Hospitalized Diabtetic Cat!!! HELP!!!

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tamitam1458

tamitam1458

Member Since 2017
I have had my "Princess" for about 11 yrs now. She was a barn kitten I rescued. In December 2016 I had her in to get her teeth cleaned and a few pulled as she had bad breath and some bad teeth. The vet called me and said she was holding off on the teeth as Princess may have diabetes (she lost about 2 lbs) When she ran a test her glucose was at 331. She said she would like to see her in the 200's. I put her on low carb high protein diet and the next time I brought her in (May 2017 her number was at 271 (in May) and she gained a bit of weight so the vet said insulin at that time would not be necessary and to keep doing what I was doing. She was doing well until a few months ago when she started to lose weight. I finally took her to a clinic who told me her glucose was very high (412) and told me I should take her to the hospital. She also dropped to 3.8 lbs. They admitted her and since have been trying her on insulin and to get her numbers down. She was never on insulin before. They can't seem to stabilize her and are trying to figure out what could be causing her to not respond. I spoke to the vet Sunday morning and said she was doing good and eating VERY well and she may be able to come home that evening. I heard nothing more from them. I spoke with the vet this morning and she said the same...she is doing well and eating which is a good thing and may possibly be able to come home this afternoon. They wanted to do an abdominal ultrasound to see if it could be chronic pancreatitis, lymphoma, cancer etc. I wanted to see if she responded today on the insulin today so I held off. I called her original dr to see if she could call the hospital and get more info that I could understand as the vets at the hospital give me little to NO information other than "she is doing really good and eating great" I guess I don't understand why they keep telling me that and getting my hopes up then keep her. My original vet was on the same page with them and agrees something else must be going on with Princess so I am waiting for the hospital vet to call back to give the OK to do the ultrasound. I asked her normal vet what the next step would be if that came back normal and she said "maybe try a different insulin" Why wouldn't they try that FIRST? Is there anything these people at this hospital are missing that maybe one of you folks that have dealt with this before can tell me. I am in tears all day over this. PLEASE any suggestions or opinions would be greatly appreciated!!!
 
I agree that there may be something else going on and an ultrasound and a full panel should be their first steps. They may be trying to find an infection or inflammation that can increase the blood glucose and make it hard to regulate her.

As for what they are telling you and not telling you, I would make a time for you to go and visit your Princess and at that time ask to have someone spend 5 minutes with you. At the time you would like to review what they have done (bloodwork, urinalysis etc), what has that information told them or didn't tell them? What insulin and what dose are they given. What food are they feeding and is it low carb? Ask your questions - if this insulin doesn't work is there another one they will try? Some insulins may take a few days to actually get the full affect of the dose.

Did they indicate if she may have DKA?
 
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Welcome you’ve come to the right place. We will help you figure out the best way to help Princess. Did you get the dental done? Ask what insulin they are using, what they are feeding her, and if she’s been checked for ketones. The ultrasound is probably a good idea, if only to rule out any other problems. Be sure to get copies of any tests they do. How long has she been at the vet?
 
Try not to work yourself up too much. Arm yourself with a list of questions and ask them to explain everything to you. Take notes. If you can’t get any answers or they aren’t willing to explain anything, then request a copy of the records and test results, then go find a vet that will work with you, explain things, and educate you.

Some questions to ask:
What kind of insulin is she getting?
How much insulin and when?
What are her glucose levels?
What diagnostic tests/treatments has she received and why?
What are the results of any diagnostic testing?
What is she eating?

This can be a very overwhelming time, but we are here to help. We have all been where you are now.
 
The walk-in vet we took Princess too on Saturday ran an extensive comprehensive blood test on her 3 pages long. He was the one who (after seeing what he saw) told me to take her to the hospital. I am unaware if she has Ketones. If I am correct that is found in a urinalysis which the walk-in clinic did not run and I have not been told by the hospital about them. I think he assumed she had them due to her condition. I feel so in the dark as to what they are doing to my baby. I asked my primary vet (after she spoke with the hospital) if her ultrasound was normal what the next step would be and she thought, was try another insulin. I have been reading these forums here and have read that a lot of vets try too much too soon to try to regulate cats when in actuality it can take much more time. I will be speaking the vet on staff at the hospital soon and will definitely get more answers. I am SO glad to have a place like this to get good information as I am new to all of this.
 
