Advice for Unmanaged Diabeties

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Sweet Charlie

Sweet Charlie

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My Charlie cat was diagnosed about 3.5 months ago with diabetes. She was losing weight, peeing a lot, and increased water intake. Her breath smelled like acetone and the vet confirmed high ketone levels in urine. Started her on Lantus and a diabetic dry/wet food diet.
Using the Libre to monitor…didn’t see results with up to 3 units of Lantus.

Switched to Vetsulin about 6 weeks ago, at first saw good progress but not enough so increased dosage to 3 units.

Progress slowed, then stopped. She lost appitire, peed on herself, and then began peeing outside of the litter box. Vet prescribed antibiotic for potential UTI 4 days ago.

Anyone have experience with this? My baby doesn’t seem to be doing to well. She’s less than 8lbs and vet prescribed an appetite stimulant. She seems very lethargic and weak. She’s eating dry Hill W/D and canned Purina Pro Plan DM about 3/4 of can 2x per day.


Any advice for manage the diabetes? Advice on how serious this all is?
 
Hi and welcome to the forum.
First I need to ask you if you are testing for ketones at home either with a ketone blood meter or with a urine tests. If not I would strongly advise you to do so. You can buy a bottle of ketostix from Walmart of a pharmacy. You then need to collect a urine sample form Charlie and test via the instructions on the bottle. It is most important if she has had ketones before that they are monitored, especially if she has an infection such a a UTI or loss of appetite. They are both big red flags. If the ketones are not dealt with, it can progress to DKA…diabetic ketoacidosis which is expensive to treat and can be deadly to cats…I don’t want to scare you but inform you.
Can you put…history of ketones …in your subject line so we can be aware please? Thanks.

with a history of ketones it is really important Charlie eats lots of food to help keep the ketones at. If she is not eating, go to the vet and ask for an antinausea medication such as ondansetron or cerenia to give her each day at home. As well a the 2 main meals give her lots of snacks in between.
Don’t skip any doses of insulin and it is insulin and foods that will help keep the ketones away. Are you still using the freestyle libre? It is importantly you can monitor the blood glucose to see what is happening with the dose and blood glucose.
Have you thought about home testing with a manual meter?

We can help you if you can set up a spreadsheet which you will find on this link HELP US HELP YOU
If you can add all the data for the last couple of weeks so we can see what is happening with the BGs we can help you.
What antibiotic is she in for the UTI?

if she is very lethargic and weak she may have ketones again and be progressing to DKA so I think you would be best to take her back to the vet or to the ER. This is not something that is a wait and see situation. It needs to be dealt with immediately.
Please keep us updated
 
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Bron and Sheba (GA) said:
ask for an anti abuser medication such as ondansetron or cerenia
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Bron fell victim to auto correct - you need to ask for an anti nausea medication. You must give an anti nausea medication before giving an appetite stimulant, or you risk kitty developing food aversion.

I second Bron's suggestion to start testing for ketones at home. It might be a life saver. This post may help: Tips to catch and test a urine sample

Going from Lantus to Vetsulin is the wrong direction. Vetsulin, called Caninsulin in the rest of the world, is a great insulin for dogs, but doesn't last long enough in cats. Lantus or Prozinc are better for cats. The following paper only suggests Lantus and Prozinc for cats:
I suspect the reason your cat wasn't getting regulated on 3 units of Lantus is that she is eating very high carb food. The W/D is not suitable for diabetics at all. I've seen cats go completely off of insulin when they stopped getting W/D. Do you think she will eat just wet food? The wet D/M is OK in terms of carbs for diabetics but not great ingredients. Many cats grow tired of it too. There are much better commercially available products, that cost a lot less. However, don't switch diets unless the Libre system is working well as the change a diet can make a big difference in the amount of insulin needed.
 
Update: We’re done the antibiotic and Charlie’s appetite is strong again.

Antibiotic was 2 weeks long, saw improvement in her appetite after about 5 days on it. She was prescribed the appetite stimulant and responded will, we have stopped using this.

She also then stopped peeing outside of the litter box. We had 3-4 days of no peeing outside the box and then it started again, while still on the antibiotic. It has continued but not consistently.

Not sure if this is behavioral at this point?

Taking the group’s advice and stopping the dry food, and she is fully on a wet food diet.

Her Vetsulin levels were increased to 4 units about 2 weeks ago and still no improvement. Her levels were great on the Vetsulin when we started then lost all progress after about 4 weeks. Lantus saw chaotic fluctuations.

