Urgent Please Help Max

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J&Max

J&Max

Member Since 2023
Hi Admin! Please help, I really need your advice. Thank you

Max is 17 years old now that I adopeted him in 2017.
Raw meat diet since in 2019.
He has Triadenitis twice in 3 months then diagnosed as diabetes in September last year.
He has high blood pressure in September this year and caused him blind.
Raw meat diet every 6 hours 1000/1600/2200/0400
1.75 unit of Lantus at 1000 & 2200
Very good control during in mid of September ( between 3mmol/L-13mmol/L)

However Max has fecal & urine incontinence at 0240 on 6 November. His blood sugar level was low at 1.9 mmol/L.
We visited the vet on the same day and the vet decided to decrease the amount of insulin to 1.5 unit.
Max has installed the Librefree sensor and the report is shown on the comment.
After that his BG level seems higher and higher and not going down.
I took Max to visit the vet again and thyroid’s function is normal.
Few days ago, the vet decided to increase the amount of insulin to 2.5unit on 26th night.
I noticed that Max’s blood test report was shown inflammation. Will periodontal bacteria affect his blood sugar? Hence he doesn’t like to brush teeth as bleeding every time I brush his teeth. He refused to eat few days after brushing teeth so I had gave up on him. Two cavities are removed in December last year.
Max has no appetite 4 days ago, I grinded the meat with some water and he finished 2/3 every time. 2 days later Max is back to normal and he finished the food every time.
I gave Max subcutaneous fluids x 100ml every other day to help his kidney functioning.
I had checked his ketones by using the urine test paper everyday and it’s Negative.
Weight 4.65kg is past 6 month then dropped to 4.45kg since last week.
The vet is off for 3 weeks, I am so worrying about his health and the BG level…

Questions
1) Does Max has resistance to the insulin?
2) How to lower his BG level?

That would be great if someone can help and give me some advices. Thank you
https://docs.google.com/spreadsheets/d/1jIYq5qZQtnyaH3xn63wPnljYRVmYYuGvC4k35sTpx3M/edit
 
I've moved your post to Feline Health, which is where we ask new people to post first. Thank you for setting up the spreadsheet. I can see from it that on 11/22, Max's dose should have been reduced to 1.25 units. Actually, that was not the first time he went too low on that dose. He should have had his dose reduced November 8th, the first time he went below 50. Keeping him on a dose where he goes below 50 repeatedly is dangerous. We have two Lantus dosing methods, and with both of them, we adjust doses based on the nadirs or how low the dose takes the cat. One reduces if they go below 90, the other if they go below 50. Our first priority is to keep Max safe.

One thing that happens when a cat goes low, is that their body dumps sugars in the blood to keep them safe. I think this is what you are seeing after he went low. We call it bouncing. Definition is:
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).

J&Max said:
Will periodontal bacteria affect his blood sugar?
Click to expand...
Any infection or inflammation will increase blood sugars. Best to schedule a dental cleaning at some point.

There is a bit of information we'd like to see in your signature that can help us. More information on that in this post:
New? How You Can Help Us Help You!
 
Hi! Thanks a lot. I had prepared honey and some canned food for Max incase he has low blood sugar.
I’m worrying about the glucose toxicity and now he has 2.5 unit of Lantus twice a day and no decrease of his BG level. what should I do? I want to save his life.
Should I remain in 2.5 unit or more? It seems like getting worse and worse if I increase the amount of insulin, however 2.5 unit doesn’t work well… I’m so confused.
Please advise me how I could help Max? Thank you.

Wendy&Neko said:
A couple posts you should read through:
How to treat HYPOS - THEY CAN KILL! Print this Out!!
Jojo and bunny's HYPO TOOL BOX

Even though Max is eating a raw food diet, you should have some higher carb canned food to give him when his numbers go low.
Click to expand...
 
The way to help Max while the vet is gone, is to follow one of our dosing methods for Lantus. Listed here:
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Max's spreadsheet says you have selected to follow SLGS (start low go slow) method. Is that correct? If so, SLGS says you stay with with the 2.5 unit dose for 7 days, then decide if the dose needs changing. You are feeding a raw diet, and testing enough, that you could switch to following Tight Regulation (TR) should you wish to.

It would be helpful if you could describe any changes in Max's health or food that happened from the end of November to early December. That's when there was a significant change to his blood sugar numbers. Most of us put notes in the Remarks column of the spreadsheet, to track changes that might impact blood sugars.
J&Max said:
I noticed that Max’s blood test report was shown inflammation.
Click to expand...
Can you tell me which specific test this was? What date was the blood test done? I'm trying to figure out what has changed in Max. For example, you said he stopped eating, then he started eating again. What changed? Did the vet say there was anything going on? Any chance his teeth or gums got infected or inflamed?
 
