4 year diabetic, recent complications

[Justin & Sebastian]

Hi all. First I just want to say I absolutely love and appreciate what ya'll are doing here. This disease is scary and frustrating and the last 6 months have been especially hard for us.

Backstory, Sebastian has been diagnosed diabetic for about 5 years now. His initial diagnosis came after he had been loosing weight for a couple months, which I foolishly didn't pay enough attention to, until one day he collapsed by the water bowl and I took to the vet where he was diagnosed with severe DKA and subsequently diabetes. They started us off on 3 units of Lantus, over the next couple years vet assisted curves brought us to 5 units, and then I self-adjusted up to 7 for the next couple years. No real issues during those 4 years, though his numbers were never really where I would like them to be and his drinking/urination was always a little excessive.

Late spring of 2018 he had a short bout where he wasn't able to keep any food or water down, so we brought him to our new local vet. They gave him an anti-nausea and fluids and he was good after that, but being a new vet they wanted to re-evaluate the dosage, saying 7 was way too high. So we re-started curve adjustments at 3, then 4, then 5. They also started exploring for pancreatitis, since some of the test results were hinting at that but after an ultrasound and a few panels they weren't able to confirm. Fast forward to Thanksgiving and his appetite starts to decrease over the weekend to the point where by Sunday he wasn't eating and on Monday (11/26) started vomiting dark fluid. He then spent a week in the hospital with DKA, pancreatitis, and possible flu. He wasn't eating on his own at the time of discharge so they put him on a feeding tube and we brought him home. This being now a third vet, this one with an internal medicine department, started us back at 3 units.

We did the tube for about a week until he started eating on his own and then started to ween him off it. During that week and a half he was better than he had been in a long time, getting back all his energy and playfulness and we were really happy. We take him in to get the tube removed and after coming home he immediately u-turns, becomes lethargic again, and within 2 days drops all the weight he had gained back and then some, about half a pound. At this point I become frustrated with the vet, who flat out tells me she doesn't believe the weight loss, like I'm an idiot who can't read a scale, and wants us to wait a month to come back for another curve. I bring him to our local vet and they think the tube site got infected so they give him some antibiotic. He responds and starts to do better but doesn't gain any weight back. I force the specialty vet to do another curve a week later at 4 units because I can't stand to see him loose any more weight. Curve results don't show much improvement and is relatively flat, so I ask if there's a different insulin we can try and they prescribe us Vetsulin at 1unit, also recommending adding fiber to the diet, so I split his usual dry food into 1/2 dry 1/2 wet mixed with 1/4tsp Metamucil.

The Vetsulin is ordered online but at that point it was the weekend and would take about 5 days to get here, so I said eff it, he was on 7 for years with no problem, I'm putting him back at 7 until the new stuff gets here. His weight immediately starts to increase. But the Vetsulin gets here and I start him on it this past Wednesday (1/30). His weight hasn't dropped yet but I take some initial readings that first day and they're in the 400s, higher than I'm used to seeing, so I start to freak out and increase to 2, debating on going up to 4.

Then I discover this website, realize I've been doing it all wrong by trying to force it, changing too quickly, and possibly having overshot the correct dosage.

So I'm here to learn, present all the data I've gathered, and get some feedback on where we go from here. I was to the point where I didn't think he'd be around much longer but now that he's started to improve a bit I want to keep the momentum going, get this under control finally, and get as much time with my little buddy as possible. Damn, tearing up just thinking about it. Anyways.

I wasn't always real good about keeping records so unfortunately I don't have a lot of historical data but since his pancreatitis attack I've become super diligent. I'm fortunate that I work from home and can watch and test him like a hawk. I've poked around the site a bit and seen all the tools, ported the data I do have over to the sheet and put it in my signature. If you need anything else, lemme know, I'm here all day.

Current status, I just started him on 1unit Vetsulin on Wednesday and after some initial frustration and trying 2 units for a day, am now being patient and waiting a week before I do a real curve, at which point I'll touch base with the vet and see what they say but I'd like a second opinion.

 

[Squeaky and KT (GA)]

Welcome to you and extra sweet Sebastian!

First, the insulin you're using, Vetsulin, is a fairly hard driving insulin - shot works all at once and then is done until the next shot. It tends to drive the glucose numbers down fast then lets it zoom back up. Not only does that feel yucky for kitty, it tends to cause lots of liver sugar dumps adding to the higher numbers. There are gentler insulins that are better for regulation.

