New Member - Tony the Tiger

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Tony’s person

Tony’s person

Member Since 2020
Hi everyone. My kittie Tony is nearly 19 years old, and he’s a Bengal. His littermate, Cleo, passed away 2 years ago from cancer. After a few weeks of grieving Tony picked himself back up and had been vibrant and (relatively) healthy ever since.

His only known issue was slowly advancing CKD. But it was well controlled and he was getting sub-Q fluids biweekly to help support him. His rear legs started to appear weaker/moderately wasted over time, but nothing terrible. I chalked it up to protein reduction via the K/D diet. He was always very fit. Never overweight; not underweight either. As a Bengal, he’s always been very active and athletic.

Then about a month ago he started to walk like a duck, and occasionally knuckled over his front paw. He lost a lot of weight quickly and started drinking tons of water and peeing loads...with very sticky litter.
I thought it was the CKD. Eventually he got so weak that I called a palliative veterinary doctor to help support him during what I thought was late-stage CKD.

Long story short ... his CKD remains pretty well controlled. But he has diabetes and his BG levels were through the roof. After 6 days in the veterinary hospital, they finally decided to send him home for at-home treatment. They waited until he was on long acting insulin and also for his intractable high sodium levels went back down into standard range. I hope they stay there without 24hr fluids??? Because of Covid I couldn’t visit while he was in hospital. I did get lots of updates, but Despite knowing that he was weak, I wish I’d asked for a video to see just how downhill he’d gone. When I picked him up I was unpleasantly surprised at his state, and sort of confused as to why all the chatter was about his BG when it seemed to me he was literally fading away before my eyes.

His neuropathy had gotten so bad that he could no longer stand or walk AT ALL. His appetite was still fantastic, and he was drinking water, and apparently not in pain per se. So when i called to hospice vet to help me decide if it was time to let him go (based on his lack of strength and extreme lethargy), she examined him and said, “not yet”. She thought it was worth a few more days to assess if he’d bounce back at all. I’m so glad I listened. He seems to be making a slow, tentative comeback. :)

His BG readings are still high I think (avg in 400s, with dips and spikes) on 4 units twice daily. Maybe they’ll up that after first check in?? Also on injectable Vit b daily for now.

But something (the vitamin b12 injections? The TLC at home??) seems to be helping - after days of going totally downhill in the hospital, he’s now home and starting to walk a few very wobbly steps. It feels like huge progress, as 48 hrs ago the most he could do was lift his head.

Tomorrow we go in for his bloodwork. Here’s hoping the sodium is ok and his kidney values haven’t precipitously worsened. Maybe they’ll add more insulin to his regimen, since we’re still averaging in the 400s.

Anyway, that’s our story so far. Thanks for accepting us into the group! It’s moment to moment with my dear old boy, but the fact that he’s home and comfortable is huge. And I want to learn and do as much as possible for him while he’s still with me.
 
WELCOME TO FDMB although I am sorry for the need.:( We are dedicated to helping anyone who finds these pages. I personally have no experience with these mounting issues. But I do send prayers for strength for you and sweet Tiger.
I know you are seeking help for these specific issues, it may take some time for members with similar issues to help.
While you are waiting you might want to learn how things work around here .:
New? How You Can Help Us Help You!

I will try and tag some folks who may be able to advise.
@Critter Mom
@Wendy&Neko
Do either of you know members that could help Tony's person?
 
Hello and welcome, good to hear Tony seems to be showing some improvement at home. How is his appetite?

Can you tell me what type of insulin he's on now? 4 units is a rather larger starting dose. Are you testing his blood sugars at home? Is the K/D he's eating wet or dry? Both are rather higher carb than we'd normally have diabetics on.

For neuropathy, two things will help. Getting his numbers regulated and methyl B12, Zobaline is one such formulation used for diabetic cats.

Good to hear you are going for repeat bloodwork to check his electrolytes. Was his potassium OK? Potassium problems can also cause wobbly legs.
 
In addition to the information Wendy asked for, you may want to order Zobaline from Amazon. It is a formulation of methylcobalamin (methyl-B12) that is for diabetic cats. In other words, it doesn't contain sugar. Methyl-B12 can be very helpful in treating diabetic neuropathy in combination with getting numbers into a better range. It does take a couple of months to see the full effects but it can be very helpful in reversing the effect of neuropathy.
 
Minnie had severe neuropathy as well. Could barely walk, couldn’t jump or even go in and out of the litter box. She recovered completely once her diabetes was regulated and with the help of b12 methyl. Just know this is not the same as regular b12 or the b12 injections he may be getting. The b12 methyl is the only one that works directly into the spinal fluid to regenerate the nerves. Zobaline is great, but if you’re in the US there’s a much more affordable version from Vitacost that some of us use instead. That’s what I give Minnie since I had her on 6mgs a day to speed up her recovery at first. The Vitacost brand comes in capsules that you can open up and mix the content into the food. I think there are 100 capsules per bottle.
 