Yes, please get a copy of the tests including the blood panel. If your kitteh is eating fine, and they are only giving insulin, then you can quickly learn how to test and dose your kitteh. We can help. And in that case you can bring her home.

If more tests are needed, you can always take her back for those tests. In the meantime you save money by having her at home.

I would also ask the vet to explain the results of the blood tests. If there is something there, they should explain it.
 
UPDATE: Princess had her abdominal ultrasound today (which they took to look for cancer) NO cancer but they said she had pancreatitis. I thought we FINALLY found the underlying issue of her not regulating but they burst my bubble AGAIN when they said they were going to up her insulin and take a few more blood tests. She said I should get back in touch about 3-4 o'clock and she may be able to come home tonight. When I called she said she still isn't regulated. I asked what her last result was and she said 500 (which I believe is the highest it has been) and that she didn't want her to go home yet as it would be hard for me and her primary vet (who I am ditching and seeing a different one for a 2nd opinion) to monitor her. She also said she wants to consult with internal medicine tomorrow. She NOW is looking at growth hormone and possibly acromegley. Just when I think things can't get any worse...they panic me more. I have been on such an emotional roller coaster with all of this. Everything I DO know is from googling these big medical terms she throws at me as the vet I talk to has NO compassion at all nor cares to put things in terms I understand nor does she explain things. I asked her "primary" soon to be EX vet, what would be next if her ultrasound came back normal and she said "switch insulin" Which I don't think they have tried. I scheduled an appointment with a new vet for thursday to get a 2nd opinion. They want me to bring ALL of Princess' records. I feel like I am being jerked around by ALL these vets. My "primary" vet told me lastnight that the vet at the hopital told her that Princess' intestines felt turgid. When I spoke with the hospital vet about it she said did talk to her but NEVER said that and that it must have been a miscommunication. SERIOUSLY how do you miscommunicate something like THAT??? I feel like I am in a circus working with a bunch of clowns!!! If any of you have ANY advice for me at this point. PLEASE PLEASE toss them at me. I am losing my mind here!!!
 
Also want to mention that lastnight my fiance talked to the night vet at the hospital (who is MUCH nicer) and she said for some odd reason Princess' numbers go down at night. She said her and Princess have conversations LOL I think maybe she spends time with her and that destresses my little girl and maybe that's why the numbers go down??? Is that possible? I know stress can cause the glucose to go up. I don't see why my baby girl can't be monitored in the relaxing comfort of her OWN HOME with the people she knows and loves and who LOVE HER!!! FYI she is on Lantis. My fiance get far more info from these people than I do.
 
The high numbers are scary but not insurmountable. Silver’s highest was 545 and that was following the vet’s dosing advice who kept increasing and increasing as they did not understand anything about nadir.

I don’t know about other underlying conditions BUT if it’s only diabetes you’re looking at I would take Princess home and follow the protocols here either TR or SLGS both of which are listed in the stickies in the Lantus forum.

Others with more experience can jump in bit at face value those high numbers can come right down with correct dosing. Look st Silver’s spreadsheet in my signature and those black numbers. (Click on the second tab to get the US equivalent numbers).

Sorry not much help but don’t despair. And yes numbers can be lower at night than daytime AND numbers usually higher with stress.

I listened to my vet at first and then decided to tell her to give me ten days to try it the forum way. He was off insulin within those ten days and never needed to go back to the vet.
 
Lantus is actually a really good insulin for cats, but it's completely unrealistic to expect "regulation" in a couple of days-- for most cats, it takes weeks or months! Maybe the vet practice is more used to treating canine diabetes?

If she's eating/drinking/peeing/pooping, no ketones, and no other health concerns besides the diabetes, I would put my foot down and insist on being allowed to take her home.

Feline diabetes can be well treated at home. Regulation is hard, but you can really help things along (and keep Princess safe) if you are willing to learn to test her blood glucose at home. Do you think you could do that? We can help with tips and tricks-- it's a steep learning curve, but most cats do great with testing as long as they get the proper motivation (treats, usually!).

