New with Zissou

Status
Not open for further replies.
KristyD

KristyD

Member Since 2022
Hello all. My 12yo boy Zissou was diagnosed Monday and the vet gave us some really bad advice (I don’t think he’s really dealt with diabetic cats, vetsulin was all he had).

Vet notes:
give 2 units twice daily for now
Feed after giving insulin and about 6 hours later
Friday Start giving 3 units twice daily
will probably end up giving about 9 units eventually
can feed DM cat Pood
Can give honey or haro syrup if blood sugar gets too low from the insulin, low blood sugar would cause shaking and staggering


I joined the Facebook group as soon as I got home and didn’t do any of the above - I started him on 1u twice a day per advice from others and have been doing that with regular testing for the week. His numbers have been consistently high. Today I did a curve and they’ve been nuts, even with feeding him canned food every two hours (after testing). He’s overall not in good shape, he has zero muscle mass and his belly is incredibly swollen with fluid that the vet said was because of his pancreas. He is looking better since starting insulin however (comparatively) and is much more active. He eats a mixture of frozen raw (primal turkey) and canned pate (wholehearted chicken) and I add extra water into every meal. No kibble (was removed Monday).
I’m a bit surprised by his numbers today and expected them to be lower after dosing- is that typical? I would’ve bet money I got that injection in there but now I’m second guessing both that and/or his dose.

any help greatly appreciated

I’m sure I’ll miss something but hopefully this helps too- ReliOn premier classic meter, vetsulin with u-40 needles, canned wholehearted pate chicken and primal frozen raw turkey fed alternately after testing and every 2 hours
 
Welcome Kristy and Zissou, my name is Kyle. Sorry to hear of Zissou's diagnosis. This is all pretty new to me and my boy Hendrick as well, so I don't have many answers or advice but just wanted to say welcome to the club, this place is fantastic and with their help Hendrick is doing sooooooo much better now.

You're amazing getting a spreadsheet setup and doing home BG testing already!! I'm impressed. This group is very numbers driven (which I love) so that is perfect. The next step would be setting up your signature so people don't pester you over and over with the same questions. (see mine for example)

How to do your signature:

https://felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340


And just lots of good info for anyone new:

https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
I know nothing about Vetsulin except that the consensus among the experts here is there are much better options for felines such as Lantus, Prozinc or Levemir so I tagged some senior members for you @KristyD
 
Hi Kristy and Zissou and welcome to the forum.
I’m glad you found the Facebook page and then us, and did not follow the vets advice.
Well done setting up the SS, hometesting and starting the low carb diet.
A couple of things……..
Are you able to get some tests in during the pm cycles? Even a before bed test would be helpful each night. If that test is much lower than the preshot test, I would set the alarm and get up later and test again to see the BG hasn’t dropped too low.
At the moment it is hard to tell if the high numbers are just because he needs more insulin or if he might be bouncing from lower numbers which have so far gone undetected.
One other thing I would do is get a bottle of Ketostix from Walmart or a pharmacy and test the urine for ketones which can form in unregulated diabetic cats. If there are any ketones let us know and tell the vet if there is more than a trace of ketones.

I would also look for another vet and ask about changing the insulin to a more suitable cat insulin such as Lantus or Prozinc, as Kyle suggested. Vetsulin is not a cat insulin. I would also ask the new vet about the belly swelling which does concern me.

Are you feeding 1/2 hour before giving the dose of insulin? It’s important with vetsulin that there is food aboard as it can hit hard and fast.
Keep asking lots of questions.
I’ll tag @FrostD as she has used vetsulin.
Bron
 
The spreadsheet definitely reads like she's dropping lower overnight and then bouncing into high numbers (very normal thing!), but the question is how low. I don't think it's too low, but need at least 2-3 nights of PM mid cycle tests (around +4).

The fluid in the belly concerns me....they couldn't drain it? Was that by x ray? Ultrasound? Or just external exam? I'd be getting a second opinion on that ASAP
 
For the vetsulin I definitely don’t plan to get another bottle of it but was hoping I could use what we have first - I know it’s not the best on the market now but figured it would work since that’s what used to be recommended. If it looks like it’s absolutely not working I’ll call on Monday and see if he can phone in a different prescription. Unfortunately right now finances are a factor since we just spent a bunch on his emergency visit and we have to move this month which means rental deposit$$. I planned to find a new vet and have him reevaluated next month (if he can wait, obviously if things are looking bad then I’ll just have to figure something out).

I will definitely do some pm testing over the next few days and get some ketone test strips. If that is high is a vet stay the only option?

