Re: 6/11 Max AMPS 496 +3.5 532 +6 376 PMPS 346
PapaDale, go ahead and toss your bag down. I don't mind at all. We need some popcorn and movies though ;-)
Thank you for your thoughts, BJ. I may have to try the Humulin, but I'll get the promise of someone on the board who has done this to help me through it. Are you volunteering?
My vet doesn't know Jack, and he's all ready referred me to a "specialist." There are no specialists in diabetes in this area. So, I'm pretty sure I would just spend a lot of money and get no better care for Max than I can get by figuring this out myself with the help of this board. I need to save that money for all the continuing care and any emergencies that may come up. I also want to spring for a euthanasia person to come to my home when the time comes to make it as peaceful for Max as possible. He deserves that.
Libby, thanks for your input, and Suze, thank you, too. These are all good ideas, and the food rationing certainly can be helpful to some cats, maybe even Max. As to Max's eating habits, Max does not scarf his food. He eats a little, and then a few hours later a little more. He will finish most of the bowl by himself only if he gets really hungry. There is always something left. Maybe he gets tired of licking and licking and licking. Even when there is a little left at the edges of the bowl, he will take chicken or roast beef from my hand, and nearly bite my fingers as if he is starving. However, it is only with meat that he does this. Any other food, and he would gingerly take it without nipping me. Of course, he no longer gets any treats except for meat. Normally, he wants me to move the food around or scrape it up into a mound before he eats it. What he likes best is for some fresh food to go on top. He did this with his dry food in the past, too, but now with the wet, he's better at finishing most of it by himself.
No, Libby, you are right -- there have not been any sudden drops in the early hours of the cycle. There are sudden spikes upward at all hours. I haven't tested much in the early hours. So, I suppose it could happen occasionally, but I'm quite sure that the one time I shoot him with a full dose when he's below 150 that will be the time he has a sudden drop == Murphy's Law. I will try to give him some food that is 10% in the late hours to see what it does the next time he is very low. I won't shoot a full dose then, but I'll test the theory. What I am wondering is if I can give him more than 25 percent of the dose -- more than 0.5 u -- when he's below 150 but over 100. Maybe I'll have a chance to try that when he's close to 150, and after I've seen the effect of a higher carb food at +11.
(I tend to be very detailed and wordy. I apologize in advance. Please bear with me.)
As for Max's medical issues, Libby: I'll start by saying that the insulin is definitely helping Max. He was quite thin before we starting using insulin. After he was diagnosed with CRF, he starting losing weight like crazy. I was feeding him a Hills k/d for CRF, he ate like a horse, and he lost weight. The vet said he could eat as much as he wanted of the Hills. Then, after he was diagnosed with FD, I read that for an FD who also has CRF, you feed the diabetic part of the cat, not the CRF cat part. Muscle wasting is a problem with CRF cats, and Max was getting very boney. I started feeding him Hills m/d believing what the girl at the vet's front desk told me -- it was to help cats who needed to gain weight -- Wrong! Just the opposite! I tried to help him gain weight with the Hills m/d, but it didn't work, of course. Now that he's eating Wellness, and getting insulin he has gained weight and muscle back -- I can feel it in his spine -- and he no longer eats more than a cat should. I am currently transitioning him to Merrick food. Anyway, the fact that he has gained weight makes me think that he is not suffering from glucose toxicity, but . . . read on, please.
His medical history: He started out last September 2011 with a BG that did NOT indicate diabetes (146), but his CRF scores were high enough and he wasn't concentrating his urine. So, with that the doctor diagnosed CRF. The creatinine was double checked before the diagnosis. Then, in February, he tested 509 for BG one day and 475 the next, and was diagnosed with FD. At the time, his CRF scores were pretty low. I know it is possible to misdiagnose diabetes as CRF, but given that we did both tests at once, it would seem unlikely. Nonetheless, as I look back at his behavior over the past couple of years, I remember signs of diabetes - drinking more and eating more. He also put up with more loving and holding. I suppose he might have been having mild neuropathy and just didn't have the strength to push off of me or get up from a snuggle session. I had thought that he was mellowing in his old age, and I also knew he had some permanent muscle damage from his ordeal in 2008. (See below.) As long as he purred through our snuggle sessions, I didn't worry about it too much.
I haven't had his CRF scores tested again because as long as his diabetes is not controlled, I know the scores may be affected by that. I also know that his kidneys are being damaged by his BG, and it seems pointless to check his CRF scores as long as I'm treating him for CRF. (I give him Rehmannia 8 tincture and sometimes solidago and Standard Process Renal Support.) He clearly has an issue with hydration which can be caused by the inability to concentrate urine caused by CRF. He's had constipation off and on, and I'm currently giving him fluids at least every other day. He needs less than 100 cc every other day, and, at the moment, I'm testing out giving him 50 cc every other day along with 1/4 teaspoon of Miralax once a day.
The past medical issue may or may not be relevant. In September of 2008 when he was 12, he developed myesthenia gravis. I didn't know this until he had lost a lot of weight and became severely dehydrated. MG is a disorder in which the brain cannot tell the muscles what do to because the signal is disrupted. The non-voluntary muscles are not affected. Max could not swallow for quite a while, which I did not know. I did know that frequently, he would throw up his food, undigested. The vet I was using didn't know what the problem was, but we didn't do any x-rays at that time. Max gradually became unable to retract his claws.
After about three weeks, when my cat starting to walk like Frankenstein, the vet sent me to ER. The ER doc suspected MG, did an x-ray, and we saw a mass right in front of his heart. The ER vet started using a temporary treatment for MG. Max's dramatic improvement with this treatment helped with the diagnosis of MG. So, I gave him the MG medication, and prednisone to suppress the immune response, for a few days while I got him in to a university hospital where they did surgery to remove his thymus. The thymus is active when we are children, and then it shrinks up. It is believed that it is relevant to the development of the immune system. It turned out that a benign cancer of the thymus was making Max's immune system overreact and attack the nerves for his voluntary muscles and the delivery system for the signal component. He would have died without the thymectomy. No amount of medicine would have kept him going as a cat will eventually stop responding to the MG meds. People can take meds for MG all their lives, but it doesn't work on cats apparently.
Anyway, I don't know exactly what damage was caused by all of this, but I presume that the prednisone could have compromised his pancreas, his kidneys were damaged by the severe dehydration, and it may be important to note that he is still not able to fully retract his claws. Who knows what that means, but some of his voluntary muscles were probably permanently damaged. I don't remember the dose of prednisone, and we discontinued it pretty quickly. Of course with all the starvation, dehydration, and illness he experienced, he could have contracted some virus or bacteria that damaged his pancreas. I will say that I noticed the increased drinking and eating sometime in 2009 or 10, but his bloodwork never showed any issues until Sept of 2011. Max may have been suffering from diabetes a long time, but he just happened to have a normal BG when he was tested. He may have glucose toxicity or something like that -- another issue I know little about.
What makes me think he does not have GT is that he is getting a lot of benefit from the insulin, and his neuropathy has improved. I give him B12 for it, but it was improving before I started doing that. He can jump up on the bed, which is higher than most beds, and he doesn't walk too funny these days.
Ahhh, I'm going to have to go to bed. Thank you for reading all of this and for any thoughts you might have. Goodnight.