Zobaline is a high dose methylcobalamin supplement which, when CKD isn't in the mix, works well to improve mobility in diabetic cats with neuropathy. However, more conservative dosing may be indicated in cats with comorbid CKD. Tanya's Site has the following cautions regarding B12 supplementation, in particular:

I would not give more than 1 mg a day to your CKD cat, and personally, I would feel more comfortable giving 500mcg (0.5mg) only.​

Bearing in mind that a number of factors may be feeding into the weakness/plantigrade stance, my suggestion would be to discuss supplementation and dosage with your vet before initiation of treatment.

Note: This is only anecdotal, but I have found that supplementation with B12 methylcobalamin had a lowering effect on my cat's resting heart rate (CKD stage III, non-diabetic). If Tony's having treatment for hypertension that may be something else to take into consideration.

Beautiful picture of Tony in your avatar. I'm glad to hear he's doing better now that he's back home with his Person. Fingers and paws crossed for continued improvement and good results from the blood tests. :cat:

(((Tony)))


Mogs
.
 
Welcome to Tony & person - youve found the best support group ever here to help you help Tony.
So glad he is seeming a bit better - 19 wow and such a strong kitty to be fighting for his health so well - he could pat my Mac on the head and call him a youngster at only 14 !
Keeping fingers crossed for all the best for you boh
PS beautiful photo of him
 
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Thank you all. I’m sorry I’m not replying very quickly. I love alone and between managing Tony an exceedingly stressful and busy job, and a Sr dog who just had major TPLO surgery last month and a horse that needs daily attention, I have my hands quite full!
Tony’s recheck went pretty well. The vet definitely noted that he seems much stronger, and his CKD and sodium levels are fine. He does seem to be quite anemic, so she asked me to come back Friday to recheck.
His BG is still trending high (mid 400s with occasional spikes up over 750!) so we went to 5 units twice a day. I do test him 3-4 times a day and he doesn’t seem to have any period where he’s lower than 400...so she felt that we did need to go up a unit. Even when he was on the insulin drop in hospital, he needed a high dose. I wonder if it could possibly be related to his being a Bengal. Bengals do always require different treatment with anesthesia when that is used. Maybe their metabolism is different from your average Tom?
Another thing is that I think I’ve screwed up his injections a couple of times. I’m new to this, and a couple of times his fur was wet after injection - so I have to think I may’ve shot through or not had needle in securely? I’m trying my best to figure the right technique. His hospice vet is coming over today to help me with that again.
His strength does continue to improve pretty well. Last night while I was asleep he somehow got off the bed (he must have fallen if he tried to jump down) and made his way to his litter box in the next room. I woke up, panicked, and eventually found him there - looking fairly pleased with himself for not having peed on the pee-per pad on the bed. This is from a kittie that literally couldn’t stand up 3 days ago. This morning he was walking again to get to me while I was preparing his food. (k/D wet pate). But, alas, his BG was through the roof again (over 750...the monitor won’t even record a specific number above 750). Ugh.
I’ve ordered the Zobaline but the vet has said she prefers I stick with the injectable. I think that’s to ensure absorption? I hadn’t heard that about CKD and Vit b. I’ll ask the vet. Thank you.
I’ll get to the full set up requested when I find some time this week. Thanks all for your concern and commentary.
 
Tony’s person said:
Thank you all. I’m sorry I’m not replying very quickly. I love alone and between managing Tony an exceedingly stressful and busy job, and a Sr dog who just had major TPLO surgery last month and a horse that needs daily attention, I have my hands quite full!
Tony’s recheck went pretty well. The vet definitely noted that he seems much stronger, and his CKD and sodium levels are fine. He does seem to be quite anemic, so she asked me to come back Friday to recheck.
His BG is still trending high (mid 400s with occasional spikes up over 750!) so we went to 5 units twice a day. I do test him 3-4 times a day and he doesn’t seem to have any period where he’s lower than 400...so she felt that we did need to go up a unit. Even when he was on the insulin drop in hospital, he needed a high dose. I wonder if it could possibly be related to his being a Bengal. Bengals do always require different treatment with anesthesia when that is used. Maybe their metabolism is different from your average Tom?
Another thing is that I think I’ve screwed up his injections a couple of times. I’m new to this, and a couple of times his fur was wet after injection - so I have to think I may’ve shot through or not had needle in securely? I’m trying my best to figure the right technique. His hospice vet is coming over today to help me with that again.
His strength does continue to improve pretty well. Last night while I was asleep he somehow got off the bed (he must have fallen if he tried to jump down) and made his way to his litter box in the next room. I woke up, panicked, and eventually found him there - looking fairly pleased with himself for not having peed on the pee-per pad on the bed. This is from a kittie that literally couldn’t stand up 3 days ago. This morning he was walking again to get to me while I was preparing his food. (k/D wet pate). But, alas, his BG was through the roof again (over 750...the monitor won’t even record a specific number above 750). Ugh.
I’ve ordered the Zobaline but the vet has said she prefers I stick with the injectable. I think that’s to ensure absorption? I hadn’t heard that about CKD and Vit b. I’ll ask the vet. Thank you.
I’ll get to the full set up requested when I find some time this week. Thanks all for your concern and commentary.
Click to expand...
My tip is to use a flashlight you aim at the spot you’re injecting so you can clearly see the skin and the needle going in and out as well. I’ve never had a fur shot since I started doing that :)
 
