? Glucose 501 Newly Diagnosed. Neuropathy. Can't walk well.

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MayDayMelK

MayDayMelK

Member Since 2020
Hello, My rotten 10/11yr old was diagnosed yesterday after experiencing a crisis. We have three indoors kitties and realized they were going through 3X's the normal amount of water, peeing non-stop, and had loose bowels so scheduled them all for next week for a check-up. Yesterday morning we woke up to our oldest being unable to walk, vomiting, and confused. I rushed him to our closest vet and he was quickly diagnosed as diabetic. After 2U of insulin they were able to get his # down to 501. This morning his glucose was 293 pre-insulin. I have downloaded the file to keep up with his levels but our vet told me not to stress him over checking it until he had more to adapt to the insulin and we do his curves. He is scheduled to go the 14th for his first curve stay. He came home with Vetsulin and I am giving it to him every 12 hours.

My question is about the neuropathy. He is able to walk slowly, but he walks on his hocks more than his pads if that makes sense. His entire back end is weak. He was a 28lb cat that we had been feeding a urinary diet and getting weight off over the last year, but I was shocked to see that since our last vet 3 months ago visit he's lost down to 18lbs. I am rubbing his belly to get him to kick at me to keep him using his legs as much as possible to try to prevent further muscle loss, but I was wondering if anyone out there has dealt with neuropathy resolving? Or has ideas on how to exercise him without stressing him too badly. He likes the game of "pet me, no don't, now do, now don't, now I kick and bite" with his belly but he's otherwise not interested in moving around much.

We've had Sid for 10 years now, we got him out of an Army dumpster at my husband's motorpool when he left for deployment all broken. We suspected he had been abused by all his injuries but he's survived broken legs X3, broken ribs, a dog attack, kidney stones, bladder stone, intestinal blockages, neutering, and being declawed on the front along with toes amputated.... just to get diabetes. I fear my $8,000 dumpster kitty has decided that he has a new goal for how much we could possibly spend on him.

Thanks for reading my rambling if you made it this far!
-Melissa
 
Hi Melissa, and welcome to you and Sid.

My goodness hasn't your boy been through a lot. (((Sid))) I'm glad the universe sent you to him.

Great that you've already got your spreadsheet up and running. :)

Urgent clarifications needed. Please confirm:

* Your vets gave a dose of 2IU immediately after diagnosis.

* Your vet has set Sid's starting dose as 5 units of Vetsulin twice a day.

* You are testing Sid's blood glucose levels at home with a Relion meter.

Assuming that you are testing BG at home, how many hours ago did you give Sid his insulin dose this morning and have you tested him at any time after giving this morning's dose?


Mogs
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Hey Melissa,

You can feel free to look in my previous post history. My wife and I are currently dealing with our 2nd diabetic cat and her insulin and diabetic neuropathy (walking on the hocks and not the toes.) Our first diabetic cat, Boo, had something similar, and after about 3 years, he is finally starting to look like his pre-diabetic self. I'm sure others will confirm, but the first and most important thing is to get the BG levels under control. Apparently, only then, will you start to notice any difference. One thing others have recommended is Methyl B-12. It is a supplement you can put in their food that will assist with the nerve damage done to the legs.

You are in for a lot of information, but I hope to share our success stories one day in the very near future! Everyone here has been such a help, and the knowledge shared has even helped our vet.
 
Welcome to FDMB. We're glad you found us. Theres a lot you can be doing for...Sid? is it? I'm a little confused on that.
Poor kitty has been through hell and back but has now landed in a safe place. We can help!
I suspect your kitty* may* have had keytones? (vomiting and confused?) Not sure but...
Anyway this is the place to come to learn everything you need to know about Feline Diabetes.
WELCOME TO OUR FAMILY!
jeanne
 
Neuropathy can be treated. Bringing the cat into regulated BG numbers and supplementation with B12 methylcobalamin can help to reverse the symptoms. Here's Tootsie's story to give you an idea of what's possible:




If the neuropathy's bad at the moment, Sid might have some problems controlling his bladder, but this should also benefit from insulin and B12 treatment.