I do feed 30 min before his insulin, right after testing.

On his belly the vet just palpated and said it felt like fluid, not a mass or enlarged organ. I assume his blood work didn’t show anything abnormal to indicate an organ failure or other issue but I don’t super trust this vet and I don’t have a copy of that test to check, just the catalyst one. He said the fluid would likely go down as his medicine starts working and regulating, which made sense to me at the time. It has gone down some but definitely is still enlarged. His vet visit initially was because his belly had gotten so enlarged overnight that he couldn’t breathe - he drained some/took a sample but didn’t want to do too much and have his blood pressure drop due to his poor body condition (they had a really hard time getting a blood sample). I’ve been kind of one step at a time right now and trying to get the diabetes under control then have his belly looked at again more thoroughly next month.

And thanks for the help and support!! I can’t even say how much I appreciate the advice and shared experience I’ve gotten here.
 
The Vetsulin is not the end of the world, but I'll be honest his numbers are very high. Vetsulin usually doesn't do great at these numbers, or allow you to increase in a way that gets overall numbers down. Let's get a couple more days (especially nights of data) and we'll see what to do. It does look like he needs an increase, but need to see how low he's going first.

What was emergency stay for?

Hiw much are you feeding? What's current and ideal weight? And feeding schedule?

@Suzanne & Darcy @Wendy&Neko @tiffmaxee what are your thoughts on the swelling/fluid? I don't like it and I don't think I buy that it's related to pancreas and insulin will solve the problem
 
I don’t like the belly issue either. It is not due to fd. I don’t know what it is. Too bad you don’t have a copy of the labs. Was an X-ray or ultrasound done?
How old is he? Has he had any other medical issues recently? Amy medications he’s on?
 
That abdominal fluid really bothers me. There has to be a reason for it and I do not believe it is diabetes either. What were the comments on the nature of the fluid that was drawn off? The problem is that fluid tends to return even after it is extracted, unless the problem can be addressed. I am worried since you said it was interfering with his breathing.
 
I also think belly issue should be looked into...
I've used Caninsulin which is the name of Vetsulin in the US and Canada. My Ti-Mousse was on it a few weeks only; after shooting he was dropping and going back up right after; changing for Lantus/Levemir really made a huge difference in controlling his numbers.
 
I also used Vetsulin. It dropped my boy a little and then he zoomed right back up after about 4 hours. It does not last long in cats. We switched to ProZinc then Lantus then Levemir, which was the most effective and gentle insulin.
 
I’m definitely also concerned about his belly and his brand of insulin but I can’t do anything about those until next month. I’m doing the best I can with what I have at the moment, I will absolutely be switching to a different insulin brand and having him seen by a new clinic asap.

For right now I need help with dosing because the vets advice didn’t seem right. Would posting on the vetsulin page be better suited? I tested him two hours after dosing and he’s still at 562.

The lab copies I have are on his spreadsheet, I just don’t have copies of his blood counts or anything else not on there.

The fluid is going down, just slowly. He can breath much better and isn’t having other related problems anymore. I agree that it doesn’t seem fd related from everything I’ve read though.
He’s had occasional uti but nothing in the last 3 years, overall good health. He was at 14lbs before getting sick and at 10lbs now. 12 years old, no other medications (ever).
He eats wholehearted canned pate chicken and beef in addition to primal frozen raw turkey patty’s. I try to feed every 2 hours or so because he’s so dang skinny. I’m a stay at home mom so I can fairly easy monitor him and feed. I’ve been reading into 8hr dosing with vetsulin and wondering if that’s something he could benefit from?

When I’m able to get a new script what would be best for him (and cheapest for me)? I’ve seen a wide range of prices so I’m not too sure how that works.
 
I would definitely not try 8 hour dosing with vetsulin. It’s a harsh fast acting insulin and you need to be really experienced to try something like that and you could run into all sorts of problems. There are many other things you can try…..….I personally would not do it with my cat.
For the next couple of days, if you could get those extra tests in we talked about during the pm cycle and during the day if you can….that will give us a lot of information. And try and get those ketone tests done as well.

There is a biosimilar insulin to Lantus called Semglee and is not too expensive, so I would look at that when you are ready.

Once you get the BGs more under control,you will find that your kitty will be able to put on some weight. At the moment the nutrients in the food are not able to be absorbed properly and he will remain hungry and not put on weight. This is very common in newly diagnosed diabetic cats, especially if they have high numbers.
Keep posting and asking questions. We are happy to answer them and help you.
 
