11/18/20 New Member, Emily and Carlito - Glucose levels not going down

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emily + carlito

emily + carlito

Member Since 2020
Hi!

I am new to this site, though not new to kitty diabetes for sweet Carlito - he was diagnosed April of 2019. Please see info section of my profile for all detailed info. I am a senior in college right now.

Lito's numbers are so high all the time, the insulin doesn't seem to do anything. He's on a crazy high dose - 6 units of PZI 2x day right now, and he is having diarrhea and vomiting. Vet says to up insulin level and advised that I increase SubQ fluids. I don't want to increase his insulin anymore, which I've read is dangerous if done too quickly. But I am now giving fluids every day, 2 hours after morning shot, up from once a week or so. His BG is regularly in the 400 - 700 range, sometimes dips into the 300s but not regularly.

I have asked vet several times if they think it could be other issues, ketoacidosis maybe, and they said it's not, though I remain skeptical. I live in a small town in Hawaii and it is not easy to find vets who are interested in/well versed in difficult diabetes cases, so I'm hoping that I can find some help here! I have values for the spreadsheet I could add from my glucose meter, but I don't remember exactly when we upped the dose, or exactly how far apart the shot/test was, and I wasn't doing the pre-shot numbers as the newest vet said that since his numbers are so high all the time, it would be safe to give the insulin and then test throughout the day.

Should I still input the values I have from July until now, or just start fresh?

Thank you all so much. This is a godsend. It's been a year and a half of worry, tearing my hair out, feeling like I am getting nowhere with the advice we get from the vet, switching vets - this is our fifth one on the diabetes journey. They have been a major improvement from last vet but now seem to be unable to help us address these emerging concerns adequately.

Thank you all so much, so grateful. =^.^=
 
Last edited:
Hi Lisa,

Thank you! He has been on Hills Science Diet Digestive Care I/D wet canned food for 6 or 7 months now on vet recommendation. No dry food (unless he sneaks it from roommate's room which is very infrequent but does happen on occasion) for 1.5 years. I crush a bit of Stella and Chewy's raw dehydrated nuggets on top to that. He eats about 4x/day, small meals.
 
WELCOME TO FDMB! We are so glad you've found us! First I want to say WELL DONE on getting your signature and spreadsheet set up!
Dont worry, You've landed in a safe place to help Carlito get back to his old self.
It does sound like your vet isnt up to par when it comes to this disease. It really isnt that uncommon. Vets dont get much more than a few hours training with this insidious disease. Theres so much to cover and the way it looks to me, the training they do get more surrounds dogs.:facepalm:
We are dedicated to helping people just like you and your extra sweet Carlito

WELCOME TO OUR FAMILY:bighug:

This is the best site on this planet to learn everything you need to know, about feline diabetes and BEYOND ;)
We look forward to getting to know you both.
jeanne:coffee:
 
Hi Jeanne and Trouble,

Thank you very much for the warm welcome! We are so happy to be here. Yes, I can't fault the vets, I know they are just doing their best, and they have all had such different training and information.

I finally have hope that Carlito will live a long life. I am really so grateful for the community support. <3
 
Is there any possibility that his food could be causing the high BG numbers? Hill's is what the vet recommended, but it's nearly 25% carbohydrate. Does anyone have any recommendations here? Should I switch to a lower carb food? Before this, he was on a raw diet of Stella and Chewy's dehydrated chicken which I rehydrated with warm water, but he wasn't doing so hot on that either- vomiting a lot- and the vet recommended the Hill's.

The Stella And Chewy's was pretty much 0 carb, and the Hill's is pretty high..maybe I need to go for something in between? Vomiting has improved but not abated yet.
 
emily + carlito said:
Is there any possibility that his food could be causing the high BG numbers? Hill's is what the vet recommended, but it's nearly 25% carbohydrate. Does anyone have any recommendations here? Should I switch to a lower carb food? Before this, he was on a raw diet of Stella and Chewy's dehydrated chicken which I rehydrated with warm water, but he wasn't doing so hot on that either- vomiting a lot- and the vet recommended the Hill's.