Mogs
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Hi Melissa,

Following on from my initial reply to you, I need to post some safety information for you and Sid.

Melissa wrote:
Yesterday morning we woke up to our oldest being unable to walk, vomiting, and confused. I rushed him to our closest vet and he was quickly diagnosed as diabetic. After 2U of insulin they were able to get his # down to 501. This morning his glucose was 293 pre-insulin.
Click to expand...

I have downloaded the file to keep up with his levels but our vet told me not to stress him over checking it until he had more to adapt to the insulin and we do his curves. He is scheduled to go the 14th for his first curve stay. He came home with Vetsulin and I am giving it to him every 12 hours.
Click to expand...

If your spreadsheet is correct and Sid is currently receiving 5 units of Vetsulin twice a day, I strongly recommend that you start home testing him as soon as possible as a safety precaution because his current dose is higher than the starting dose recommended by the manufacturer of the insulin.

Merck Caninsulin Dosing Protocol

(Note: Caninsulin and Vetsulin are the same insulin, it's just sold under different names in different countries.)

From the above document:

upload_2020-9-6_15-23-57.png


The path to regulation normally goes through the following stages:

- Start at a low dose and check this is safe (vet should run a curve for the dose that is to be given at home).

Then:

- (Ideally) check fasting blood glucose before each injection, and at least once a day when blood glucose (BG) level is likely to be at its lowest (between about +3 and +6 hours after the dose was given for Vetsulin).
- Hold the dose for several days (typically 7) unless testing or clinical signs of hypoglycaemia show that there is a need to reduce it.
- Run a curve to assess the safety and efficacy of the dose.
- Make any necessary adjustment to dose.
- Rinse and repeat.

By following these steps, over a period of weeks a suitable dose can be identified safely.

As Sid seems to have been started on a much higher dose than normal, I felt it wise to recommend that you start home testing straight away. I understand that your vet has suggested that you refrain from home testing at this time (many vets do), but our experience at FDMB - gained over many years - is that it is much safer for the kitty to home test from the get0go, especially for cats who are started out on high doses of insulin. Hopefully the dose is fine, but it is far, far safer to check.

If you're not already set up to home test, we can help you to learn how, and also where to get reasonably priced supplies. Just shout if you need help with this. :)


IMPORTANT:

Whatever you do, DO NOT SWITCH SID TO A LOWER CARB FOOD!! If he is on 5 units of Vetsulin and not being home tested at the moment, then this could be extremely dangerous.

You can safely change diet later when you've learned to home test. When a diabetic cat's diet is changed from a higher to a lower carb food, insulin doses usually need to be reduced in line with the reduction in the dietary carb load. More information about safely managing diet transitions for feline diabetics can be found at catinfo.org (a vet-authored site).

Here are some very important safety documents for you to read, also there are recommendations on medium and high carb foods and treats that are used to help cats back up out of low numbers:

How to Treat Hypos (Please read and familiarise you with this ASAP, and print out a copy so you can grab it easily should you need it in a hurry.)

Hypo Toolkit

Until you can properly determine the safety of his current dose, if ever you are away from home and also overnight, please leave food out for Sid just in case his numbers get low.

At FDMB, for newly diagnosed cats who don't have much BG data available we recommend not giving insulin if preshot fasting BG reading is 200mg/dL as measured on a human BG meter (and the limit needs to be higher if using a pet meter). I recommend discussing and agreeing this limit with your vet.

When home testing, we normally recommend that you remove all food for two hours before taking a preshot test prior to insulin dose because a fasting BG reading needs to be taken in order to determine whether it is safe to give the next dose. (Food eaten in the previous 2 hours can temporarily elevate BG.)

Given that Sid's on quite a high starting dose and there are only a handful of BG readings available so far, I'm not sure how to advise you on the safety of lifting his food. Vetsulin typically peters out a few hours before the next dose is due but we don't yet know how low Sid's running now.

