see Austin as he is so easygoing. But he is starting to scratch my hand as I am putting his food dish down-something my usually gentle cat never does.
 
Is he still losing weight? If so, or if he's underweight and not gaining, you should feed him more, and you can spread the meals out over the course of the day.
The cats here that have been diagnosed with GI problems usually had symptoms that caused them to be taken in for the tests in the first place. I would hold off on those expensive tests at least for now. Hopefully Wendy and Tricia will check in soon and be able to give you more info on that.
 
Save your money on the GI tests. If he's neither vomiting or chronic diarrhea or constipation, it's not worth investigating. I have/had two kitties with lymphoma and an ultrasound is the first step, and cheaper than endoscopy.

Getting the spreadsheet set up will really help us help you. It could be that your kitty is on too much insulin as you have been doing larger increases than we would do. Or it could still be too little insulin. Both conditions can look similar. And the suggestion of possible high dose condition is worth exploring, as one in four diabetic cats have acromegaly. Polyphagia is a common symptom. My Neko had both acromegaly and insulin auto antibodies and we had to hide food or she would steal it, until we got to a dose where her blood sugar was much better. If he is losing weight, feedmhim a little more food.
 
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Two months is not a lot of time, but it is strange that the numbers are that flat with 3 unit dose!

It certainly wouldn't hurt to try the vetsulin just to see if it has an effect... If it is still flat then there may be some other issue like acromegaly. If it goes doen then maybe there's something wrong with the lantus.
 
My vet messaged me that I could try giving 1 unit of Vetsulin twice a day (yay), so will start that tonight. How do you guys test so often? I am pre diabetic, and am supposed to be testing myself once a day, but I have been using my strips on Austin. I just ordered a refill of my strips as I am getting low, but testing him so often would deplete my prescription way before I could get another. Tried testing just before a meal today-did not go well. He was very squirmy and just wanted to EAT! I use a one touch ultra glucometer, and early in this journey, my glucometer gave close to vet's results-mid 400s at the same time.

Will try and get the spreadsheet set up. Have been looking at some of those here to see what they look like. I would kill to have something lower than 400s. Loved seeing Janet's SS showing remission.

One thing I hadn't mentioned-he has been grooming less since this all started. He has dandruff. something I never noticed was a problem for him.
 
Good luck with the insulin switch. Most of us use the Relion meter from Walmart. It and the strips are pretty cheap. It reads a little lower than the vets meter, but we know that and can make adjustments. Lots of cats have coat problems with diabetes. If he'll let you brush him, that can help. If you want some help with the spreadsheet, just holler!
 
You can get the WalMart Relion Confirm or Micro meter.....it's about $14 and the strips are $35.88/100 so you're not using your own strips (both are great meters that take a tiny sample size)

Most of us are buying our Lantus from Canada because it's 1/3rd the cost. Information on buying from Canada is in this "Buying from Canadian Pharmacies" thread

A 5 pack of pens is only $175 (including shipping) and you can use every last drop in the pens, where with the vials, you can end up having to throw a lot away when it eventually loses efficacy.

You may have gone up in dose too quickly and by too much......With feline diabetes, too much insulin can look like too little!!! We only increase in .25 unit increments so we don't bypass what could be a "good dose" for our kitty. If the dose is too high, the liver will react by releasing stored sugars and hormones to bring the blood glucose back up quickly. Without daily testing, there's no way to know if the day you did your last curve was a day when he was "bouncing" from those hormones or he really needs more insulin

It's also not necessary to only feed twice a day....if he's hungry, it's most likely because he's not regulated and he's starving. Most of us feed multiple small meals per day .....just like human diabetics are told to eat smaller, more frequent meals....it works the same in our sugarcats.

There's so much to learn when it comes to treating kitties!.....If he's not showing any other symptoms or signs of distress, I'd strongly suggest trying it "our way" and seeing how he does before you do any further testing.

The spreadsheet looks a lot more complicated than it is......it's already formatted and all you have to do is enter the numbers. I'd be happy to set it up for you if you want me to! Just click on my name and chose "Start Conversation" so I can get some details...it takes about 30 seconds to set up.
 
Shiramb said:
My vet messaged me that I could try giving 1 unit of Vetsulin twice a day (yay), so will start that tonight. How do you guys test so often? I am pre diabetic, and am supposed to be testing myself once a day, but I have been using my strips on Austin. I just ordered a refill of my strips as I am getting low, but testing him so often would deplete my prescription way before I could get another. Tried testing just before a meal today-did not go well. He was very squirmy and just wanted to EAT! I use a one touch ultra glucometer, and early in this journey, my glucometer gave close to vet's results-mid 400s at the same time.

Will try and get the spreadsheet set up. Have been looking at some of those here to see what they look like. I would kill to have something lower than 400s. Loved seeing Janet's SS showing remission.