Hi Kristy. I’m sorry you are going through all this with your beautiful Zissou. It’s very stressful, I know.

In looking over the labs results that you shared, a few things stand out: one is the liver enzymes are elevated as is the Bilirubin. These two together and the abdominal fluid are making me think that your kitty has some liver damage/disease. Abdominal fluid can definitely be a result of liver disease. The liver, as you know, has a great capacity to regenerate and heal itself. If you are able to pill your kitty, I would highly recommend a supplement to aid his liver called Denamarin. It’s not that expensive. I ordered mine from Chewy. You can read up on it. It’s very good. If you are not able to pill him at all I would recommend getting Milk Thistle powder and mixing it into food. I prefer the Denamarin because it has more ingredients to help heal the liver, but milk thistle is also very helpful.

The other thing is that Zissou’s Lipase is off the charts. Vets don’t usually pay much attention to slightly elevated Lipase levels, but when the levels are three times greater than normal — and Zissou’s are much greater than that — it becomes significant. This can indicate pancreatitis, liver disease, peritonitis and a bunch of other stuff. There is a specific test for pancreatitis. Since funds are limited, I would not do it unless he is showing signs. I’m just pointing it out since it’s part of the picture. The blood results that you have are somewhat limited. The Denamarin/milk thistle is something that you can do without spending a ton of money.

I know you will do your best to switch insulins, so I won’t harp on that. I’m really hoping that your lovely boy will start to feel better soon and be able to gain weight when his blood glucose levels decline. I hate seeing people’s beloved cats hurting.
 
As others have noted, I'm concerned about the fluid. It is not anything I've seen with a diabetic cat. I know finances are an issue -- you really need a better vet. Dismissing abdominal fluid is bad clinical judgement. I also agree with what Suzanne posted. (I was about to say the same things!)

I would consider raising Zissou's dose to 1.25u. You're kitty's numbers are high -- as you noted. I would keep getting tests, although you don't need to do a curve on a daily basis. You just want to make sure that a dose increase doesn't cause a huge drop in numbers. I'd also be sure to get at the minimum, a test before you go to bed every night. Many cat's experience lower numbers during the PM cycle. Not having PM tests means you're missing half of your data.

Just so you have more guidance, this is information on dosing with Vetsulin.
 
High ALT combined with the very high Bilirubin goes with liver problems, as does abdominal fluid (which admittedly could be anything- even FIP). Since none of the other liver values were included in the labs, who knows? It’s a guessing game if an ultrasound cannot be done (which it cannot right now due to finances.)

As I mentioned, the super high Lipase indicates a probable problem with the pancreas as well.
 
Well yesterday was a bit of a wash, I messed up his AM injection and got a complete fur shot (I literally saw the meds shoot onto the floor :banghead:) I did not try again since the instructions here seem pretty clear not to. Dosed PM and tested again before bed, those numbers are still really high but at least didn’t max the meter.
I also tested his ketones which was a big fat negative! I was pretty shocked to be honest. Tested twice.

I’m calling today to see if I can get a different script over the phone - I have no idea if this vet will cooperate or not but figured it’s worth a try. IF I do get one I’ll obviously have to pick it up locally.
I want to be as clear as possible for them and I’ve been researching the different brands all Sunday. It looks like, from online prices, Lantus or Levemir (or Semglee / basaglar) would be the cheapest long term with the pens but I’m not sure I’d be able to get any of those for a reasonable price locally. I’ve looked into the savings card but it seems like people have mixed success with that and it usually takes a few pharmacies to find one that will cooperate (this is all just from what I’ve read online, if I’m misguided please lmk!). From all of that it seems like prozinc would be easier/cheaper for me to obtain right now. Would it be bad for him to switch to prozinc now and then to Lantus/similar later on? I just want him on whatever’s best that we can afford, within reason. If so do I just ask for “prozinc” or is there more to it? And are syringes a separate perscription?

I cannot find cat sized Denamerin in stock anywhere so I’m going to ask my vet if they have that as well. If they don’t have that then I’ll try milk thistle and denosyl for a while.

Thanks again for the help everyone! Old man followed me around all day yesterday like “hey aren’t you going to test me and give me treats now?” Lol. Diabetes may be the most stressful cat thing I’ve ever done but he’s loving all the extra pats and attention.
 
Forgot to add, I had planned to increase his dose to 1.25u Sunday before I missed the first shot. I wasn’t quite sure if I should still increase or not but decided to go ahead and continue based on what I’ve read in the vetsulin board. I really didn't feel like his 1u dose was doing enough even in the short term but I’m not sure if that’s more related to his dose or the meds in general.
 