Before you lift the food, I suggest testing Sid's BG level first to make sure he's at a safe number. This normally isn't necessary but because you don't yet know how low the current dose is taking him it's best to check that he will be safe for the next couple of hours. If his numbers need a little help you could make sure he eats something before lifting the food. (I'm tagging some other members who might have better suggestions about this: @tiffmaxee, @Panic, @Deb & Wink). Once you have a better picture of Sid's response to his insulin, things will be more straightforward.

Remember that you can always post here for help.


Mogs
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Some Tips:

- Vetsulin hits quite hard and fast early in the cycle so we recommend feeding a substantial meal and waiting for about 20 minutes before giving insulin (allows the food to start working its way into the system before the insulin kicks in).

- Testing at +2 hours after the dose was given can give early warning of a big drop in BG. If the +2 test is much lower than the preshot test, monitor Sid closely and check again at +3 to make sure he's not going too low.

- Vetsulin has its strongest effect typically between +3 and +6 hours after dose adminstration, so any tests done during that period are the likeliest to catch how low the dose is taking Sid.

Here are some additional resources to help you learn more about the insulin you are using:

FDMB Introduction to Vetsulin/Caninsulin and Novolin N

FDMB Beginner's Guide to Vetsulin/Caninsulin



Mogs
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I’ve no experience with other than lantus/levimir but that’s a huge starting dose. Is Sid a huge cat? If you test at home you will save a lot of money because there won’t be a need for an expensive trip to the vet for a curve. You can simply email the spreadsheet. At the same time you won’t be rushing to the ER with a hypo cat. It was hard for me to trust strangers but I quickly learned and my vet said I managed Max better than any client he ever had.
 
tiffmaxee said:
Is Sid a huge cat?
Click to expand...
To answer your question:

MayDayMelK said:
He was a 28lb cat that we had been feeding a urinary diet and getting weight off over the last year, but I was shocked to see that since our last vet 3 months ago visit he's lost down to 18lbs.
Click to expand...
Just a tad! :)

Starting dose for Caninsulin/Vetsulin is now based solely on BG levels at time of Dx, not weight, according to the manufacturer's protocol currently on their website (presumably what most vets would use to determine start dose and subsequent adjustments).

(There is a vague niggle in my mind that an older version of the Merck protocol may have factored in the cat's weight when determining start dose, but I can't swear to that.)

Any ideas on what to suggest about lifting food before preshot, Elise? I'm worried about lifting food from Sid at all until more is known about how he's responding to his current dose.

I hope Melissa picks this up soon so that we can find out a little more about how she's fixed and then perhaps make better suggestions.

I'm worried that Sid went from the blacks on his first dose at the vets (2IU according to the opening post) and he ended up with a yellow preshot after just that one dose. If the spreadsheet info's correct then what is the 5IU doing?


Mogs
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Home Testing Info:

If you're in the US, the Relion Prime from Walmart is a popular meter and it has the best-priced test strips. You need lancets that are 29-gauge or lower (higher gauge lancets are too fine and it's more difficult to obtain blood samples). Also Walmart do ketone strips.

In case you haven't yet seen these:

Home Testing Links and Tips

Testing and Injection Tips (inc. good diagram of where to test on the ear)


Mogs
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I'm so sorry I wasn't back on, we've had storms and my already spotty signal was nonexistant (of course, when I needed to use the internet to research!)

The 2IU versus 5IU is because we did not have any U40 syringes to bring home with us. We live in a very, very rural area and as a result had to use U100 syringes. So he IS getting 2IU of Vetsulin, it is just being marked down as 5 due to the conversion for the syringes.

I am glad I found this site. It is a lot to take in but I've already found out more here than the tech knew to tell me. She suggested pulling his food and not feeding him until after an insulin shot, which didn't sound right to me so I called another tech from the Army days and she said NO, don't because Vetsulin can drop him quickly so it could make it drop too low, especially if he didn't eat what I gave him.

Times and how to feed him I am still very lost on. They told me to wean him off his dry completely and I did purchase wet food for him and have some Fancy Feast Classic Chicken Feast being shipped- it's one we know he will eat.
 