Pancreatitis is tricky, but can be managed. The main thing is to keep them comfortable enough that they don't stop eating (that can trigger a downward spiral). Ask the vets about pain meds and anti-nausea meds to be used at home (note: often they will go with an appetite stimulant, but that can be counterproductive in a nauseated cat). Again, if she's eating now, even at the vet, that's great! She may not need interventions at the moment. But if she's prone to pancreatitis, those are the tools (pain meds, anti-nausea meds, and sometimes subcutaneous fluids).

Last thing: I'm surprised they're already thinking about acromelagy! Most vets don't even know about it. It's more common in diabetic cats than previously thought, but usually it's not a suspected diagnosis until dosage gets 5-10U-- I assume they don't have Princess on anything like that much insulin already??????
 
She hit a low of 118 at 5:00 a.m the morning the night vet was there. That's pretty darn low considering how she is normally in the high 300's to 400 What are your thoughts of Somogyi effect? The ONLY reason I know of this is all the research I have been doing online since Saturday. So much research my brain hurts and I am mentally exhausted from all of this!!!
 
Add another vote for what @Nan & Amber said

Go in, pay your bill and take your cat home!! There's absolutely no reason you can't handle this at home...and that's where it SHOULD be handled!!!

The people here can help teach you what you need to know as well as give you the best advice on dose increases and when to do them

We don't suggest testing for acromegaly or IAA until they're up around 6U twice a day (and that 6U has to have been raised slowly ....we see a lot of cats on insane amounts of insulin because their vets increase too quickly and by too much too!)
 
More like bouncing than the Somogyi effect. She’s been in lower than usual numbers and bounced.

We have ALL been there with the mental exhaustion. Believe me I have cried many tears over Silver. But the rewards are huge when you see those numbers coming down.

Take her home. Pick a protocol and get your starting dose from there. Test before every shot and post often. They will help you set up a spreadsheet so you can record your readings. It’s NOT hard and you CAN do this.
 
tamitam1458 said:
What are your thoughts of Somogyi effect?
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Fancy words that vets use to impress clients.....Somogyi has never really been proven in the first place.

What IS going on is what we call "bouncing"....by the time we get our cats diagnosed, they've usually been diabetic for quite some time. Their bodies have gotten used to living in those higher numbers. When they drop into lower numbers that they're not used to anymore, the liver releases stored sugars and hormones to bring them back up....they "bounce" high.

It can take up to 3 days for those excess sugars and hormones to clear the body before you'll really know what's going on again.

Just a housekeeping note....can we get you to "edit" your original subject line and remove the 911? We save that for medical emergencies like hypo's. They tend to scare us when we see them so we only use the 911 for emergencies
 
I most definitely would, as scared and nervous as I would be would do monitoring at HOME where I know my baby would be more comfortable and with ME! The vet told me she must have had undiagnosed pancreatitis but gave me the impression she does not have it now and that whatever damage was done is done YET in the same breath tells me the pancreas is a "problem" These people are SO confusing!!! Princess never threw up so that I don't get either. My fiance said the vet told him lastnight she is on 1 unit. We don't know if that is in 1 day or 12 hrs. We are so new to this and don't know the questions to ask and when I ask the one vet she seems to get exasperated at me. She knows I do my own research and I don't think she likes me questioning her.
 
Oh get shot of the vet and come here. My vet doesn’t even know I am treating Silver. Lantus should be given twice a day at 12 hr intervals. 1u twice a day is a good starting dose. Is she fed dry food or wet? Changing to wet only can often bring a cat right into remission. That happened to Silver in just ten days.
 
tamitam1458 said:
She knows I do my own research and I don't think she likes me questioning her.
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If we had a dollar for every time we heard a vet tell someone "don't believe anything you read on the internet", we'd all be rich

My own cat has never been back to the vet for her diabetes since she was originally diagnosed. I've done everything according to what the people here, who live and breathe this disease 24/7 have told me until I was confident enough to make my own decisions.
 
