One Month of Insulin Treatment; Reflections & Concerns

[StefO]

I can't believe it's been a month since we've started Garth's insulin treatment. Honestly, it has felt like a million years.

We were doing 1U of Lantus 2x a day until his first curve, where his lowest BG was around 450. The vet increased his dose to 3U and he goes in for his next curve on 7/6.

He started peeing right outside of the litter box, so we have introduced pee pads. They're helpful but don't absorb the entire mess. When he peed on the downstairs door mat, we decided to keep him gated upstairs, where it is mostly hardwood. Plus, with his neuropathy, it probably makes the most sense for him to not have to use the stairs. It's been about a week of this. For the first few nights, we also locked him out of the bedroom, which is something we have never done in his lifetime. I woke up to two full pee puddles outside of the bedroom door, as well as pee/poop in another room upstairs. Yesterday I got rid of the rug in this room and mopped entirely. It only took 20 minutes for Garth to pee in the same spot again! I keep thinking it's behaviorial, husband thinks its the old age/FD etc. He wants to move the litter box into our upstairs storage room, so that will be the only zone, but I feel bad continuing to quarantine him more.

A friend whose FD cat recently passed gave us a case of Purina DM wet food, unopened bag of DM dry, and 2 bags of feline pine. We were so incredibly thankful. So he has been eating a can of Purina DM in the AM and a can of Fancy Feast in the PM. He still meows incessantly and is still quite ravenous throughout the day. So I was giving him handfuls of the DM or freeze dried to salmon, to subdue him a little. I felt guilty about the dry food, so I started to give a half can of FF around 2pm.

This morning, he took a few bites of the Purina DM and walked away. I decided to see if he wanted FF, which he nibbled half of and I gave him his shot. I brought the food upstairs and he finished it. He is normally crying around 6:30am for food, but not this AM. I am going to home test in a few since it's been about 2 hours since he last ate but a lil worried today!

Every day, I think he is improving but now I'm not so sure. So thankful for this community!

 

[Julia & Bandit (GA)]

So, is it correct that your vet raised him from 1U of insulin to 3U of insulin, all at once? How long has he been on 3U? That is a really large dose increase, and not how Lantus should be increased. Dose increases should be done in .25-.5u increases, depending on how low he's going in each cycle. Most cats don't need much more than 1u-2u of insulin if they're eating a canned, low carb diet.

You mention that you're testing at home, but you're also taking him in to the vet for curves? If you do a curve at home, that's going to be more accurate than the curve at the vet, because stress inflates curve numbers at the vet and leads to dangerous chronic overdosing. However, even if his vet curve showed super high numbers, a 2u increase would STILL be dangerous. Can you post the blood tests that you've gotten for him at home so far? There's instructions on how to set up a spreadsheet to track his numbers here, but anything you have might be helpful.

I would definitely test him today and see how he's doing--I am worried that there is too much insulin on board. Keep in mind that cats that are on too high a dose will also throw you high numbers--that's why we like to dose Lantus based off daily testing, not weekly curves (although a curve at home once a week is a good idea to give you an idea of how insulin works in him throughout the day). When a cat is getting too much insulin, his liver will dump glucose into his bloodstream to counteract the low blood sugar, which then causes high blood sugar for several days until he goes low again and the cycle repeats itself. That's why we recommend daily testing to determine dose adjustments. With Lantus, you want to test at least three times a day--once before each shot to make sure it's safe to give insulin, and then one test in the middle of either cycle (although it never hurts to get more tests when you can), and a (home) curve once a week.

The Purina DM canned is ok to feed diabetic cats (Hills M/D is not), but it's liver based so a lot of cats get sick of it quickly. If you look at the ingredients though, it's pretty much the same thing as Fancy Feast, so there's nothing in the DM that makes it better for diabetics than other low carb canned foods--it's just more expensive. The DM dry is too high in carbs for diabetic cats, and will cause problems with regulation. Can you feed him more canned food more frequently throughout the day? Most diabetics do best eating at least 4 times a day--I feed Bandit at 7am/1pm/7pm/1am, and I freeze food and put it out in an auto feeder when I'm not home or sleeping.

 

[Julia & Bandit (GA)]

He started peeing right outside of the litter box, so we have introduced pee pads. They're helpful but don't absorb the entire mess. When he peed on the downstairs door mat, we decided to keep him gated upstairs, where it is mostly hardwood. Plus, with his neuropathy, it probably makes the most sense for him to not have to use the stairs. It's been about a week of this. For the first few nights, we also locked him out of the bedroom, which is something we have never done in his lifetime. I woke up to two full pee puddles outside of the bedroom door, as well as pee/poop in another room upstairs. Yesterday I got rid of the rug in this room and mopped entirely. It only took 20 minutes for Garth to pee in the same spot again! I keep thinking it's behaviorial, husband thinks its the old age/FD etc. He wants to move the litter box into our upstairs storage room, so that will be the only zone, but I feel bad continuing to quarantine him more.

