12/20 Dewee is not improving

J

Jeanie B.

Member Since 2020
I need advice!

We are struggling regulating Dewee's glucose. She is currently on .25u Lantus every 36 hours per IM vet as she was having hypo episodes at .25u every 12 hours, .25 units every 24 hours. While she has been on Lantus every 36 hours, we gave her a 1 drop dose after 24 hours one time and then gave her a 2 drop dose after 24 hours another time hoping that while we were waiting for our vet appointment we would make some progress towards finding that magic dose.
Dewee had received a depomedrol shot on 10-16 for excoriating her skin and that appears to be out of her system as she is back to excoriating. (That is a whole other story). The depo injection pushed her into DKA which was her first sign that she was diabetic.
Dewee's back legs appear to be getting weaker. She slides all over our hardwood floors and has a hard time getting up onto the bed. We have made accommodations to help her with those things.

We are very discouraged and would like to see if anyone has any good recommendations we can take to our vet at our appointment on Tuesday. (Dewee is not scheduled for a dose of insulin until Tuesday AM).
Thanks in advance!
 
Hi :bighug: hang in there :bighug::bighug::bighug: Dewwee is lucky to have you looking out for her :cat:

Here's your last condo for continuity - https://www.felinediabetes.com/FDMB/posts/2671297/

Can you share the food Dewee is eating (type, how much, and when)?

I can't advise to dosing but looks like @Wendy&Neko stopped by last time - perhaps if she's online later she can come by again to peek at your SS and see what's been going on the last month or so.

I do know lantus is a depot insulin and craves consistency but I also see tiny doses taking Dewee low - I'm hoping Wendy or perhaps @tiffmaxee can advise...I've seen food changes help slow the BG drop and even out the curve. Olive is one cat that comes to mind but I can't get to her SS :(
 
Are you still giving depomedrol? If so, it may be contributing to the swings in numbers. It's prednisolone. Many cats do not have a strong reaction to that particular steroid but some do. Steroids cause a rise in BG levels.

Another observation.... Lantus may not be the best insulin if you are not going to dose every 12 hours. Lantus (and Levemir) are depot-type insulins. If you do not dose every 12 hours, you are constantly disrupting the depot which results in wonky numbers and defeats the purpose of using Lantus. You may want to think about Prozinc which is a very good insulin and is not a depot-type of insulin.

You may also want to intervene earlier with food. If you see a drop in numbers by +2 or +3, you may want to start steering Dewee's numbers with food. For example, on 12/7, your AMPS was 306. By +3, Dewee was at 101. Giving Dewee some LC or MC food would have slowed the drop and potentially not had him in the 40s at +6. (Apologies if you're doing this already -- there's no info on your spreadsheet to indicate when or if you intervene with food.)
 
Thanks for the replies. We are giving her Fancy Feast pate only. It’s out all the time but we offer it to her frequently especially after we check her blood. we haven’t given MC food when we see her decrease.
Her last dose of depomedrol was on 10-16 and she won’t likely ever get it again.
 
On the Facebook, Jeanie stated that they free feed Fancy Feast. Are you feeding only the pate, flaked, or chunky style? Those are the FF that are low enough carb.

I agree that with lantus 2x a day is what's needed to keep the depot up. Even if that means a drop dose every 12 hours. Or half of a .25 dose, if you can eyeball that. I know it's scary to give insulin after a drop, but if the pre-shot test is high enough, insulin is needed. Sometimes the biggest trick is finding a dose low enough to give twice a day.

The high preshot numbers are certainly bouncy. The lows indicate that .25 is too large a dose. Without a steady 12 hour dose of some level, there's going to be some wonkiness. But I can't help wondering if something else is going on. Is Dewee getting into food he shouldn't? Having high carb cat treats? Sneaking people food?

Are there any alternative treatments for the skin issue other than steroids? Have you discussed alternative treatments with the vet?
 
I was thinking of proposing 2 drops of Lantus every 12 hours or switching to ProZinc. The .25units seems to be 3 drops. We have a vial of Prozinc in our fridge that we got from our general vet when Dewee was diagnosed but she ended up hospitalized for DKA and the critical cat clinic started her on Lantus and we’ve been following up with them.
 