Sorry, I am reading through replies and trying to respond to questions. Sid did have ketones at the vet. He is having issues making it to the litter box right now (and of course HIS room is the only room in the house with carpet still :() I have ordered strips to test so we can keep an eye on this the best we can if we can get him back to urinating in the box.

He hasn't vomited anymore since we had him at the vet's. I am hopeful the neuropathy will resolve once we get his levels where they need to be. He was a VERY big kitty. He was down to around 23lbs 3 months ago, so 5 lbs in 3 months was lost compared to the 5lbs it took almost a year to get off.

PS, my spreadsheet had assistance from my 9yr old. She started clicking away and typing in stuff. So we had to start over. :banghead: She is special needs and didn't know what it was, just that she found pretty colors.
 
Critter Mom said:
Neuropathy can be treated. Bringing the cat into regulated BG numbers and supplementation with B12 methylcobalamin can help to reverse the symptoms. Here's Tootsie's story to give you an idea of what's possible:




If the neuropathy's bad at the moment, Sid might have some problems controlling his bladder, but this should also benefit from insulin and B12 treatment.


Mogs
.
Click to expand...
Your video about made me cry. Where Tootsie was, is where Sid is right now. Can I ask where you get your B12 Methylcobalamin?
 
MayDayMelK said:
so I called another tech from the Army days and she said NO, don't because Vetsulin can drop him quickly so it could make it drop too low, especially if he didn't eat what I gave him.
Click to expand...
Your army tech is right. Vetsulin does drop a cat hard.
You test to make sure the number is high enough to shoot
You feed to make sure your cat has eaten enough.\
Wait 30 minutes and then shoot.
A good sized snack around +2 helps the cat deal with vetsulin. Another snack 2 hours later. Over time and with testing, you will be able to figure out when is the best time to give snacks.

MayDayMelK said:
They told me to wean him off his dry completely and I did purchase wet food for him and have some Fancy Feast Classic Chicken Feast being shipped- it's one we know he will eat.
Click to expand...
Changing to low carb food can drop a cat's number by up to 100. You will need to introduce the low carb food gradually.
1. So you can monitor the changes in blood glucose.
2. To prevent stomach upsets.


MayDayMelK said:
The 2IU versus 5IU is because we did not have any U40 syringes to bring home with us. We live in a very, very rural area and as a result had to use U100 syringes. So he IS getting 2IU of Vetsulin, it is just being marked down as 5 due to the conversion for the syringes.
Click to expand...
Can you change the units on your spreadsheet from 5 to 2?
You can add "using U100 syringes" to your signature.

MayDayMelK said:
PS, my spreadsheet had assistance from my 9yr old.
Click to expand...
Clever girl. At a glance, it's all about the colours. Why not set up a pretend spreadsheet for her?
 
tiffmaxee said:
Zobaline is a brand used and I’m pretty sure you can get it from chewy,co and amazon. Where abouts do you live? In the US? If so west, East , or central time zone?
Click to expand...
I am in CST, in North-west Alabama.
We have always been dry-food free feeders. I am trying to make sure the other 2 cats have access to their dry food throughout the day but also keep Sid away from it, and them away from Sid's. Right now Sid is staying in his room with the door shut overnight so I can have Ash & Softpaws loose and their dry food set out. I pick it up in the AM and open Sid's door so he has run of the house. I'm trying to figure out how to fit everything in because right now I'm scheduling his insulin right behind doing my 9yr old's tube feedings and medication- which makes it hard to guard him eating.
 
