When to see improvement?

[Becky Young]

Hey all,

I was just curious if anyone new how long it takes before clinical symptoms start to improve in a diabetic cat? Does it typically take several months before things turn around? How long did it take for your kitty to feel better?

Davis has been on 1 unit of Lantus 2x day for the past 2 months. In some instances, he seems to be getting worse. His neuropathy is sooo bad (giving Zobaline 2x day), it's heartbreaking. He can't control his hind legs at all so he frequently walks through his poop after using the litter box and He can just barely do stairs. He still drinks and pees quite a bit and he has not gained any weight (I'm feeding 3-4 cans of Fancy Feast per day). He doesn't play, rarely purs and just isn't himself.

It's disheartening that we've been trying SO hard and it feels like I have nothing to show for it. I guess I'm just feeling discouraged, I thought after 2 months, we'd see some improvement in his symptoms but maybe I just need to be more patient. Does anyone have any thoughts? Thanks

 

[Wendy&Neko]

Not all cats get neuropathy, my Neko did not. But getting a cat into better regulation can help, in addition to the zobaline. My Neko had other issues hat took much longer than two months to fix. But she was complicated with two high dose conditions. I have heard zobaline can take a few months to help.

I see you are skipping some shots due to low preshots. It might help to lower the dose a bit to 0.75 units, so you don't have to skip which causes higher numbers. I would also suggest getting some more mid cycle tests, including at night. We dose Lantus based on the low point, which is mid cycle, instead of the preshot values which are often the high points of the cycle. Doing a curve will help you figure out the onset, nadir, and duration and help you to help Davis better.

 

[Marvin's Mom - Nat]

Hi my kitty has really bad neuropathy, vet says that until he is regulated I will not see much change. HOWEVER I recieved alot of great suggestion here which has shown some progress. He isn't walking properly yet, but he is moving around compared to when he was first diagnosed and really didn't move at all. I remember posting here in tears the first time as he couldn't get up to pee and was peeing on himself. My heart was broken and I thought I may have to let him go. Now every cat is different, this is what I did for my kitty, it may help you.

1. Zobaline (once Marvin is regulated I may look into B-12 Meth shots, if affordable)
2. Cosequin (arthritis med), if you can afford you may want to try Adequan shots (I assume you are in the US), I am not sure he has arthritis or not, but figured it couldn't hurt, and found this made the most difference.
3. fish oil (not sure why but it has helped also)
4. I replaced his litter box with a cover from an old plastic bin, so he could just walk in and out (you can also cut a side of a litter box) . This helped him alot

In Marvin's case I found that the Cosequin on top of the Zobaline really helped, @Bronx's dad I belive also mentioned that Tumeric paste helped their cat alot.

The last couple weeks Marvin's BG has improved, and I have noticed that even though he is walking on his hocks at the moment, he is moving around alot more, and has even ventured down the stairs to lay down on the tiles. He used to only take a few steps at a time. Now if he want to cross the room he does without stopping. He still does the few steps at a time if he isn't focused on getting to a specific spot, but I can tell that he is feeling better as moving more often.

For me neuropathy is the hardest part for me, as it has affected his mobililty. Since he has been feeling better, I still see my cat, he purrs, he gets around (less than before, nolonger stuck in one place or room anymore), he doesn't seem depressed anymore, able to use the litter box, his hocks most time are no longer covered in litter, which would indicate he has a little bit more control with his hind legs, he just seems better if not yet walking properly. Small steps with this condition.

 

[Doodles & Karen]

Good job home testing and finding this group of family so quickly. My Doodles had neuropathy and took 6 months but he fully recovered. Although I didn't home test dose correctly until 4 months in, then we found this group. Regulation was key and I also did b-12 capsules twice a day. Also too Doodles for acupuncture about 1/2 dozen times. We added a litter box to every room. Ended up using non clumping litter for a while because it hurt him to get his feet washed. Doodles would stay in the same spot mostly so I started moving him around, even putting him on low furniture and assisting him down etc. to try and build his muscle back up. Hand in there.