The Stella And Chewy's was pretty much 0 carb, and the Hill's is pretty high..maybe I need to go for something in between? Vomiting has improved but not abated yet.
Click to expand...
i can't speak at all to dosing or carlito's history and how everything plays together (some other people here might be able to) but generally we try to keep food for diabetics 10% or less carbs. A lot of us use Dr. Pierson's Food chart (linked here) - I try to bump up the foods against the manufacturer site or check the chewy Q&A in case carb content has changed. A lot of caregivers use Fancy Feast Classic Pates as low carb (LC). I hope you can find something that works for Carlito :bighug:

You'll also want to make sure you have medium carb (MC) (11-15%) and high carb (HC) (16+%...I go for 20% personally) and some karo/honey/syrup on hand as part of your supplies. Check out the hypo toolbox link in the Important Links document. Hope that helps some :bighug:
 
Hi JaxBenji,

Thank you for the spreadsheet - that is very helpful!! And the kind words.
I really appreciate your recommendations!! I do keep most of the hypo toolbox kit items stocked other than the MC. I will grab some of that next time.

Thanks again!
 
Welcome Emily, can you please add Carlitos DX(diagnosis date) date to your
Signature, members will look at that first rather than having to go back and
look for it.
Also the meter you are using.
Whatever tests you can add to the spreadsheet is good.

I am going to tag some members who might be able to help you out
Did you look at the food chart yet.
The Hills you say you are feeding is that wet or dry food and yes 25% carbs is way too high.
If you are feeding dry food and switch to an all wet diet you must do it slowly.
Just cutting out dry food altogether can drop his BG over 100 points
So that's why you must test him in the morning pre shot
and in the evening pre shot to see if it's safe to shoot.
Can you start getting more tests in during the day and at night.


@JanetNJ

@Deb & Wink

@Wendy&Neko

Please read the information she wrote in her profile, its very detailed, she's a college student from Hawaii

Hi ladies trying to help out @emily + carlito
Thanks ladies
 
Last edited:
Diane Tyler's Mom said:
Welcome Emily, can you please add Carlitos DX(diagnosis date) date to your
Signature, members will look at that first rather than having to go back and
look for it.
Also the meter you are using.
Whatever tests you can add to the spreadsheet is good.

I am going to tag some members who might be able to help you out
Did you look at the food chart yet.
The Hills you say you are feeding is that wet or dry food and yes 25% carbs is way too high.
If you are feeding dry food and switch to an all wet diet you must do it slowly.
Just cutting out dry food altogether can drop his BG over 100 points
So that's why you must test him in the morning pre shot
and in the evening pre shot to see if it's safe to shoot.
Can you start getting more tests in during the day and at night.


@JanetNJ

@Deb & Wink

@Wendy&Neko

Please read the information she wrote in her profile, its very detailed, she's a college student from Hawaii

Hi ladies trying to help out @emily + carlito
Thanks ladies
Click to expand...

Thank you Diane!!
He is not on dry food thankfully, which is why I'm so puzzled by the consistently high numbers. Yes, I will definitely continue adding more numbers!
Another member did thankfully send me the food chart so I will look into getting a new food for him. Fancy Feast Pate looks promising. I have had him on other wet foods (Nulo brand) that are high-protein, low carb but the vomiting wasn't improving. The vet recommended the I/d Digestive to help with vomiting, which it has seemed to, but perhaps we can get there with another low-carb option. I will transition him slowly (do you think a week is enough time?) so as not to shock his system.
 
Hi Emily, welcome to the forum.
You got good advice for everyone. I just tought that if budget is an issue, human glucometers also work fine to keep an eye on cats, and is a fraction of the cost. I started with a pet meter, but had to think twice everytime I wnet to test because the strips were so expensive. Using pet meters I can test 10 times for the price of one pet strip. So it allowed me to understand much better the effect of food and insulin.
 
Hercule's mum said:
Hi Emily, welcome to the forum.
You got good advice for everyone. I just tought that if budget is an issue, human glucometers also work fine to keep an eye on cats, and is a fraction of the cost. I started with a pet meter, but had to think twice everytime I wnet to test because the strips were so expensive. Using pet meters I can test 10 times for the price of one pet strip. So it allowed me to understand much better the effect of food and insulin.
Click to expand...

Thank you for saying that - that is exactly why I've been having a difficult time testing regularly. I always thought the human meters were not good to use??