WHen comparing insulin prices you have to remember that ProZinc s a U40 insulin while the human Lantus/glargine/Levemir are U100 insulins. A 10 ml vial of ProZinc contains 400 units while five 3 ml pens of Lantus/glargine/Levemir contain 1500 units of insulin.
 
Larry and Kitties said:
WHen comparing insulin prices you have to remember that ProZinc s a U40 insulin while the human Lantus/glargine/Levemir are U100 insulins. A 10 ml vial of ProZinc contains 400 units while five 3 ml pens of Lantus/glargine/Levemir contain 1500 units of insulin.
Click to expand...

Agreed! This is why I want to do Lantus long term but right now I believe it’s still less expensive to fill a single script for prozinc. I know it would make more sense for most to just do the Lantus and eat the bigger cost up front since it lasts way longer but my options financially are limited at the moment. Next month and on I’ll have more options
 
Are you in the US?

Based on nighttime tests you have, yes increasing was good. See where he's at tomorrow, if he still is black/red, I'd go to 1.5U Wednesday (I'd have said go straight to 1.5U if it weren't for the furshot, want to give that a chance to settle down). I know the Vetsulin guides say 0.25U but he's so high a 0.5U increase should be ok (this time anyway, not always the case)
 
I was able to get Lantus for $99 per vial. This was from a privately owned pharmacy in my local area -- NOT a chain pharmacy like CVS, Walgreens, Walmart, etc. They had simply awful prices. But the locally-owned pharmacist was really nice and they said they had a coupon they could apply to bring the price down to $99. So you might want to see about a non-chain, locally owned pharmacy to see if they can help. Just a thought.

But don't worry about harming your kitty by using ProZinc first if that's the way things work out. I went through Vetsulin, ProZinc, Lantus and, finally, Levemir. No harm done.
 
Small update: called the vet and and got a script for “Insulin Glargine-yfgn (Solution Pen-injector, 5x 3.000 ML Pen, 100 unit/ml)” but I’m still waiting to pick it up from Costco.

Right now (still on vetsulin 1.25u) his numbers are worse than before. Can anyone advise when I should be testing him today? Is it normal to see such little effect and rising numbers after starting?
All of those 600 are just “HI” readings so I’m not even sure how high he is going.

If I’m able to pick up his new insulin today can I start it this evening?

Also his belly has continued to go away thankfully and he’s lost nearly 1#, which I’m assuming is from the fluids leaving.

I am in the US

Oh and I found a cat only vet and made an appointment for next month (soonest they had anyways).
 
Last edited:
I think I just successfully ordered 5 pens of generic lantus for around $140 from CanShipMeds AKA Mark's Marine

https://canshipmeds.com/

I say "I think" because they still have to get the script from Vetsource and then call me back and finalize the order. But if this works, holy crap what a huge price difference. We paid $130 per pen before.

branded Lantus Solostar pens are back-ordered about a month right now they said. Fine with me, I'm happy to take the generic.
 
Supposedly Costco is $83 for the five pens (I think it’s Semglee) but I’m not holding my breath on it just yet! I’m half expecting to go pick it up and have it just be the outer pens minus meds or something lol.

Marks will be my next try if Costco doesn’t work out, that’s great to know!!
 
Hendrick's mom and dad said:
I think I just successfully ordered 5 pens of generic lantus for around $140 from CanShipMeds AKA Mark's Marine

https://canshipmeds.com/

I say "I think" because they still have to get the script from Vetsource and then call me back and finalize the order. But if this works, holy crap what a huge price difference. We paid $130 per pen before.

branded Lantus Solostar pens are back-ordered about a month right now they said. Fine with me, I'm happy to take the generic.
Click to expand...
Yes I've ordered from them several times, works out to be cheaper than ProZinc too
 
FINALLY have Semglee in hand to dose for tonight -yay!
What unit should I start him at? I just moved to 1.5 on vetsulin this morning. Its been a huge pain to get the vet to a) call it in and b) actually call in the right stuff so I wasn’t counting on having it today when I increased that dose.

And Costco did turn out to be $83 for five pens but my vet would only call in the 100ml vial for whatever reason and at that point I was done arguing with him ($62 for a vial). I’m just going to order pens from marks when I run out (added bonus, human version doesn’t require a prescription and it’s the same thing).
 
Can you start a thread in the Lantus forum please? They are better to advise on dose. I suspect they'll say 1.5 or possibly 1.75 but better to ask
 
Status
Not open for further replies.
Back
Top