She did go to the vet derm specialist this past week and they prescribed a drug called Atopica. She took the first 2 doses fine and then puked her guts out last night. Ugh. She doesn’t just pull the fur out when she excoriates - she digs holes into her skin.
 
I get it. I do. My boy suddenly developed food allergies and tried to scratch off his face and ears. We had to cone him to give the wounds time to heal while we tried to figure out what he was allergic to.

If the Atopica is making her nauseated, ask the vet for an anti-nausea med. It might give her time to adjust to the new med. You can also ask if she can have something like Pepsid, and proper dosage for her.

Two drops every 12 hours sounds like a good plan. And you can absolutely switch back to the ProZinc if you think it might help. It is also a good insulin for cats, but has no depot, so it's a little more forgiving of skipped doses and such. Though, like all insulins, it works best when given twice a day.
 
We do have a dose called 0.1 unit, maybe that is what your two drops is? Dewee definitely needs insulin more often. She goes down to a green (but safe) number after her shot, then spends the rest of the time in very high numbers until the next shot.

As for skin allergies, maybe it's time to look at alternate foods. Often kitty allergies can be solved by going to novel proteins like lamb, venison, or rabbit. Not sure which Fancy Feasts you are feeding, but chicken and fish are common allergens for cats. Also beef. I am also a fan of raw food, which I have seen help many a pet with skin allergies. And has the benefit of more types of protein options and being low carb. Any chance you have fleas in the house? I've also seen that been the cause of licking/allergy chewing. What type of litter are you using? I've also seen that cause problems.

Are you giving Methyl B12 or Zobaline for neuropathy? As long as Dewee stays in such high numbers, the legs will be a problem. See here for more info: Feline Diabetic Neuropathy
 
I have a cat that has EGC and dermatitis. Switching to a novel protein she has never eaten really helped. Occasionally I see spots of dermatitis and I give her zyrtec and she stops scratching so far. Anti-jinx!
 
We went down the novel protein approach before she was diabetic and that didn’t work. I didn’t try raw food. We wash the blankets she lays on with the low allergenic detergent and extra rinse.
It’s very unlikely we have fleas. We don’t have any outdoor pets and have hardwoods on our first floor. She’s not supposed to be on raw food if she is on Atopica but if she doesn’t stay on Atopica I will try it.
I measured the drops of my syringe. It’s 2 drops from 1 unit to .5units. So I draw up to .5 and waste a drop to get to .25u and when I eyeball the syring it looks reasonable. However there are 2 more drops in the syringe so that is what I gave! I also did the ‘needle juice’ technique and that was 1 drop. I used a Walgreens syringe and a Monoject and the drop counts were the same for both of them.
Also we just started with zobaline but it sounds like her sugar is too high for that to help.
 
Jeanie B. said:
Also we just started with zobaline but it sounds like her sugar is too high for that to help.
Click to expand...
It takes time for zobaline to start helping. More of a longer term healing effect. Cosmo had bad neuropathy for a few months and is now much better. Nerves heal and grow very slowly, even in humans.

I don’t have any helpful advice for the allergies, unfortunately...We have had several cats allergic to FF - all varieties. I am not entirely convinced it contains adequate nutrition or vitamins, personally. Vitamin deficiencies can also cause skin issues.
 
I’m so sorry for your poor girl. Did the steroid cause the diabetes? If it happened days after the one shot I guess that’s unlikely. I worry it could happen to my girl some day. Theres another member here that tried atopica and then another drug. I will be back with the name.
 
Her derm has her using hydroxyzine. She just upped it to 3 times a day a couple weeks ago so I guess the jury is out on whether it is working
 
tiffmaxee said:
I’m so sorry for your poor girl. Did the steroid cause the diabetes? If it happened days after the one shot I guess that’s unlikely. I worry it could happen to my girl some day. Theres another member here that tried atopica and then another drug. I will be back with the name.
Click to expand...

She has had multiple steroid shots over the years. The vets think they caused the diabetes. The diabetic ketoacidosis occurred 2 days after the last steroid shot. I’m sure the steroid caused the DKA but I’m not as sure that they caused the diabetes.
tiffmaxee said:
Her derm has her using hydroxyzine. She just upped it to 3 times a day a couple weeks ago so I guess the jury is out on whether it is working
Click to expand...
 
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