Blood test on 9 December, I couldn’t load the pictures of the report here but I had posted on Feline Diabetes Facebook, please have a look thanks.
I left home due to work reasons on 9-25 November that I had discussed with the vet on 6 November. My maid is responsible for taking care of Max when I’m not at home.
however she didn’t informed me and the vet that Max has low BG few times during this period until I’m back. She said Max seems normal even without feeding him honey. He just had some raw meat.
I noticed that Max BG level was keeping high and less muscle on his body compare with before I left. So we visited the vet again on 9 December and did the blood test.
During end of November to beginning of December Max acting normal, he prefers us to feed him by hand and he seems difficult to chew the meat. Not sure it’s because he doesn’t see or getting old. Or drawing the attention as I was not at home for a while.
He has no good appetite since on 22-24December and I grinded the raw meat with some water for him. He had finished 2/3 every time and licked all the liquid. On 25 eating morning he has intentioned to eat again.
We noticed that Max has the e problem sometimes, 2 hours ago I put on some Maxi/Guard oral cleansing gel on his teeth by using tooth brush instead of brushing them to avoid bleeding and caused him refused to eat. 10 mins later max was threw up some saliva as usual. He doesn’t like the oral gel.
I did mentioned that would the tartar or inflammation caused Max’s BG level higher and out of control however he didn’t reply.
There is nothing I can do as the vet is off for 3 weeks. I had sent his reports to others vet and they didn’t response I was told by the nurse that me was they refused to take the case. It’s common in HK.
Anyway Max has good appetite after 25 December, muscle loss since we decreased the amount of insulin in November. Drink and wee a lot. NO Ketones.
Shall we change the amount of insulin after 7 days of insulin dose of 2.5unit? I have no idea how to help Max now.
thank you
 
I would do as Wendy suggested and stay with the current dose of 2.5 units and follow the SLGS dosing method. Stay with that dose unless Max drops under 90 in which case you would reduce to 2.25 U
Wendy has posted the SLGS dosing method above in post 5 above for you.
Keep posting here daily and we can help you. You have been 2 days so far on the current dose. As long as he is eating well and drinking and no ketones he should be fine..
If you could write in the remarks column of the spreadsheet each time you test for ketones and tell us the result, that would be great. Well done testing for ketones, by the way!
Also if you could set up his signature that would be helpful as ell. Directions can be found in the link in post 2
Keep asking questions.
 
Thank you for the advice. As mentioned, Max hated brushing teeth so he refused to eat himself at 1600, I grinded the raw meat with some water then he finished.
I will make an appointment to visit the vet and hope will find the best way to get rid of the tartar.
Will remark that when I check his urine thanks for reminding.
Set up his signature? I have no clue about that, let me have a look thanks.
Bron and Sheba (GA) said:
I would do as Wendy suggested and stay with the current dose of 2.5 units and follow the SLGS dosing method. Stay with that dose unless Max drops under 90 in which case you would reduce to 2.25 U
Wendy has posted the SLGS dosing method above in post 5 above for you.
Keep posting here daily and we can help you. You have been 2 days so far on the current dose. As long as he is eating well and drinking and no ketones he should be fine..
If you could write in the remarks column of the spreadsheet each time you test for ketones and tell us the result, that would be great. Well done testing for ketones, by the way!
Also if you could set up his signature that would be helpful as ell. Directions can be found in the link in post 2
Keep asking questions.
Click to expand...
 
I have a question. You say that Max has/had high blood pressure and has gone blind? Is he being treated with blood pressure medication?

Dental problems/mouth inflammation can definitely contribute to insulin resistance causing higher blood glucose.
 
Yes Max has the following medicine:
1)Gabapentin 50mg twice a day at 1000 & 2200
2)Amlodipine 5mg 1/8 piece for every 24 hours
3)Lantus insulin 2.5 unit twice a day at 1000 & 2200
( from 2.0 unit increased to 2.5 unit on 26 December 23)

1) Gabapentin is for his serious bony spur, we tried diffent injection/ medicine and the vet recommended that he thinks is the best way to get rid of pain for Max.
 
Regarding the dental issue, his gum and teeth are not bad as the last visit on 6 December the vet had checked and said not to worry about that and said don’t brush his teeth anymore.
I just try to think of anything that causes his BG level high, anyway my next appointment will ask the vet to check his teeth and gum again.
And his blood pressure is controlling well, the vet checked every visit and it’s remain at 100. The vet is happy about that.
 
Any time you brush your cat's teeth or even when a human brushes their teeth and the brushing is causing the teeth to bleed, there's gingivitis or some other gum inflammation or infection. It is extremely hard to assess dental health in cats because they don't generally like to have the vet examine their teeth. It is unlikely that brushing your cat's teeth at home will remove the tarter. Max's teeth will need to be cleaned by a vet. The advice to stop cleaning his teeth if he had an issue within the last several weeks is not good advice. If you can find a veterinary dentist, I would suggest an appointment.

As Wendy suggested, please read over the link to information on Lantus dosing methods. Insulin doses change. There is no "one good dose." If you look at other Lantus users' spreadsheets, dose adjustments are made based on what the blood glucose numbers are telling you. If Max's numbers are outside of the normal range, his dose needs to be increased. If his numbers drop below 90 for the Start Low Go Slow method or below 50 with Tight Regulation, you need to reduce the dose. There is also a time period (a week with SLGS and 3 days with TR) for assessing whether the dose needs to be increased.
 
J&Max said:
Regarding the dental issue, his gum and teeth are not bad as the last visit on 6 December the vet had checked and said not to worry about that and said don’t brush his teeth anymore.
I just try to think of anything that causes his BG level high, anyway my next appointment will ask the vet to check his teeth and gum again.
And his blood pressure is controlling well, the vet checked every visit and it’s remain at 100. The vet is happy about that.
Click to expand...
If his teeth are bleeding when you brush them then he has gum inflammation. You probably can see this yourself if you look in there or pull his lips back — it probably will appear red near the gum line where the gums meet the teeth.
 
Oh, I forgot to add that some dental problems are not visible to the eye and a dental x-ray is required- because the problem with the tooth can be with the root beneath the gums. This has happened with my cats at times when they were taken for a “routine” dental cleaning and ended up having teeth removed due to resorptive lesions on the teeth. It’s quite painful as well.
 
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