Wendy&Neko said:
Hello and welcome, good to hear Tony seems to be showing some improvement at home. How is his appetite?

Can you tell me what type of insulin he's on now? 4 units is a rather larger starting dose. Are you testing his blood sugars at home? Is the K/D he's eating wet or dry? Both are rather higher carb than we'd normally have diabetics on.

For neuropathy, two things will help. Getting his numbers regulated and methyl B12, Zobaline is one such formulation used for diabetic cats.

Good to hear you are going for repeat bloodwork to check his electrolytes. Was his potassium OK? Potassium problems can also cause wobbly legs.
Click to expand...
 
Hi there. Tony is on Lantus. He was in the hospital for 5 days on a continuous drip type of insulin - well, I guess the last two days they transitioned him to the longer acting/Lantus. I guess his BG was so high that they thought he needed the 4 units. Even with 4 units his sugars once he came home have been averaging over 400 with a few spikes over 750. Upon his recheck the vet changed him to twice daily 5 units. Then yesterday, boom - 89 after overnight fasting. So after he’d eaten well (he has a consistently good appetite) and his BG was up to 197 I gave him 3 units. It continued to rise throughout the day. By evening dose he was over 430. I have him 4 units. This morning, 85. So, 2 units. Tonight -647. Ugh. 4 units.
We go back in tomorrow. At this point I’m most concerned about his anemia. If that isn’t clearing up then these BG numbers are almost irrelevant. but if we can get the anemia under control then I’m thinking the Units need to perhaps decrease?? I worry he’s getting that syndrome wherein they crash and spike due to high dosage.
what about the KD food? They say he needs it for his CKD. But I k ow it’s high in carbohydrates by definition, right?
 
Btw, he gets daily Vit b shots. The vet keeps Insisting hat the injectable is better than the oral, but I did order the oral online.

Btw, Tony continues to get stronger in some ways. Lord knows how, but he’s jumping up on bed and sofa. I swear I cannot imagine how he has the strength. But he’s determined!
 
Please read post #12 where Mogs gave you a link to the two different types of B12. Cyanocobalamin shots are better than pills. Methyl B12 is something different and comes in pills. You need to give both.

You might also want to pop over to the Lantus/Basaglar/Levemir forum and read some of the yellow starred Sticky Notes on the top of that forum. One concept you'll learn about soon enough is the concept of bouncing, From the New to the Group Sticky Note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

I think a lot of what you've been seeing in Tony's numbers is bouncing, or high numbers as a reaction to going to low. He has been going too low because his dose is too high. We determine how to change the Lantus dose based on how low it's taking kitty, not the highs, which are likely due to bounces. The lows are typically somewhere in the mid point betweej the shots. We also make changes by 0.25 or 0.5 units at once. Are you using syringes with half unit markings on them to inject the insulin?

Why is Tony fasting overnight? Small frequent meals are easier on his pancreas. As for K/D, it depends how bad his CKD is. In earlier stages, many of us give good quality protein with low phosphorus. K/D being reserved for later stages. My Neko never went on K/D and her internal medicine specialist was fine with that.
 
Wendy&Neko said:
Please read post #12 where Mogs gave you a link to the two different types of B12. Cyanocobalamin shots are better than pills. Methyl B12 is something different and comes in pills. You need to give both.

You might also want to pop over to the Lantus/Basaglar/Levemir forum and read some of the yellow starred Sticky Notes on the top of that forum. One concept you'll learn about soon enough is the concept of bouncing, From the New to the Group Sticky Note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

I think a lot of what you've been seeing in Tony's numbers is bouncing, or high numbers as a reaction to going to low. He has been going too low because his dose is too high. We determine how to change the Lantus dose based on how low it's taking kitty, not the highs, which are likely due to bounces. The lows are typically somewhere in the mid point betweej the shots. We also make changes by 0.25 or 0.5 units at once. Are you using syringes with half unit markings on them to inject the insulin?