We are still using the Libre to monitor and she is consistently in the “high” range at this point.

Vet is suggesting internal medicine doctor and exploring underlying conditions. Not looking to put my baby though endless testing with a specialist if there isn’t a quality of life outcome.

Where do I go from here? Keep trying insulins? Go back to Lantus? Make her comfortable?

Advice?
 
Would it be possible for you to create a spreadsheet with some of the recent blood sugar values? Information on how to do that in here:
New? How You Can Help Us Help You!

We are very data driven here and need to see what the blood sugar values look like.

It's possible your kitty needs more than 3 units of Lantus. Getting rid of the dry food completely was a good move.

An internal medicine doctor may be able to help, but we generally don't suggest people need to do that until kitty gets to 6 units, unless there are signs and symptoms of some other endocrine condition. Some cats just need more insulin than others. If she does have another condition then depending on which one, there are treatments. My girl had both acromegaly, which one in four diabetics has, and IAA or insulin auto antibodies. Her dose got up to 8.75 units of Lantus, but then she was treated and spent most of the rest of 5 years under 3 units of insulin. Her quality of life was much better after treatment too.
 
Updated the signature and working on completing Charlie's Spreadsheet.

What would be symptoms of an endocrine condition?

She's very lethargic, I've noticed weakness in her jumping, still intermittently peeing outside of litter box, she's been sneezing often, and her nose is running/crusty, breathing is sometimes rapid.

She's currently not taking the best care of herself and I'm cleaning her daily.

Extreme thirst is still present.
 
Lethargy can be a symptom of acromegaly, or just high blood sugars. Weakness in jumping could be either early signs of neuropathy (non uncommon in all diabetic cats) or arthritis. The vet should be able to say if it's arthritis. It intermittent peeing may be just a sign of high blood sugars. Not sure about the sneezing, runny nose - those two sound maybe like a upper respiratory issue? Is her breathing noisy or just fast? Has the vet checked her heart? Normal kitty heart rate should be in the 20-30 complete in and out breaths per minute when in a resting state. You can time that will the timer on your cell phone. The grooming thing could be just a sign of unregulated diabetes.

The different endocrine conditions have different symptoms. Acromegaly is the more common (others are insulin auto antibodies (IAA) and Cushings) and is caused by a benign growth on the pituitary that sends out excess growth hormone. Note, my girl had it and IAA, diagnosed with a blood test. The symptoms generally results from that growth hormone. You can see larger cats, big paws, raspy breathing, pot belly are some of the common ones. My girl had very few symptoms at diagnosis, other than her dose and one runny eye. And ravenous hunger - think teenage boys during their growth spurts due to more growth hormone. But that hunger can also be common with a cat in high numbers.
 
So what would be my best next step?

Should I go for a more extensive blood panel? Get her checked out for upper respiratory issues? Schedule with internal medicine? Go back to Lantus and up the dose, the vet stopped trying with it at 3 units?

She's 7.8 lbs and I'd like to stop the decline of weight ASAP.

I feel like I'm against a clock and don't know how serious this all is right now.
 
How's it going on the spreadsheet? We have people who can help with that if you need help. We make a lot of our suggestions based on data we see.

Are you home testing for ketones? This is really important with her in high numbers and ketones in the past.

How much food is she eating a day? Is her appetite healthy? If not, is she getting any anti nausea meds? If not, I'd get some. She may also need an appetite stimulant again, though I'd try treating nausea first.

If you think your vet can help you, go to that vet and get her checked out. If the vet suggested an internal medicine vet, it could because your general vet doesn't feel they have the skills needed. I'd try an IM vet.
 
Spreadsheet is complete and in my signature. Appreciate feedback.

Testing for ketones and no concern there right now.

Appetite is very healthy. She was eating 2 cans of wet food per day and we're up to 4 cans since eliminating the dry food option.

Don't feel we need the appetite stimulant at this point as she's eating well. Just need to regulate her levels.
 
It says "You need access". I think there's a way to allow anyone with the link to view it.
 
Yes, working! A favour to ask, could you put a blank line after the last Lantus shot and before the Vetsulin one and label it "start Vetsulin". It just makes the change more obvious.

How many calories is 4 cans of food? My 14 lb girl ate about one 5.5 oz can a day if eating wet food, though more often on raw of 4 oz per day. And maintained her weight on that. It was about 220 calories.