 

[Marvin's Mom - Nat]

Doodles would stay in the same spot mostly so I started moving him around, even putting him on low furniture and assisting him down etc. to try and build his muscle back up. Hand in there

I do this a little too since he is feeling better. I didn't think of acupuncture yet, heard that the closest one to me for pets is over an hour away and Marvin doesn't travel well. What helped the most for Doodles? I am still looking for any advice and suggestions for Marvin too. Next on my list is trying the Tumeric paste, but was also wondering what type of physical therapy I could think of, even if it's just rubbing his legs a bit (which he will not let me do, touching his hind legs results in hiss hiss, bite bite(soft bites, but the meaning is clear)).

 

[Doodles & Karen]

What helped the most for Doodles

Wish I knew the magic combo. I'd say getting him regulated and just time. Doodles was once a tightly regulated cat before the IAA and heart issues came into play. People with neuropathy have nerve pain so touching his legs much isn't something I did, especially his feet. Doodles also had hair loss but recovered from that too. My regular vet did the acupuncture.. might call around, you never know who might be doing it. I can't say for sure if it helped or not since all those things above were in play at the same time.

 

[Sienne and Gabby (GA)]

Hi, Becky. I'm not sure I've stopped by before.

One thought is that by primarily relying on pre-shot tests, you can't really tell what kind of progress Davis is making. First, how's your kitty acting? (Not everything is by the numbers.) I would encourage you to get some spot checks during the cycle. I always worry when I see a low pre-shot, where the numbers were at nadir (lowest point in the cycle). If you see some of those green pre-shots, they look like they are typically followed by a high pre-shot number during the next cycle. This is a "bounce." It's entirely possible that there's more bouncing going on and because you're not getting some tests during the rest of the cycle, you have no idea how good Davis' numbers may be. Looking at yesterday, you saw a sizable drop from AMPS to your test at +6. I agree with Wendy -- having a handle on Davis' onset, nadir, and duration will help you better understand his cycles.

It may also help to keep in mind that the Lantus (and Levemir) dose is based on the lowest number in the cycle. You don't really want to adjust the dose based on the pre-shot value. (You need to keep the pre-shot number in mind in order to determine if it's safe to shoot.) I also don't see any information in your signature lines about which approach to dosing you're following. We use two approaches. However, since you're feeding Young Again, your only option is Start Low Go Slow (SLGS) -- you can't be feeding any dry food if you want to use the Tight Regulation Protocol. You might want to read through SLGS. This will help you to manage dose changes and, hopefully, get Davis better regulated.

 

[Marvin's Mom - Nat]

I can't say for sure if it helped or not since all those things above were in play at the same time.

I hear ya with that.

The real healing is during times of BG in good ranges. I will check into the Acupuncture, I will probably need to save up for it. I didn't think of checking if a general vet may do it, as one of my friends went to one who specialized in it. Good idea.

Becky :hugs: to you and Davis.... it's a slow process.

 

[Bronx's dad (GA)]

@Bronx's dad[/USER] I belive also mentioned that Tumeric paste helped their cat alot.

People swear by it for arthritis/joint issues with their horses, dogs and cats. Bronx is walking better since we started it and he eats it no problem which is a good thing. But the neuropathy issues are better resolved with B-12 is what I hear.

 

[Becky Young]

Hi, Becky. I'm not sure I've stopped by before.

One thought is that by primarily relying on pre-shot tests, you can't really tell what kind of progress Davis is making. First, how's your kitty acting? (Not everything is by the numbers.) I would encourage you to get some spot checks during the cycle. I always worry when I see a low pre-shot, where the numbers were at nadir (lowest point in the cycle). If you see some of those green pre-shots, they look like they are typically followed by a high pre-shot number during the next cycle. This is a "bounce." It's entirely possible that there's more bouncing going on and because you're not getting some tests during the rest of the cycle, you have no idea how good Davis' numbers may be. Looking at yesterday, you saw a sizable drop from AMPS to your test at +6. I agree with Wendy -- having a handle on Davis' onset, nadir, and duration will help you better understand his cycles.