The AlphaTrak test strips are crazy expensive. When he was first diagnosed I was worried I couldn't afford treatment, but he was on a much cheaper human insulin and it was really affordable for the first 6 mos or so. But now with the PZI (which runs out super fast now b/c he's on such a high dose), the test strips, the SubQ fluid bags, and the Hill's, the costs are frighteningly high.

I don't mean to complain, I love Carlito and as long as I can afford it, I will keep up with the treatments, but I am a college student and broke :( Something that drew me here was that so many members found it very affordable to treat so I'm hoping that if I can get this managed better, his treatment will at least not escalate in price anymore.
 
emily + carlito said:
Thank you for saying that - that is exactly why I've been having a difficult time testing regularly. I always thought the human meters were not good to use??

The AlphaTrak test strips are crazy expensive. When he was first diagnosed I was worried I couldn't afford treatment, but he was on a much cheaper human insulin and it was really affordable for the first 6 mos or so. But now with the PZI (which runs out super fast now b/c he's on such a high dose), the test strips, the SubQ fluid bags, and the Hill's, the costs are frighteningly high.

I don't mean to complain, I love Carlito and as long as I can afford it, I will keep up with the treatments, but I am a college student and broke :( Something that drew me here was that so many members found it very affordable to treat so I'm hoping that if I can get this managed better, his treatment will at least not escalate in price anymore.
Click to expand...
Emily,
I was just looking in the "Supply Closet" and saw a bottle of Prozinc at half price. I inquired if it is still available. Who knows? Maybe it is still available .
 
emily + carlito said:
I always thought the human meters were not good to use??
Click to expand...
They both meassure the same thing, is just that the curves are adjusted slightly different ( the alphatrak number go up faster). There aer many discussions in here about it, and most people eventually chnage to human meters and never look back. You just have to know that the "action number" of when is too low is slightly different.

You mentioned he was on human insulin before... was his number any better on it? We are using prozing, but considering moving to a human insulin. Many people here think their cats do better on it...
 
emily + carlito said:
Thank you Diane!!
He is not on dry food thankfully, which is why I'm so puzzled by the consistently high numbers. Yes, I will definitely continue adding more numbers!
Another member did thankfully send me the food chart so I will look into getting a new food for him. Fancy Feast Pate looks promising. I have had him on other wet foods (Nulo brand) that are high-protein, low carb but the vomiting wasn't improving. The vet recommended the I/d Digestive to help with vomiting, which it has seemed to, but perhaps we can get there with another low-carb option. I will transition him slowly (do you think a week is enough time?) so as not to shock his system.
Click to expand...
I'm not sure if you can just start him on the Fancy Feast even though he is on wet food already ,
I'll tag some members for advice

@Lisa and Witn (GA)

@JanetNJ

@Chris & China (GA)

Hi ladies @emily + carlito kitty is eating Hills Science Diet canned wet I/D Digestive to help with vomiting which Emily said it has. The carbs are nearly 25% carbs which she stated. Can she switch to Fancy Feast immediately or should she start adding
some of the FF a little each day.
Thank you
 
Hercule's mum said:
They both meassure the same thing, is just that the curves are adjusted slightly different ( the alphatrak number go up faster). There aer many discussions in here about it, and most people eventually chnage to human meters and never look back. You just have to know that the "action number" of when is too low is slightly different.

You mentioned he was on human insulin before... was his number any better on it? We are using prozing, but considering moving to a human insulin. Many people here think their cats do better on it...
Click to expand...
When he was on the human insulin I was not home testing so it's hard to say. He was pretty hi still, which was why the vet recommended switching to Vetsulin, because they thought it would work better for him. His numbers have been pretty steadily high throughout all types of insulins though and the vomiting was worse when he was on human insulin, though this could be from the different type of food he was on. I'd say try it, I know some have luck with a switch like that
 
Hercule's mum said:
They both meassure the same thing, is just that the curves are adjusted slightly different ( the alphatrak number go up faster). There aer many discussions in here about it, and most people eventually chnage to human meters and never look back. You just have to know that the "action number" of when is too low is slightly different.

You mentioned he was on human insulin before... was his number any better on it? We are using prozing, but considering moving to a human insulin. Many people here think their cats do better on it...
Click to expand...
That is great to hear about the human meters though. I will look into that!
 