Chris & China said:
Fancy words that vets use to impress clients.....Somogyi has never really been proven in the first place.

What IS going on is what we call "bouncing"....by the time we get our cats diagnosed, they've usually been diabetic for quite some time. Their bodies have gotten used to living in those higher numbers. When they drop into lower numbers that they're not used to anymore, the liver releases stored sugars and hormones to bring them back up....they "bounce" high.

It can take up to 3 days for those excess sugars and hormones to clear the body before you'll really know what's going on again.

Just a housekeeping note....can we get you to "edit" your original subject line and remove the 911? We save that for medical emergencies like hypo's. They tend to scare us when we see them so we only use the 911 for emergencies
Click to expand...
How do I remove the 911?
 
upload_2017-12-12_20-44-18.png


Choose "No prefix" once you're able to
 
It appears that if the only thing they are doing at the vet is giving her insulin and trying to get her regulated which is not going to happen in a few days it takes time. I totally agree with @Nan & Amber.

You can do that at home cats usually do much better at home than at the vet they usually stress to much out of their home.
 
I guess their concern is she isn't regulated so they don't know what dose to send me home with. To be honest as a new diabetic cat mom, that scares me too!!! I am so afraid I will do the wrong thing.
 
tamitam1458 said:
I guess their concern is she isn't regulated so they don't know what dose to send me home with. To be honest as a new diabetic cat mom, that scares me too!!! I am so afraid I will do the wrong thing.
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Also WHY she isn't regulating. They feel there is SOMETHING else going on preventing her to regulate.
 
tamitam1458 said:
Also WHY she isn't regulating. They feel there is SOMETHING else going on preventing her to regulate.
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Regulation doesn’t happen that quick. It can take several weeks. Did you look at my spreadsheet? I’ve been trying to regulate now for two months. Please please please take her home. We are going to worry for her until you are testing and dosing her yourself at home.
 
@Juliet your spreadsheet scares me. I have NO idea what I am looking at :( You guys are going to have your hands full teaching me this complicated stuff
 
tamitam1458 said:
@Juliet your spreadsheet scares me. I have NO idea what I am looking at :( You guys are going to have your hands full teaching me this complicated stuff
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Don’t be scared. Take your time. Read lots of the stickies on the Lantus forum. Basically the spreadsheet is color coded ranging from green good numbers to black bad numbers.
Take this all in bite sized chunks. All the spreadsheet is is recording what the test meter says. When you type in the number it automatically colors the right color for the number. I was showing it to let you see that high numbers over 500 are not the end of the world.
 
tamitam1458 said:
You guys are going to have your hands full teaching me this complicated stuff
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don't try to understand everything overnight....it was at least 6 months before I felt confident that I understood things well enough to start to make my own decisions (and I still double checked with the more experienced people here!!)

Do you know how much Princess weighs? And if it's a good weight?
 
You can do this! It's a lot to take in in the beginning, but there are tons of people here who have been through it and can help with advice and support.

Chris & China said:
Do you know how much Princess weighs? And if it's a good weight?
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Chris: I think in the first intro post she mentioned that Princess had lost a lot of weight and was at 3.8lbs, so probably pretty underweight.
 
I haven’t read all the posts but want to reassure you about a few things. Pancreatitis is way more common than anyone ever thought. There’s a blood test for it, Spec fPL. Max had chronic pancreatitis for several years that likely contributed to his becoming diabetic. During episodes the BG often goes up. Symptoms include lethargy, nausea, inappetence, diarrhea, dehydration, constipation, and pain. Some or all of these may occur and each episode can be different. For Max he always became inappetent and nauseous. You treat the symptoms. What worked for him was ondansetron, a human drug for nausea, and sometimes cyproheptadine to stimulate his appetite but only after the nausea medication. Cerenia is a veterinary drug that many use.

I did see others told you that it’s way too soon to expect regulation.

Cats OFTEN go lower at night. Max did and his first low green numbers were after I had gone to sleep with my thinking he had hit bottom, nadir, for that cycle.

Here’s some info on pancreatitis. I’ll send a link to my favorite one later.

https://www.idexx.com/files/small-a...pec-fpl-treatment-for-feline-pancreatitis.pdf

I agree with the others. Get your cat home ASAP.