It may also help to keep in mind that the Lantus (and Levemir) dose is based on the lowest number in the cycle. You don't really want to adjust the dose based on the pre-shot value. (You need to keep the pre-shot number in mind in order to determine if it's safe to shoot.) I also don't see any information in your signature lines about which approach to dosing you're following. We use two approaches. However, since you're feeding Young Again, your only option is Start Low Go Slow (SLGS) -- you can't be feeding any dry food if you want to use the Tight Regulation Protocol. You might want to read through SLGS. This will help you to manage dose changes and, hopefully, get Davis better regulated.

Thanks for your response. I guess we're on the SLGS protocol. I've read through it before but I should probably do it again. The bouncing is so frustrating and it seems to happen all the time now. I'm not sure how to correct that. Lower his dose? I will attempt a full curve tomorrow.

I'd say in general, he is declining. Neuropathy is worse, constant diahrrea, chewing his fur off, sleeps all day, seems agitated and restless when he's awake and he always seems hungry even though I feed 4 cans of FF + leave some Young Again dry out for him. He's not himself and hasn't been so for a while now. I guess I had high hopes that he'd feel better instantly. I want him to get back to being the spunky kitty he used to be but I'm starting to doubt if that will ever happen, he seems so far from that

 

[Becky Young]

We dose Lantus based on the low point, which is mid cycle, instead of the preshot values which are often the high points of the cycle. Doing a curve will help you figure out the onset, nadir, and duration and help you to help Davis better.

Can you help me understand this better? What if his pre-shot is 150? Still shoot? What if I'm not home to catch the nadir? I'm gone a lot and I don't think I'd be able to get it all the time...

 

[Becky Young]

and I also did b-12 capsules twice a day.

Do you know if I can do b12 and Zobaline together?

 

[Chris/China (GA)/Garfield]

What if his pre-shot is 150? Still shoot?

Until you learn more about how Davis responds to food and insulin and have more data, you'd want to stall, don't feed and post for help. The first few times someone shoots a lower than usual number, we want someone with experience to watch over them. We make a promise to everyone here that if we sign on to watch over someone, we stay until we're sure everyone is OK and it's safe ......and if we can't, we either find someone else to watch over you or we say up front that we can't stay so you can take that into consideration.

In 20-30 minutes you re-test to see if the number goes up.....if it does, that's usually a good sign that that the last insulin shot is wearing off and it'll be OK to go ahead and shoot....but again, it's important to not feed or you won't know if the number is a food spike or if it's actually going up on its own.

The first few times you shoot a lower PS, we'll tell you to test at +1 and +2....this is so you can intervene early if you need to, as well as learning what kind of food spike your cat usually gets.

If you can't get other tests in later in the cycle, we'll probably tell you to skip the shot for safety.....better to be too high for a day than too low for a moment

 

[Chris/China (GA)/Garfield]

Do you know if I can do b12 and Zobaline together?

Zobaline is B-12.....it's just the methylcobalamin form (along with folic acid which is also good for nerves)....where the injections are usually the cyanocobalamin form of B-12

For neuropathy, the methyl form works best....for appetite and general energy (as well as other things) the injectable form works better

 

[Sienne and Gabby (GA)]

@Becky Young - Bouncing is normal -- it's annoying but it's a normal part of getting a kitty regulated. Some cats bounce for a brief period and others take a lot longer to get their system's used to being in lower/normal numbers. I would not lower the dose. It doesn't help and all you do is lose time since you end up bringing the dose back up.

I really, really, really want to encourage you to start getting a "before bed" test every night. I understand your concern about shooting a lower number and having to leave the house. However, you're doing the same thing by not getting any tests during the PM cycle. When I see the 77 at AMPS on Davis' spreadsheet, what goes through my head is the question, "How low were his numbers last night?" The only way you have control over Davis' BG numbers is by testing. Right now, you're missing half of your data. It also means that if his numbers have dropped low, you didn't have the opportunity to intervene and potentially prevent or soften a bounce. Many cats wander into lower numbers at night. Testing is the best way to keep Davis safe. I know I'm being a pain about this. I've been on this board for a long time and getting even one test every night before you go to bed could save your cat's life. It gives you a great deal of control.