Your vet has you holding doses too long. I wouldn't hold any longer than a week if you aren't seeing good numbers, then increase. With Vetsulin, our dosing methods are more limited. If you were to switch to Lantus, you'd be able to increase faster with a dosing method you can use when she's eating all low carb wet or raw. If you hold a dose too long that's not getting good numbers, you can get glucose toxicity built up - which basically means she gets used to those higher numbers.

We typically do smaller increases than what your vet has you doing.
 
Great feedback, updated the sheet.

She's 7.8 lbs right now. Cans are 5.5 oz. 158kcal per can....so about 632-790 calories. That seems high now seeing your number?

Current food is Pro Plan Purina DM Savory Selects....better suggestion?
 
That's a lot of food and still have her lose weight. Has her thyroid been tested? Any GI issues such as vomiting or diarrhea that might give a clue she's not otherwise absorbing food properly?

DM Selects is 10% carbs. Still but just barely considered low carb. Most of us feed in the 3-5% carbs range. For a carb sensitive cat (which mine was) those extra percents can make a difference in blood sugar values. This food chart, although a few years old, still has a lot of the cat foods you can buy. Just pick something under 10% carbs. You don't need a special diabetic food - DM is actually called dietetic management, not diabetic. You also might want to look at something with higher fat content/higher calories than the 40% that DM selects has. That might fill her up more. What did she eat before diagnosis?
 
No consistent vomiting and absolutely no diarrhea.

We have no specifically tested her thyroid. We have done blood work, urine analysis, and physical examinations.

Just ordered the Blue Wilderness Chicken and will give that a shot starting this weekend.

Before diagnosis she was eating Purina ONE Sensitive Sensitive Stomach/Sensitive Skin for about 7.5 years. When I first adopted her she experienced severe scabbing on her head and it was thought to be a food allergy. However we switched 6 months before her diagnosis to Purina ONE High Protein. She also got 2.6 oz every morning of Sheba Perfect Portions Pate Chicken & Turkey.
 
Depending on which blood work panel was done, it may or may not include a T4 test. If not done recently, worth adding to the next time you do blood work. Hyperthyroidism can contribute to insulin resistance too as well as lead to weight loss.
 
Great to know! Thank you, this is all so helpful!

Talking to the vet tomorrow about her insulin as the Vetsulin expires next week. Any advice on where we should go next with insulin treatment? Back to Lantus with a higher dose? Any other insulin you'd recommend?
 
I'd give Lantus more of a chance. We typically recommend trying an insulin for 3 months at least before switching. Lantus/glargine a longer lasting insulin than Vetsulin - which isn't even recommended by the AAHA for cats any more. I do also like Levemir, but unfortunately it's discontinued in the US as of end of this year. And with the Lantus generics out there, the price is very reasonable.
 
Visited the vet today and good news weight is up 1 lb!

We're going back to the Lantus, the VERY reluctantly said we could give it another try....and that we could up to 4 units. Also offered Prozinc as an alternative option. Still think Lantus is the right choice?

It was mentioned in the thread that my vet is holding dosing for too long. How long do I hold, 1 week without progress? How much do I increase? What is the limit to levels? Is weight a factor?

The Vet is also very heavily pushing towards an internal medicine specialist. Its $400 just for a consult with them and if I'm honest I'm not sure if I'm optimistic about the outlook of whatever they might find....is this pessimistic? Worth every penny? Too soon to be exploring?

I don't want cost to limit care, but at the end of the day there is a limit and cost is a factor. I want to be smart and strategic about how resources are being allotted.

We last did blood work and urine analysis 3/1 when Charlie was diagnosed, is this worth repeating?


What are best next steps?
  • Hold off on testing, just try new food & Lantus
  • See Internal Medicine Specialist
  • Get blood and urine at regular vet
 
Yes on that weight gain!
Sweet Charlie said:
Also offered Prozinc as an alternative option. Still think Lantus is the right choice?
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In my time at the board, I think I've seen one person go back to Prozinc from Lantus, but we regularly get people switch from Prozinc to Lantus. Really, the best insulin is the one that works for your cat. Lantus didn't get a fair trial, you weren't on it long enough. I would try it first. Plus you can get Lantus at good prices now!
Sweet Charlie said:
It was mentioned in the thread that my vet is holding dosing for too long. How long do I hold, 1 week without progress? How much do I increase? What is the limit to levels? Is weight a factor?
Click to expand...
We have two dosing methods for Lantus. If you are feeding just low carb wet or raw, you can follow either one. The decision which to follow is yours based on life style and goals for the cat. Details here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

The two methods differ in how long you hold a dose and how much you can increase by. If all you are seeing is 300 and above, you can increase faster and by larger amounts with TR. I always recommend TR for those with cats needing larger amounts of insulin, so you can get to that good dose much faster. Provided that's something you can do. With TR you can increase as soon as every 3 days. With SLGS it's every 7 days. There is no limit to how much insulin a cat needs. We have a saying here, ECID or every cat is different. Weight is not a factor. I've seen larger cats end up on a tiny dose than regulates them and small cats on larger doses, and everywhere in between. We use weight to determine start dose with TR, but that's the only time. And only when new to insulin. When switching we take the dose of the current insulin into mind.