Don’t forget to get a copy of her complete chart, all labs, and the ultrasound report.
 
Is she having any vomiting or diarrhea? If she's eating well and drinking well she should come home. It takes weeks to regulate bgl. That being said you should start home testing so you can know how she is doing on the insulin. There
is a spreadsheet here you can look into. Vet's also typically rush insulin amounts looking for an immediate regulation. It can take weeks and the food cats ear is important. If she's getting a high carb good she will certainly have high BGL and many prescription diets are high carb. Many cats have low bgl in the am. They fast overnight.

Pancreatitis is treatable at home. Bgl levels can be monitored at home. A vet clinic causes stress and this alone can affect levels. Look into getting a monitor and supplies. Most of us use human monitors as they are less expensive. Great how to videos on you tube. Whatever meds they are recommending for her pancreatitis as well. A simple ingredient low carb wet food is ideal as well.

You kind of have to grab the bull by the horns here unfortunately. Go to the clinic and ask to see her and speak with her vet.
Find out what reason they are keeping her.
What insulin and how much.
What food and how much.
Does she have pancreatitis and what meds will she need at home.

Take a bossy friend with you for support if needed.
If you take her to a new vet they can request copies of her file.
Take a deep breath and just follow your instincts of what's best for your kitty. Many of us have had to do this and still do. It's tough at first but after a while gets easier. Especially after your kitty starts to do well. You are in a great place for support!!
 
CassWTribby said:
Is she having any vomiting or diarrhea? If she's eating well and drinking well she should come home. It takes weeks to regulate bgl. That being said you should start home testing so you can know how she is doing on the insulin. There
is a spreadsheet here you can look into. Vet's also typically rush insulin amounts looking for an immediate regulation. It can take weeks and the food cats ear is important. If she's getting a high carb good she will certainly have high BGL and many prescription diets are high carb. Many cats have low bgl in the am. They fast overnight.

Pancreatitis is treatable at home. Bgl levels can be monitored at home. A vet clinic causes stress and this alone can affect levels. Look into getting a monitor and supplies. Most of us use human monitors as they are less expensive. Great how to videos on you tube. Whatever meds they are recommending for her pancreatitis as well. A simple ingredient low carb wet food is ideal as well.

You kind of have to grab the bull by the horns here unfortunately. Go to the clinic and ask to see her and speak with her vet.
Find out what reason they are keeping her.
What insulin and how much.
What food and how much.
Does she have pancreatitis and what meds will she need at home.

Take a bossy friend with you for support if needed.
If you take her to a new vet they can request copies of her file.
Take a deep breath and just follow your instincts of what's best for your kitty. Many of us have had to do this and still do. It's tough at first but after a while gets easier. Especially after your kitty starts to do well. You are in a great place for support!!
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Cass - great advice in honour of Tribby. :):bighug:
 
And just so you don't think that we're completely bucking the whole vet establishment: my vets (cat specialists) are 100% on board with the approach to feline diabetes followed here, and what we recommend is in line with current research. It's just that lots of vets simply don't have the training or experience to deal with FD-- they get almost no training (literally a few hours) in vet school on diabetes in all animals, so unless they've made an effort to educate themselves, it can be a steep learning curve for them, too, when a diabetic cat shows up in their practice.
 
tamitam1458 said:
@Juliet your spreadsheet scares me. I have NO idea what I am looking at :( You guys are going to have your hands full teaching me this complicated stuff
Click to expand...
I sympathize completely about the spreadsheet. It took me a stupid amount of time to get started using the spreadsheet. But now that I'm comfortable with it, it helps tremendously.

One of the vets where I take Jester was very impressed with it. And the owner of the practice, when I simplified the numbers (just the basics without the color coding, etc.), complimented me and told me that he's pleased with how I'm treating Jester, including how I'm dosing him according to his BG numbers.

You may have to retrain your vet, but if s/he is intelligent and receptive, they should be willing to work with you. That's currently my experience with my vet's office.
 