Second, vet testing - stress raises glucose levels. Stress of driving to clinic, being in a scary place with unknown sounds, seeing vet - all that can raise glucose numbers by 150-200 points alone. Relying on testing in a stressed environment is just asking for a hypo when back in a comfortable environment giving the same dose. It's not hard to test at home but most vets don't recommend it - many even advise against it BUT, dealing with this for many years, I've realized that most vets don't know HOW to test BG without a vein draw. No vein draws shouldn't be done at home but we use ear edges to test. A cat has few nerves there so it's not painful. See that sweet little old man kitty that's my avatar? He's been diabetic for over 9 years - I test a min. of 3 times a day - he's been tested over 10,000 times. He's 18 1/2 and still plodding along. Heck, he sleeps thru half his tests. Testing should be done before each shot to be sure it's safe to give insulin as well as at least once during that 12 hour cycle to see how low that dose is sending kitty. Doses are based on the lowest point in the cycle, not the 'pre-shot' number.

Meter - vet may say you can't use a human meter because it won't read accurately but you can. It's just a difference in what is a 'normal' reading just like a thermometer that reads either celsius or fahrenheit. 'Freezing' is Zero degree Celsius while the same 'freezing' is 32 degrees Fahrenheit.

Next, food! Goal is canned/pouch at 10% or less. Dry food is extremely high in carbs - you'll never reach regulation if using dry food. Here's a good food chart giving lots of food's carb counts: Food Chart 2017 - CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Justin & Sebastian]

He was previously on Lantus, only started Vetsulin this week, and I'm wondering if I should switch back. He's already losing weight. He was back up to the low 11s when I gave him 7 units of Lantus for a week, now he's back down under 11lbs within 3 days of starting Vetsulin. His ideal weight is 13lbs.

I know all about the vet stress, though Sebastian is really chill and I don't think it affects him much. We haven't seen much difference in the numbers from vet testing vs home testing. Still, the majority of my tests are done at home. Every number that's on his spreadsheet is from a test I've done at home. I personally test from his paw, he has zero issue with it and just lays on his back in my lap while I do it.

I have an AlphaTrak 2 meter.

I have him on the Purina Pro DM, which is specifically formulated for diabetics, but I see now that even the dry has 18% carbs vs the original or savory wet that has 0%. So I think I'll switch to 100% original wet.

I'm still just stressing over these numbers. It would be one thing if he was just riding high but the fact that he's loosing weight has me really concerned.

Should I abandon the Vetsulin and switch back to the Lantus and try to find a dosage that works? Is it worth giving the Vetsulin a shot if I have access to the Lantus?

 

[Justin & Sebastian]

Also I looked over the food chart and it has my head swimming. That's just so much data, and so many options, I don't even know what to look for. Choice paralysis, as they say. Is there just a general recommendation I can try or at least some kind of direction I should be basing my choice on?

Edit: So like, I sort the chart by Protein, top choice is the Tiki Cat chicken only. Looks like a good choice? Meets all the listed desired criteria. However, when I go to the actual brand page, the numbers don't match what's on the chart. The page says protein 16%, fat 2.6%, and nothing about carbs. The spreadsheet says 84% protein and 16% fat. Is there some kind of conversion going on that I'm missing, or did the recipe change, or what?

 

[Squeaky and KT (GA)]

Is there just a general recommendation I can try or at least some kind of direction I should be basing my choice on?

How I get that! Many feed either Friskies pates or Fancy Feast pates unless there's another medical situation that causes those to not be good. I have 1 that is severely allergic to fish of any kind and amount plus another that fish causes diarrhea - both of those foods have a bit of fish (meat by-products if nothing else) so I can't feed those. I use Merrick's Limited Ingredient Turkey and Chicken.

If I were you, I'd go back to Lantus - that's a much better insulin for cats.

I didn't realize all your test numbers were yours - good job! Yep some use paw pads which is just fine. One bad thing about only doing curves - if kitty happens to be bouncing, isn't feeling well that day...your numbers aren't going to be a good reflection of how that insulin dose is truly working. Testing daily while varying the times will give you a much better understanding of how his body is working. A curve has it's place but by having a good track record, you will be able to tell when a curve isn't going to tell you anything or when it's a good time to do it.

 

[Justin & Sebastian]

So how concerned should I be about the phosphorous content? Sebastian hasn't had any kidney problems yet, however with him being not properly regulated and with high urination for so long I'm afraid of setting something off if I give him something with a higher amount than he's used to. At the moment I'm looking at the Friskies Classic Pate Ocean Whitefish & Tuna (40prot/56fat/4carb/373phos), the Wellness Core Turkey & Duck (38prot/57fat/5carb/265phos), and the Purina Pro Vet DM (43prot/52fat/6carb/297phos)

I've had him on Wellness Core before, at the time I was doing a mix between dry and wet, using the Indoor Chicken & Chicken Liver wet. Which I see now has too many carbs. And he's currently on a mix of half-and-half DM dry with DM wet. I like the numbers of the DM, however if I switch to 100% wet it's gonna be a little over $200 a month in food since I have a second cat and have to feed them both the same to keep them honest. Friskies numbers are decent too, and half the cost, but about 30% more phosphorous. $200/mo wouldn't be the end of the world and I'll do what I have to, but if the phosphorus isn't a major concern at this point it sure would be nice to go with the cheaper option.