Sweet Charlie said:
The Vet is also very heavily pushing towards an internal medicine specialist. Its $400 just for a consult with them and if I'm honest I'm not sure if I'm optimistic about the outlook of whatever they might find....is this pessimistic? Worth every penny? Too soon to be exploring?
Click to expand...
You can wait a bit if you want. We do suggest people get additional blood work to test for a couple conditions once they get to 6 units. Cats can have those condition below 6 units, but above that the likelihood is much stronger. There are treatments so it's good to know if you are dealing with one of them. Your regular vet can get that blood testing done.

Side note: my vet tried to fire me to an internal medicine vet when I got Neko's testing results back that she was positive for two of them (acromegaly and insulin auto antibodies), but I stuck with her for another 3 years until Neko got more complicated.

My suggestion of order to do things. You can make a food change any time. She's already on a "barely" low carb wet food so I'd try the lower carb food first. That likely won't make a huge change given that she's almost entirely in the 300+ range. Nice to see that 260 last night. :) You can do that for a few days and see if that makes any difference.

Do you still have the Lantus/glargine? If not, source it. After the short food trial, start the Lantus. Post on the Lantus subforum when you do that. In case you need any help. Make sure you have some higher carb food around and your hypo kit is stocked with strips. Not saying you'll need it, but the odd cat has a strong reaction to an insulin change. She's already been on Lantus, so I expect not in this case. Do you still have some of the U-100 syringes around? Ones with half unit markings? You will need to source those too if not. When you start the Lantus, make sure you are testing for ketones regularly. As you should be now.

How long ago was her last blood work? We can wait a little bit to do this again.
 
Looks like Raisin's case is very similar to Charlie's. Struggling to contain Raisins levels which shot beyon 600 today.

Note from Charlie's spreadsheet for the 11th - 'Took away dry food, wet only. Ate 6 of the 5.5 oz cans of Pro Plan Purina DM Savory Selects'. Can anybody comment whether it is this amount of food that is keeping the levels high? I give about half this to Raisin and my wife is not happy saying it is the food that is keeping his sugar high! Bit confused on this aspect. Can we give as much as they want when they are hungry till levels staibilise? Or is the increase in food causing the levels to stay high?

Thanks.
 
Picking up the Lantus prescription up today.

Last blood work and urine was 2/29/24 when she was diagnosed 3/1/24.

Saw a slight improvement on the levels since removing the dry food and switching to the Blue Wilderness Chicken.

Charlie has not been eating since yesterday. She is very lethargic and unwell right now.

I gave her the appetite stimulator last night and she ate a bit of cooked shrimp overnight I made because I became desperate for her to eat something. I again gave her the appetite stimulator this morning, but the ended up throwing up.

She's lost .4lbs in the last week.

Still a good idea to switch to Lantus? How can I get her to eat? Please help, its heartbreaking right now.
 
What appetite stimulant are you giving? It sounds like she’s nauseous. Ondansetron works really well for that when dosed every 6-8 hours.
 
Have you been testing for ketones? You can get urine test strips -- Ketostix -- at any pharmacy. Lethargy can be a result of ketones building up.
 
Giving her Mirataz. Seeing the vet tomorrow will discuss anti-nausea meds.

I have the strips, I've keep missing her when she pees as its been a busy day.

Planning to get urine analysis tomorrow also at the vet but will try to test tonight with my strips.
 
Keep trying on those ketones strips. Ketones can go from trace to high really quickly - which means emergency.
 
Finally she peed! She’s drinking significantly less water and still not eating much of anything.

She is between small (15) and moderate (40) amounts of Ketones on the at home test strip.

We’re on our way to the vet. What do I need to be asking at this appointment?
 
Any signs of infection/inflammation? Ask for a nausea med such as ondansetron. Is she dehydrated, would fluids help?

Good luck, keep us posted.
 
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