 

[Becky Young]

@Becky Young - Bouncing is normal -- it's annoying but it's a normal part of getting a kitty regulated. Some cats bounce for a brief period and others take a lot longer to get their system's used to being in lower/normal numbers. I would not lower the dose. It doesn't help and all you do is lose time since you end up bringing the dose back up.

I really, really, really want to encourage you to start getting a "before bed" test every night. I understand your concern about shooting a lower number and having to leave the house. However, you're doing the same thing by not getting any tests during the PM cycle. When I see the 77 at AMPS on Davis' spreadsheet, what goes through my head is the question, "How low were his numbers last night?" The only way you have control over Davis' BG numbers is by testing. Right now, you're missing half of your data. It also means that if his numbers have dropped low, you didn't have the opportunity to intervene and potentially prevent or soften a bounce. Many cats wander into lower numbers at night. Testing is the best way to keep Davis safe. I know I'm being a pain about this. I've been on this board for a long time and getting even one test every night before you go to bed could save your cat's life. It gives you a great deal of control.

Thanks for your input! I have dont any "before bed" tests because I feed and administer insulin at bedtime (10pm) when I get home from work. Maybe some nights I can set an alarm for 12am, 2am, 4am? I'm rarely home due to my work and travel schedule so a lot of his tests are done by our cat sitter, to the tune of $900/month

How long does bouncing last? Will he eventually get through the bouncing? His clinical symptoms are getting worse, I feel like I'm not helping him at all

 

[Kris & Teasel]

Thanks for your input! I have dont any "before bed" tests because I feed and administer insulin at bedtime (10pm) when I get home from work. Maybe some nights I can set an alarm for 12am, 2am, 4am? I'm rarely home due to my work and travel schedule so a lot of his tests are done by our cat sitter, to the tune of $900/month

How long does bouncing last? Will he eventually get through the bouncing? His clinical symptoms are getting worse, I feel like I'm not helping him at all

You do have a challenge with your work schedule. Lantus works best if you can find a dose that you can give consistently AM and PM while avoiding NSs as much as possible. I think you can start at 1 u AM and PM and raise it in 0.25 u increments according to the guidelines of SLGS. You have many numbers on your SS where no shot was given but the BG was more than adequate to support a dose of Lantus. I think things would calm down quite a lot if you aim for a better dosing regimen and do what you can for testing on weekends, etc. More consistency = less bouncing = gradual uncovering of the best dose range = kitty who feels better.

 

[Marvin's Mom - Nat]

depends on the cat, they can last I believe up to 6 cycles, however from what I see from the last few days it seems to settle the same day. If there were more tests it be easier to tell. It is possible his numbers are better than you see as pre-shot numbers would be the higher and that is normal the lowest point are mid cycle. He had a few greens at beginning of his cycle so the insulin is having an affect on him. A curve would help to see how he holds his numbers during the full cycle.

I know that it's hard based on our schedules, and it's no fun poking our fur babies. I don't know what your schedule is, but nights where you are up longer get an extra test in, and when you get up before heading out maybe you can get one or two in at the end of the PM cycle. Another suggestion, add a time column to your spread sheet, Lantus works best if 12 hour between shots, I assume the sitter does some of the shots, so would be good to see if they are about 12 hours apart. It would help stabilize his numbers. If they are 12 hours apart that is great. The fact that you are here and asking for assistance is great. I am sure there is a way to figure out how he is doing with your schedule, by taking advantage of the times you are available.

If the sitter needs help too, they can reach out here if need be

 

[Becky Young]

You do have a challenge with your work schedule. Lantus works best if you can find a dose that you can give consistently AM and PM while avoiding NSs as much as possible. I think you can start at 1 u AM and PM and raise it in 0.25 u increments according to the guidelines of SLGS. You have many numbers on your SS where no shot was given but the BG was more than adequate to support a dose of Lantus. I think things would calm down quite a lot if you aim for a better dosing regimen and do what you can for testing on weekends, etc. More consistency = less bouncing = gradual uncovering of the best dose range = kitty who feels better.