One thing I hadn't mentioned-he has been grooming less since this all started. He has dandruff. something I never noticed was a problem for him.
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My cats coat was terribly oily with dandruff which was one of the symptoms. It resolved ed itself once she was regulated. Here's a before and after pic.
IMG_3560.JPG
 
Chris & China said:
You can get the WalMart Relion Confirm or Micro meter.....it's about $14 and the strips are $35.88/100 so you're not using your own strips (both are great meters that take a tiny sample size)

Most of us are buying our Lantus from Canada because it's 1/3rd the cost. Information on buying from Canada is in this "Buying from Canadian Pharmacies" thread

A 5 pack of pens is only $175 (including shipping) and you can use every last drop in the pens, where with the vials, you can end up having to throw a lot away when it eventually loses efficacy.

You may have gone up in dose too quickly and by too much......With feline diabetes, too much insulin can look like too little!!! We only increase in .25 unit increments so we don't bypass what could be a "good dose" for our kitty. If the dose is too high, the liver will react by releasing stored sugars and hormones to bring the blood glucose back up quickly. Without daily testing, there's no way to know if the day you did your last curve was a day when he was "bouncing" from those hormones or he really needs more insulin

It's also not necessary to only feed twice a day....if he's hungry, it's most likely because he's not regulated and he's starving. Most of us feed multiple small meals per day .....just like human diabetics are told to eat smaller, more frequent meals....it works the same in our sugarcats.

There's so much to learn when it comes to treating kitties!.....If he's not showing any other symptoms or signs of distress, I'd strongly suggest trying it "our way" and seeing how he does before you do any further testing.

The spreadsheet looks a lot more complicated than it is......it's already formatted and all you have to do is enter the numbers. I'd be happy to set it up for you if you want me to! Just click on my name and chose "Start Conversation" so I can get some details...it takes about 30 seconds to set up.
Click to expand...

Thank you Chris. You all here are so helpful and there is a wealth of information on this site. Waiting on testing and using your advice and information is so encouraging for me. I cried when I read that in your post because I was feeling like a bad kitty mom if I didn't agree to the testing, and the endoscopy and biopsy just seemed so invasive!

I had already decided after my first vial, that I would be using Marks Marine in Canada for any future insulin. Finding out I can feed more than twice a day is a godsend, and will hopefully give my hands a break from his "eager paws" at mealtimes.

I will definitely contact you for help with the spreadsheet. While tech savvy, I have never used anything like that before.
 
Shiramb said:
Thank you Chris. You all here are so helpful and there is a wealth of information on this site. Waiting on testing and using your advice and information is so encouraging for me. I cried when I read that in your post because I was feeling like a bad kitty mom if I didn't agree to the testing, and the endoscopy and biopsy just seemed so invasive!

I had already decided after my first vial, that I would be using Marks Marine in Canada for any future insulin. Finding out I can feed more than twice a day is a godsend, and will hopefully give my hands a break from his "eager paws" at mealtimes.

I will definitely contact you for help with the spreadsheet. While tech savvy, I have never used anything like that before.
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Your can feed whenever, just no food 2 hours prior to your preshot test so the number is not food influenced. I feed fancy feast classic twice a day and then free feed Young Again Zero carb food.
 
Shiramb said:
What drives me crazy is that neither pet was overweight, they were fed high quality grain free food, not given treats or people food, but got diabetes, while my 13 yr old fat indoor cat, is fine.
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My boy was also fed high-quality grain-free food his whole life and never overweight when he was diagnosed with diabetes, I couldn't understand it. It was recommended here to get the IAA & IGF-1 test after we hit 6u of Lantus, and sure enough he was dx with acromegaly. Took us 4 months to get his blood glucose under control from the 400s & 500s.
 
Bronx's dad said:
My boy was also fed high-quality grain-free food his whole life and never overweight when he was diagnosed with diabetes, I couldn't understand it.
Click to expand...

As we've all learned the hard way, "grain free" doesn't mean "low carb"

Also, just as with humans, a large component of diabetes is genetic, so although we can limit the risk factors by preventing weight gain, getting plenty of exercise and feeding a low carb diet, there's no way to fight genetics
 
My cat was thrown into diabetes after a steroid shot. He went from 13.5 pounds to a low of 9 pounds in 3-4 months. He's back up to 10.8 pounds. He gets extra food to help him gain and he's on a higher dose of insulin because of it. We use prozinc. He's not a "normal" diabetic cat. My spreadsheet is a crazy mess but we are officially 6 months into it on the 7th. Still not regulated and on 5+ units. He was a pretty normal cat before...my fat cat (21 pounds at his heaviest, back up to 18 pounds currently) is no where near diabetic. All my friends and family were shocked to find out it wasn't my fat cat that was diabetic! Don't lose hope. You are in the right place
 
Shiramb said:
Finding out I can feed more than twice a day is a godsend, and will hopefully give my hands a break from his "eager paws" at mealtimes.
Click to expand...
It's a little different with Vetsulin. It's a lot harsher (faster acting) insulin than Lantus, so it's better to have the majority of his food in him early on in the cycle. We tried Vetsulin (in Canada it's called Caninsulin, ie. canine insulin, but same thing) first. It wasn't lasting the full 12 hours for my Neko.

Since you are going back in dose quite a bit, I would strongly encourage you to get daily ketone tests. Typically we switch doses to something close to that of the other insulin.
 
The only time we don't want them eating is the 2 hours immediately before those Pre-shot tests.....Even with Vetsulin, you want to test and feed and then shoot 20-30 minutes later but since you test before you feed, the test should be fine
 
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