I am new here too, but my kitty Cotton was just recently discovered to be diabetic.
I use the Accuchek Aviva, it was $34 CAD and the strips were about $45 CAD. It is a human meter but my mother's diabetic so I'm used to the measure. I have been told to multiply any number on the meter by 18 to get the US BG level. I am so used to it I think the US numbers would be baffling lol - BUT when I put my meter's numbers in the spreadsheet it sutomatically converts to US numbers.
 
CB Terri said:
I am new here too, but my kitty Cotton was just recently discovered to be diabetic.
I use the Accuchek Aviva, it was $34 CAD and the strips were about $45 CAD. It is a human meter but my mother's diabetic so I'm used to the measure. I have been told to multiply any number on the meter by 18 to get the US BG level. I am so used to it I think the US numbers would be baffling lol - BUT when I put my meter's numbers in the spreadsheet it sutomatically converts to US numbers.
Click to expand...
Thank you, @CB Terri ! That is very helpful to know. Would you be able to tell me how many test strips come for that much? It seems close in price to AlphaTrak - it's $50 for 50 strips I believe
 
emily + carlito said:
Thank you, @CB Terri ! That is very helpful to know. Would you be able to tell me how many test strips come for that much? It seems close in price to AlphaTrak - it's $50 for 50 strips I believe
Click to expand...
Hi Emily + Carlito
It was 50 strips - so like a dollar or so each.

BUT I just ordered a sealed container from Amazon for $43.99 CAD for 50 strips ( around $35 USD?) with an expiration for a year or more away. I have Prime so free shipping and so very worth the $9 CAD a month for mrmbership. Prices vary and bargains can be had when shopping around.

https://www.amazon.ca/Accu-Chek-Avi...urple/dp/636568245X?tag=felinediabetesfdmb-20
 
If you are in Hawaii, do you have a Walmart near you? The Relion Prime meter and strips are way cheaper. Or maybe you can order them on line.

I am a little worried about the diabetes and vomiting. How often is he vomiting? Any chance he has allergies to particular proteins, like chicken? If he likes the Stella and Chewy's, you could try their rabbit which might be a novel protein for him.

By the way, some cats just need higher doses of insulin. But being on 25% carb food will make a huge difference in how much insulin he needs. Any food transition to lower carb will have to be done slowly and with lots of monitoring.
 
Wendy&Neko said:
If you are in Hawaii, do you have a Walmart near you? The Relion Prime meter and strips are way cheaper. Or maybe you can order them on line.

I am a little worried about the diabetes and vomiting. How often is he vomiting? Any chance he has allergies to particular proteins, like chicken? If he likes the Stella and Chewy's, you could try their rabbit which might be a novel protein for him.

By the way, some cats just need higher doses of insulin. But being on 25% carb food will make a huge difference in how much insulin he needs. Any food transition to lower carb will have to be done slowly and with lots of monitoring.
Click to expand...

Hi @Wendy&Neko,

Mmmm I have not considered the allergies. Yes, it's definitely possible. Unfortunately I can't get the rabbit Stella and Chewy's in Hilo -- the only place I have been able to find the is a small pet boutique and they don't carry that flavor unfortunately. I will see if they special order. I don't think the popular website Chewy ships to HI and I have looked other places online but haven't found. If you know of any reputable place I could buy online I'd love to know!!

I have just returned from the vet. She thinks he has pancreatitis, though a previous vet ruled that out - his amalyse (?) was at 1160 (I guess for full-blown pancreatitis the levels are up around 1500 usually). Liver and protein were slightly elevated. She thinks he may have a tumor on his pancreas which is keeping him insulin resistant and wants to do an ultrasound. I may go through with the ultrasound but I want to see if shifting foods does anything to his levels first.

I have just started switching out his food (10%) with FF naturals chicken flavor (I hope he's not allergic) as of tonight, so I will increase dose by 10% each week? Does anyone have thoughts on if that is slow enough? I am monitoring as much as I can, usually 4-6 times per day, I'll make sure to keep it up and increase as schedule allows since we are switching the food.