We know you are scared, we all were or to be fair still are sometimes, but it does get easier and with the support of your vet (some are lucky and vet got on board and agreed with the protocols we use here after explaining everything to them ) or without it or finding a new vet.

We would need to know what dose are they giving him and what numbers are they getting to be able to help, maybe you can take him home with whatever dose they are giving , start testing him at home ( this is very important, probably one of the most important things ) and adjust either lower or higher depending on how he's doing, it is not like medicine that the vet calculates certain dose and that's it, insulin dose has to be adjusted depending on how he reacts and changes over time.
 
Chris & China said:
Somogyi has never really been proven in the first place.

What IS going on is what we call "bouncing"....by the time we get our cats diagnosed, they've usually been diabetic for quite some time. Their bodies have gotten used to living in those higher numbers. When they drop into lower numbers that they're not used to anymore, the liver releases stored sugars and hormones to bring them back up....they "bounce" high.
Click to expand...

Sorry for going slightly OT here, but what is this if it's not Somogyi? what is the difference (metabolically) between "bouncing" and Somogyi? To me it sounds like exactly the same phenomenon, except Somogyi was described following clinical hypoglycemia, but with more and more home testing we were able to observe that it happens also with "relative" hypoglycemia. Or is there something else that is fundamentally different?

tiffmaxee said:
Pancreatitis is way more common than anyone ever thought. There’s a blood test for it, Spec fPL. Max had chronic pancreatitis for several years that likely contributed to his becoming diabetic.
Click to expand...

Quintus can second that. He has pancreatitis, and we only discovered it because I thought he was "slowing down" a little in September and decided to get him fully checked before starting a new job in another city. His lipases (?) were way up, so we did an echo, and indeed, pancreatitis. His gallbladder was also "jelly-like" when it should be liquid (stone formation possibly?). Anyway, he maybe has this low-level pancreatitis for quite some time. And it's clearly what has caused his diabetes. After he relapsed with the pancreatitis early Nov, the vet who examined him told me that he wasn't having any abdominal pain. He didn't throw up once and never lost his appetite.

So... keep an eye open for chronic pancreatitis, which is often asymptomatic in cats!
 
tamitam1458 said:
She also dropped to 3.8 lbs.
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I think the fact that Princess is underweight could potentially be complicating her early treatment. I suggest you do a forum search for posts by member @Meya14 about brittle diabetes.

Here's an extract from one of Meya's posts on the subject:

Meya14 said:
Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.
Click to expand...

[Emphasis mine]

Source link: http://www.felinediabetes.com/FDMB/threads/cat-not-improving.169098/#post-1836148

It may be a good idea to discuss with the most helpful vet and/or the internal medicine specialist whether brittle diabetes may be a factor in Princess's case and whether going with an initial treatment protocol using a higher carb food along with an insulin dose to suit the higher carb intake might help Princess to regain weight faster and reduce the wild swings in BG level. Once Princess gets back to optimal weight and is stable you could then work to optimise carb intake for a diabetic cat and adjust insulin accordingly in order to improve her overall BG regulation.

Per Meya's advice above I'd strongly recommend testing Princess regularly for urine ketones (daily).

As others have said above, achieving good regulation is typically a gradual process: it takes time for the body to 'relearn' what healthy blood glucose levels look like. It's very much a marathon, not a sprint. :)

For home management of pancreatitis a home supply of anti-nausea and appetite stimulant meds are key. For flare treatment, a course of B12 injections can help a great deal. If the kitty's in pain then treatment with buprenorphine eases the discomfort during the acute stage of a flare (and the flare may resolve more quickly). With chronic pancreatitis it's also important to keep a kitty properly hydrated and also to keep an eye on bowel movements as constipation can make things worse.


Mogs
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My vet is a VERY experienced older man who is an IM and well respected vet. He shows the spreadsheets to all his third year students that spend a week with him. He’s got all the degrees yet always included my opinions and respected them. Once I told him I should have taken a tech course and he said no. I should have gone to vet school. It takes weeks to get appointments with him because he is so respected and yet he isn’t too big headed to acknowledge the benefit of the FDMB. He stopped even giving me advice on Max’s diabetes and just concentrated on his other issues.
 
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