MayDayMelK said:
Sorry, I am reading through replies and trying to respond to questions. Sid did have ketones at the vet. He is having issues making it to the litter box right now (and of course HIS room is the only room in the house with carpet still :() I have ordered strips to test so we can keep an eye on this the best we can if we can get him back to urinating in the box.
Click to expand...
Given that Sid was throwing ketones when diagnosed, it might be a good idea to get a blood beta ketone (BBK) meter, Melissa. You test in exactly the same way as for blood glucose. The strips are pricey but catching any potential ketone build-up early and addressing it promptly could save Sid a lot of discomfort and you a lot of money: DKA is hard on the kitty and on the wallet. You'd probably only need to check for ketones once a day, and it would overcome the difficulties you currently have with collection of urine samples. Here's a recent thread with recommendations for BBK meters:

https://felinediabetes.com/FDMB/threads/recommendations-for-blood-ketone-meter.234598/


Mogs
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MayDayMelK said:
I did order some B-12 methylcobalamin tonight after seeing that video from Vitacost. This site is a lifesaver!
Click to expand...
M B12 is a life saver but please know you wont see a difference over night. Its a gradual thing that works WITH lower BG levels. I just dont want you to get discouraged too quickly. Like Diabetes Sid didnt get neuropathy over night. It takes a while for us to notice something is off then maybe a week or two later your off to the vet for the dx you never thought was possible.

KEEP UP THE GOOD FIGHT! You'll get there!;)
jeanne:coffee:
 
Critter Mom said:
Given that Sid was throwing ketones when diagnosed, it might be a good idea to get a blood beta ketone (BBK) meter, Melissa. You test in exactly the same way as for blood glucose. The strips are pricey but catching any potential ketone build-up early and addressing it promptly could save Sid a lot of discomfort and you a lot of money: DKA is hard on the kitty and on the wallet. You'd probably only need to check for ketones once a day, and it would overcome the difficulties you currently have with collection of urine samples. Here's a recent thread with recommendations for BBK meters:

https://felinediabetes.com/FDMB/threads/recommendations-for-blood-ketone-meter.234598/


Mogs
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Click to expand...
I didn't know such a thing existed! I will see what we can do come payday. Sid had really poor timing, bless him. My sons dog missed a few months of his Heartguard due to covid19 causing issues- so when we tested him to start back on it of course he was heartworm positive. :'( We've been shelling out for him to be treated and now Sid's stay the 3rd has maxed my credit card.

jt and trouble (GA) said:
M B12 is a life saver but please know you wont see a difference over night. Its a gradual thing that works WITH lower BG levels. I just dont want you to get discouraged too quickly. Like Diabetes Sid didnt get neuropathy over night. It takes a while for us to notice something is off then maybe a week or two later your off to the vet for the dx you never thought was possible.

KEEP UP THE GOOD FIGHT! You'll get there!;)
jeanne:coffee:
Click to expand...

I know it won't be a miracle overnight, but I am hopeful we can get him back at a good baseline once we get his numbers down as well. We have a video of him from 2 weeks before diagnosis and looking back I can see that he was starting to turn his hind legs. I wish I had caught it sooner and am heartbroken that I didn't. He doesn't like for us to go room-to-room because he can't keep up so I dug out some puff balls (the big pom poms from the craft store) that he loves and tossed the whole pack in the floor. He was so funny to watch trying to decide which one he wanted and it made him happy for awhile. I moved our bird feeder to a window so he can watch them easier since he can't climb the cat tower.

I know this is a long-haul type thing. I'm just trying my best to juggle what we can afford with what will give him the best quality of life. I appreciate you guys- the information is invaluable!
 
MayDayMelK said:
so I dug out some puff balls (the big pom poms from the craft store) that he loves and tossed the whole pack in the floor
Click to expand...
THAT right there is progress! I LOVE reading this! I too felt the same way the first time I saw Trouble walking on is hocks. How could I have missed this??? I kicked myself all the way to the vets that day. Trouble recovered and so will Sid!
You got this! ;)
j
 
I'm hopeful that we can have him another 5 years. He has spent many if his 9 lives but he really has been the best cat. He loves to play fetch so maybe when we get him functioning a little better he'll feel up to it.
T
morning he was at 305 prior to insulin so that was a lot better than the 400/500's we've seen this past week.

His order should be here tomorrow for his new dietary plan. Fingers crossed!
 