I also picked up ketoacidosis tests - they are generic brand, I hope they work. Vet did not say anything about whether he is at risk for developing DKA due to chronically high BG and I forgot to ask. --

(Sorry, going to vent a little: vet was packed, waited an hour to be seen, vet came in and half-listened to the answers I gave to her questions and then after about fifteen minutes literally walked out the door while I was in the middle of asking her a question -- the vet tech looked at me, wide eyed, and asked if I still needed to speak to her, and I said I did, and she shrugged and walked out !!!)
--

The vet did say when she called back with the test results that she wanted to put him on ursodiol for his pancreatitis (which has not been confirmed yet) - anyone know anything about ursodiol? I can't find much about it online.

Carlito's levels are high as ever - he's been really high today especially, but vet got 467 on him when he was SSUUUUUPER stressed while they had him pinned to the table for the tests :(
 
Wendy&Neko said:
How often is he vomiting?
Click to expand...

Totally didn't answer this --

It's intermittent. It won't happen for a month and then it'll be twice in a week. He vomited after an application of Revolution last week. But yeah very irregular.

Also - thank you for the tip about the Relion meter - I will look into this, I do have a walmart near me. I just bought two more packs of AlphaTrak test strips but they won't last long.
 
CB Terri said:
Hi Emily + Carlito
It was 50 strips - so like a dollar or so each.

BUT I just ordered a sealed container from Amazon for $43.99 CAD for 50 strips ( around $35 USD?) with an expiration for a year or more away. I have Prime so free shipping and so very worth the $9 CAD a month for mrmbership. Prices vary and bargains can be had when shopping around.

https://www.amazon.ca/Accu-Chek-Avi...urple/dp/636568245X?tag=felinediabetesfdmb-20
Click to expand...

Thank you for the tip! It's certainly an improvement from AlphaTrak. I am looking into new meter options now and will keep this on the list.
 
You might want to read this Primer on Pancreatitis. Besides being impatient, you vet might be a little out of date on it. :rolleyes: You will note ursodiol is not a treatment nor is amylase how you diagnose it in cats. Here is some info on ursodiol.

I can think of a couple conditions that might make him resistant to insulin, acromegaly and/or insulin auto anti bodies. My Neko girl had both of them. One in four diabetic cats has acromegaly, which is caused by a benign tumour on the pituitary gland, causing excess growth hormone to be output. Both conditions are diagnosed with blood tests that have to be send to Michigan State University.

There are other novel protein cat foods. I just mentioned the rabbit cause it's one I serve at my house. If you can get Ziwipeak canned food, they have venison and lamb, plus there are other brands you can try that have limited ingredient novel protein options.
 
Wendy&Neko said:
You might want to read this Primer on Pancreatitis. Besides being impatient, you vet might be a little out of date on it. :rolleyes: You will note ursodiol is not a treatment nor is amylase how you diagnose it in cats. Here is some info on ursodiol.

I can think of a couple conditions that might make him resistant to insulin, acromegaly and/or insulin auto anti bodies. My Neko girl had both of them. One in four diabetic cats has acromegaly, which is caused by a benign tumour on the pituitary gland, causing excess growth hormone to be output. Both conditions are diagnosed with blood tests that have to be send to Michigan State University.

There are other novel protein cat foods. I just mentioned the rabbit cause it's one I serve at my house. If you can get Ziwipeak canned food, they have venison and lamb, plus there are other brands you can try that have limited ingredient novel protein options.
Click to expand...

@Wendy&Neko ,
I am so grateful you mentioned this. I have run across acromegaly in my googling. Can I just ask my vet to test for it? I will also bring up the insulin auto anti bodies. I checked out symptoms and he has the "weight loss (despite a good appetite) and increased thirst and urination. Acromegalic cats also develop changes in their appearance such as enlargement of the jaw, paws, and abdominal organs" the NC State Vet hospital reports.

I will also check out novel protein foods. Have you ever tried feeding raw/do you have any opinions about it?
Thank you so much! Carlito and I are very grateful :)
 
It is concerning that the vet wants to put your cat on a medication for a condition they have not confirmed to exist? Wendy gave a link on pancreatitis, and there are tests I know that are more specific to determining pancreatitis - it might even have been she who mentioned them to me.

I share your frustration with vets in a hurry. Nothing like waiting with a sick cat in a parking lot for 2 hours past your appointment, to be rushed through in 15 minutes and feel like you're hardly further shead.