The urination problems should resolve once you get him regulated--especially if he has neuropathy. Are you giving him methyl-B12 for his neuropathy? It can improve neuropathy a great deal in cats. How many litter boxes do you have in your house? I would put one in every room that he seems to pee in--it seems most likely that it's difficult for him to get to/in the litterbox because of his neuropathy. I would also try litter boxes with a very low front, like this one--cats with neuropathy will often pee outside the box because it's difficult or painful for them to get in it.

 

[StefO]

Yes, my vet increased his dose from 1U to 3U, all at once. I asked if that was normal and they were mostly concerned about his BG getting too low. So far, the lowest reading we have gotten from him was 361 but that was a few days ago. We have not been testing consistently but now that I know that we should with Lantus, we will start. And of course, my meter is acting up at the moment and I can't get a reading on him! I've already used 5 test strips! Hoping my husband will be home soon to assist! If we can get my meter working correctly, I will attempt a home curve tomorrow. Should I decrease his dose for the weekend? Hoping to get him into the vet after the holiday, if his behavior continues to change.

Thank you for letting me know about Purina DM, I was wondering what I should do after we ran out. I am pretty happy with FF and I think Garth is too. We have been loosely trying to feed at 8am/2pm/8pm/12am but sometimes give the freeze dried salmon at 12am. I am not giving him anything for neuropathy but would love to start. I will also get a second litter box. Thanks for all of the suggestions.

I will post his test results as soon as I can !

 

[Julia & Bandit (GA)]

There's a couple choices when it comes to Methyl B12--you can get the capsules made for humans (I've used these in the past with various cats), open and mix one of the capsules with his food once a day. Or you can order Zobaline, which is a B12 supplement specifically for diabetic cats.

I wouldn't decrease the dose without testing first to see how it's effecting him--but I think it's likely you'll probably need to lower it once you get those tests in. If you haven't already read this thread on hypos, I would definitely do so! What meter are you using? Is it giving you an error message? If so, which one? Maybe you can run out and get another meter and strips that works? Walmart has some decent meters that are pretty inexpensive. It never hurts to have a "back up" meter. And don't be afraid to feed him extra canned food if he's acting hungry--Fancy Feast pates are all fine to feed. You might also want to grab a couple of the gravy ones to keep in your house just in case you need a higher carb food if he has a hypoglycemic incident.

I would, starting as soon as you're able, test a few times a day over the next 3-5 days (once before each shot, once halfway through either cycle, and then whatever other random tests you're able to get). If at any point he drops below 50, you're going to want to treat him for hypoglycemia (see the thread I linked) and lower the dose--the folks in the Lantus Forum can help you figure out what that dose should be.

 

[Noah & me (GA)]

I feel your pain about closing the bedroom door, or any door. We've tried this over and over again over 20+ years with 18 cats and a dog, primarily to try and get some actual sleep. It's never worked and although it might not be what's happening there cats have a unique way of telling you how annoyed they are. I once found a poop dead center on my pillow. Just one, no pee, nothing else disturbed. They know you love them and now this? Being "annoyed" could mean so many things; I'm in pain and you're not helping, I don't like this food etc. It's just one more thing to think about. I hope things get better for you, that's one mess I've never enjoyed cleaning when I know I'll be doing the same thing in 24 hours.
I totally agree about doing curves at home. Nothing is the same at the vet even for cats that like to travel and love the vet (I've had a few) and I've been sent home more than once with a "curve" that made no sense at all.

 

[StefO]

Garth is doing much better today! The meter is working now but drawing enough blood for a sample has been a challenge with my feisty little guy. My husband was unable to get a reading before last nights shot and only gave him 2U. I was not able to test before his 8am shot but tested him around 10:15am and he was at 363 and at 2pm, he was at 360. He is back to his ravenous self. I was in panic mode yesterday and made an appointment with the new vet that I had been wanting to try. So I will get a second opinion on Monday.

Thank you for the advice !

 

[JanetNJ]

Garth is doing much better today! The meter is working now but drawing enough blood for a sample has been a challenge with my feisty little guy. My husband was unable to get a reading before last nights shot and only gave him 2U. I was not able to test before his 8am shot but tested him around 10:15am and he was at 363 and at 2pm, he was at 360. He is back to his ravenous self. I was in panic mode yesterday and made an appointment with the new vet that I had been wanting to try. So I will get a second opinion on Monday.

Thank you for the advice !

what meter are you using? If it is one that requires a larger sample I would switch to one that only requires .3 sample such as the relion confirm or micro. Definitely start the b12!! you can buy zobaline on amazon.