Oh, he's a dote! (((Sidders))) :cat:

Big improvement in this morning's preshot BG, Melissa. :)

If you're around, it would be great if you could grab a BG test somewhere between +3 and +5 hours after the insulin dose was given. It would start giving you an idea of where Sid's BG is at when the insulin is working at peak effect.

Here's a helpful diagram of an 'ideal' curve for a cat on Vetsulin/Caninsulin to give you a better idea of how it works:


latest



Mogs
.
 
I got him at +3 today, and this evening's check was even better but he didn't eat much. Apparently the can I left out for him while I was gone for an appointment didn't meet his criteria so he ignored it. I checked him tonight and then opened a can of his favorite which he wolfed down. We've officially kicked all the dry food to the curb for him. He's not amused, but I'll take grumpy kitty over seriously sick kitty.
 
Hi Melissa,

Very glad to hear that Sid is improving. :cat:

I see you're starting to get much better preshot readings, presumably driven by the removal of the dry food.

Vetsulin can drop numbers very significantly between PS and nadir (lowest point in cycle). Now that Sid's getting much better PS numbers now then I'd very much recommend that you get mid-cycle tests AM and PM each day to check just how far down Sid's current dose is taking him. Nadir for this insulin is typically between +3 and +6 hours after dose administration, although sometimes it can be earlier (c.+2) or later. If you could run a full curve it would give you a picture of both nadir and also the duration he's getting on the Vetsulin.


Mogs
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Thanks!

I know the vet wants him to come in for a curve, but I sent a message asking if I could just do it at home. Sid is mad at me and hiding over pricking his ears, so I'm making sure they accept that I'll do it at home before aggravating him that badly. We are done with dry food, so he is pouting over that as well. Silly cat, I'm trying to get him better lol. The good news is he's eating his wet food with his M-B12 mixed in with no problem, otherwise I'd be forcing a pill down him, too.
 
There's no reason why you can't run the curve at home, Melissa. The data will be more reliable, too, because it can't be influenced by vet/travel stress.

Great that Sidders is getting his B12 supplement. I hope it does him a power of good, and as quickly as possible. :)



Mogs
.
 
He stashed himself under my bed where I couldn't get to him yesterday and according to husband he slept most of the day. I ended up having emergency surgery so unfortunately I wasn't able to do it yesterday or today. I'm going home so I will get his curve done at home tomorrow if at all possible. Thankfully hubby gave himself a crash course in giving insulin so he at least got his meds.

I appreciate all of you!
 
MayDayMelK said:
He stashed himself under my bed where I couldn't get to him yesterday and according to husband he slept most of the day. I ended up having emergency surgery so unfortunately I wasn't able to do it yesterday or today. I'm going home so I will get his curve done at home tomorrow if at all possible. Thankfully hubby gave himself a crash course in giving insulin so he at least got his meds.

I appreciate all of you!
Click to expand...
Oh my gosh Prayers for a quick and painless recovery!
 
So far so good today. Yesterday he had a low moment but we've found he doesn't like the Science Diet RX food that has carrots in it so he was refusing to eat it. Picky thing! He is still losing a little weight, so today the vet suggested moving him to another wet food, as well as buying some of the keto dry cat food to use as treats because he is sitting beside the treat cabinet crying and swatting at us as we walk by. (No more than 2 or 3 kibbles, just with sugar checks and shots) His favorite thing in the world are the Temptations Chicken treats, but since he's completely off dry and treats he is a grumpy old man.

Right now I check him, open a can and let him eat for 15-30 mins, and then give him his shot. I open another can around 3-4 hrs in and leave it out for him. In the late evening I check him again, feed him, and do his PM shot. We've been leaving an open can in his room overnight in case he gets low or hungry. He is finally drinking a normal amount of water and not half a gallon daily! We've gotten solid BM's from him as well, and he is bathing himself finally. He's still having hind-end trouble and peeing beside the litterbox but that's to be expected with his neuropathy I know.

And Yes, hubby is a good one :) He managed to keep the cat alive AND take care of the kiddos tube feeding without either one getting the other's meds lol.
 
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