Wendy also mentions the Relion meter and if I was in US I'd get one. I may still yet if I can get enough strips to not worry about online ordering/shipping delays. Nobody said we couldn't use accuchek tho if temporarily running low on Relion...
 
emily + carlito said:
I have run across acromegaly in my googling. Can I just ask my vet to test for it?
Click to expand...
When people here hit 6 units, we suggest getting the test done for acromegaly. You should be able to ask your vet to have the test done at MSU. Vets of a certain age used to be trained "this is acromegaly in cats, you will never see it". Now we know otherwise. I had to ask my vet to humour me, some people see resistance in testing from their vets. Not all cats show physical signs of it early on. Some common symptoms are a pot belly, actually gaining weight if not regulated (excess growth hormone at work), loud breathy breathing (called stridor) or snoring. Larger paws in some and facial changes, mostly widening of the jaw. University of North Carolina is a very good source of info - one of the most knowledgeable endocrine vet researchers in the US teaches there.
 
CB Terri said:
Wendy also mentions the Relion meter and if I was in US I'd get one. I may still yet if I can get enough strips to not worry about online ordering/shipping delays. Nobody said we couldn't use accuchek tho if temporarily running low on Relion...
Click to expand...

@CB Terri ,
Yes, I am very curious about this meter. I have been testing Carlito several times/day now and his numbers are reading higher than usual, rarely below 600. I tried to do 2 tests back to back because I was curious and his right ear consistently reads in the 200-300 range, his left in the 600s. Has anyone else had this problem with AlphaTrak 2 meter? When this happens, what should I record the number as? An average? Sometimes I even test back to back in the same ear and will get wildly different results.
 
Wendy&Neko said:
When people here hit 6 units, we suggest getting the test done for acromegaly. You should be able to ask your vet to have the test done at MSU. Vets of a certain age used to be trained "this is acromegaly in cats, you will never see it". Now we know otherwise. I had to ask my vet to humour me, some people see resistance in testing from their vets. Not all cats show physical signs of it early on. Some common symptoms are a pot belly, actually gaining weight if not regulated (excess growth hormone at work), loud breathy breathing (called stridor) or snoring. Larger paws in some and facial changes, mostly widening of the jaw. University of North Carolina is a very good source of info - one of the most knowledgeable endocrine vet researchers in the US teaches there.
Click to expand...

He definitely has the pot belly though he has lost weight since his diagnosis and switching foods (about 10 lbs) and the loud breathing. His jaw and paws have always been big so it's hard for me to tell.

His numbers are going up as I'm switching the food over. He's at 20% new food 80% old food. It also seems like his appetite is increasing majorly - he seems crazy hungry only 2 or 3 hours after eating, whereas before he used to be ok for about 4 hours between feedings. Is it ok to feed him extra food when he's nonstop meowing/pacing/seems very distressed? I don't know what to do. My meter also may not be so reliable - got one ear each one right after the other and one side was in the 300s the other 600s.

Thank you very much for all the information. I am trying a new vet this week, though it's almost a two hour drive there. They were the office that originally diagnosed Carlito and we had a good experience there, especially compared to where I live now, which has been either decent, but uninterested in pursuing things like acromegaly and only seem to suggest increasing his dose, or downright rude.
 
Critter Mom said:
This is a very good document to wave under your vet's nose when discussing diagnosis and appropriate treatment for feline pancreatitis.

IDEXX Feline Pancreatitis Treatment Guidelines

That's assuming they stay in the consulting room long enough...

(Very unprofessional behaviour on your vet's part, IMO.)


Mogs
.
Click to expand...

Thank you @Critter Mom! I will print this and bring it next time. We are going to a new vet on Thursday (well, it was the first vet who diagnosed Carlito initially 1.5 years ago) but since moving it has been too far to bring him regularly. So we'll see what they have to say. I specifically said while booking my appt that I wanted him tested for acromegaly, and I'll have all the paperwork from the three different vets who all said different things about whether or not he has pancreatitis, so maybe we can get some actual new information rather than just spinning the wheels round and round.

So grateful for everyone weighing in, it is definitely stressful and I so look forward to getting to hop on here and compare notes and get advice from genuine folks. Thank you!!
 
jt and trouble (GA) said:
Glad to hear no dry food! Yay
Click to expand...
@ jt and trouble (GA)
OH and I've also been testing him for ketones - he is testing in the "trace" and "small" categories it looks like...does he require immediate medical attention for that? will he be ok?
 

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