Which numbers are adepquate for a dose? I read that if the number is 200 or lower, it's best to skip. Is this incorrect? Let's say he's at 160 amps...is that high enough for 1u? Are .5 doses ok to give or does that throw the whole thing off?

 

[Becky Young]

depends on the cat, they can last I believe up to 6 cycles, however from what I see from the last few days it seems to settle the same day. If there were more tests it be easier to tell. It is possible his numbers are better than you see as pre-shot numbers would be the higher and that is normal the lowest point are mid cycle. He had a few greens at beginning of his cycle so the insulin is having an affect on him. A curve would help to see how he holds his numbers during the full cycle.

I know that it's hard based on our schedules, and it's no fun poking our fur babies. I don't know what your schedule is, but nights where you are up longer get an extra test in, and when you get up before heading out maybe you can get one or two in at the end of the PM cycle. Another suggestion, add a time column to your spread sheet, Lantus works best if 12 hour between shots, I assume the sitter does some of the shots, so would be good to see if they are about 12 hours apart. It would help stabilize his numbers. If they are 12 hours apart that is great. The fact that you are here and asking for assistance is great. I am sure there is a way to figure out how he is doing with your schedule, by taking advantage of the times you are available.

If the sitter needs help too, they can reach out here if need be

We've been super strict about the time, that's one thing I do feel confident about! 10am and 10pm on the dot every day. My schedule is sooo wacky, I'm frequently gone 18 hours per day, hence the cat sitter. I will try to be more diligent about getting some more mid-cycle tests in!

 

[Kris & Teasel]

Which numbers are adepquate for a dose? I read that if the number is 200 or lower, it's best to skip. Is this incorrect? Let's say he's at 160 amps...is that high enough for 1u? Are .5 doses ok to give or does that throw the whole thing off?

The no dose under 200 is a general guideline for new diabetics but your kitty has been on Lantus or a couple of months. I will backpedal a bit, however, and say that the lack of mid cycle data (and I truly understand your difficulties) makes it hard to know how low he's going. Lantus is dosed based on how low the BG goes, not on how high the PSs are. Testing at PS is to ensure that giving insulin is safe. Let's put that aside for a moment. Here's an example of an inconsistency: on June 25/17 AM AMPS was 191 and there's an NS whereas on June 24/17 a dose of 0.3 u (?) was given on an AMPS of 171 and on June 29/17 a dose of 0.2 u was given on an AMPS of 151. On July 10/17 you gave 0.5 u on an AMPS of 156 and he didn't go below blue. These are a few examples that tell me striving for consistency is what you want to do first and foremost.

SLGS has a guideline of doing a curve once a week (whenever you have a day off?) and dropping the dose by 0.25 u whenever the BG has dropped below 90. I strongly recommend you review the info sticky on SLGS and try the best you can to work on a consistent dosing program.

 

[Marvin's Mom - Nat]

Which numbers are adepquate for a dose? I read that if the number is 200 or lower, it's best to skip. Is this incorrect? Let's say he's at 160 amps...is that high enough for 1u? Are .5 doses ok to give or does that throw the whole thing off?

You will get different advice on this, and will also depend if you are around to test. Once you have a better idea how you kitty reacts will also help. The last few weeks I have lowered my No Shot limit as I have a better idea how Marvin typically reacts when I shoot on a lower number. Like you at first my limit was about 200, when I felt comfortable I lowered, last week at the beginning it was 130, now around 100, but that is because I am around to test, if I wasn't I think I would do BCS (big chicken shot) lower dose, or no shot depending on how he has been reacting to his shots during the week. Keep in mind when you lower the shot amount or no shot, the depo comes into play so the cat still gets insulin from the depo. In my opinion since you do not have a lot of data yet, I think your call to not give a shot is good for now. However Kris is correct, it would help to regulate him faster to lower the numbers of No Shots, but not sure you have the data needed yet. If it happens when you can monitor him, the you may want to set a lower number for those days.

Hope this makes sense, it's a lot of information so one day at a time, and don't worry if we need to review a few times, and adjust to what works for the both of you. I myself had to take it one step and one change at a time, I was very overwhelmed the first few months or so.