Why is Tony fasting overnight? Small frequent meals are easier on his pancreas. As for K/D, it depends how bad his CKD is. In earlier stages, many of us give good quality protein with low phosphorus. K/D being reserved for later stages. My Neko never went on K/D and her internal medicine specialist was fine with that.
Click to expand...

hi there. Thanks for your input. I have read all about the Vit B differences, and I keep asking the veterinary internist about it and she keeps dismissing the difference, telling me that the injections are better for him. I did buy the oral, so would it be problematic for me to just add that? How much?? I thought I read in another post somewhere that with CKD there can be “too much” even though they pee out extra.

I’ve also read about the bouncing, but his lows are at the end of his fast, just before next shot of insulin. The vet has told me to do the twice a day feeding - I guess so that he’s sure to be hungry enough to eat when he gets his insulin? I’ve backed down from 5 units to 4. I’m tempted to go even lower, but I am afraid to complete disregard what the trained internist is telling me. When y’all have done that, has it been in agreement with what the specialists say or more as a self-directed move based on the collective wisdom of this group?

Thanks.
 
Tony’s person said:
I’ve also read about the bouncing, but his lows are at the end of his fast, just before next shot of insulin.
Click to expand...
While cats on Lantus typically hit nadir in the middle of a cycle, later nadirs can and do occur. Seeing the nadir BG at the preshot reading does not mean that the cat doesn't experience bounces.

Tony’s person said:
The vet has told me to do the twice a day feeding
Click to expand...
The vets we were with when Saoirse was diagnosed told me that under no circumstances should I feed her at any other time than the meal just before administration of her insulin injections. Within a couple of days she started howling with pain and then vomiting about 3-3½ without any food. The response from the vets? Verbatim: "She'll just have to get used to it. She's had it her own way for too long." I started feeding my cat every three hours. The pain and vomiting stopped immediately. There was no way on God's green earth I was going to put a vet's say so over Saoirse's well-being. We also moved to a different veterinary practice.

Tony’s person said:
I am afraid to complete disregard what the trained internist is telling me. When y’all have done that, has it been in agreement with what the specialists say or more as a self-directed move based on the collective wisdom of this group?
Click to expand...
Initially I was guided by dosing advice from the vets involved in Saoirse's care - until one time I followed a vet's advice and gave a dose that I was certain was too high based on what I had read here and at catinfo.org, and on Saoirse's BG readings and events at the time because I didn't yet have the confidence to go against what they recommended. As a consequence, Saoirse had her one and only symptomatic hypo that night. Thereafter I followed Saoirse's BG data and, by reading stickies and posts here, learned how to adjust her dose myself. Our main vet at the practice also had a diabetic cat and they were great to work with. I gave them the link to Saoirse's spreadsheet, showed them showed the Roomp-Rand published treatment protocol I wished to follow and thereafter they were happy for me to adjust the dose myself as Saoirse's needs dictated.

On feline diabetes specialists, our own vets often consult with external experts when they don't have specialised knowledge of an area themselves. Shortly after moving to our current practice, our main vet asked an external FD specialist to review Saoirse's BG data at that time. Said expert pronounced Saoirse a "true diabetic" with "no hope of remission" (on Caninsulin and Hill's w/d Dry diet, as prescribed by the vet Saoirse was under at time of Dx). A switch to low carb wet food plus Lantus insulin and five months later Saoirse achieved remission. Of great concern here is that the diabetes specialist didn't even suggest an alternative approach to Saoirse's treatment. Of even greater concern is that these specialists are from one of the UK's leading veterinary teaching centres.

During a face-to-face consult I had with one of the feline diabetes specialists at the self same veterinary school, she told me that it is never safe to give insulin to a cat whose preshot fasting BG level is below 11mmol/L / 200mg/dL as measured on a veterinary glucometer (an equivalent human meter reading would be significantly higher than this). At the time she was sitting in front of a screenful of Saoirse's spreadsheet data which completely contradicted her (false) claim.

Some specialists are extraordinary physicians, but not all of them are all what a specialist is cracked up to be. As in all walks of life, in the veterinary profession you get good, bad, and indifferent. When it comes to FD, self-education goes a long way toward helping oneself judge which advice is solid and which is complete horse feathers.

When it comes to day-to-day regulation of a cat's blood sugars, I have found the most effective way to optimise treatment is to:

* learn all one can about FD.
* gather adequate data to keep the cat safe.
* learn to properly interpret the cat's BG data to identify its individual 'style' of response to the insulin with which they are being treated.
* take into consideration suggestions from people sufficiently knowledgeable about feline diabetes (experienced lay people and competent professionals).
* be guided by evidence.
* tailor treatment and feeding to the cat's needs and the individual circumstances of both cat and caregiver.


Mogs
.
 
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