BG in the 600!

[MClarke087]

My cat Dennis was diagnosed with diabetes about 2 months ago. Originally I brought him to the vet when I noticed he was shaky and not acting right. It turned out he had ketones and had to be hospitalized for 3 days to save his life. Since he's been home I test his blood glucose multiple times per day (before eating to make sure his sugar levels are not too low to receive insulin, and sometimes 6 hours after he gets his insulin to see what he's at during his "low point".) Lately his BG before receiving insulin have been in the 400-500 range which is unusual but the vet did some tests 2 weeks ago and said he was ok (he's only on 1 unit of insulin). He went in for a fructoseamene test today and we will have the results tomorrow but I'm concerned... He's very wobbly and when I tested his BG before insulin tonight the reader just registered as "Hi" meaning he's over 600!
He's acting just like he was when he had ketones, and I'm afraid he's got them again even though the vet is not concerned about this. I borrowed money for his $1,400 ER visit, and I'm still paying it back. Taking him back to the ER is not an option if he has ketones again.
Any thoughts? Has anyone experienced this issue before?

edit:
- He's on Novolin for insulin.
- I was able to catch him using the cat box just now and I used a combined glucose/ketone strip (the kind made for humans)- there are no traces of ketones based on that test, although my vet has told me not to use ketone strips because they're unreliable (his glucose is through the roof but that's to be expected).
Any thoughts?

 

[Sharon14]

I'm so sorry Dennis is having problems. You said the vet did some tests two weeks ago. Was that because his BG's had started going up? What tests were done? Is he eating? I don't know much about Novolin, but it is considered a fast acting insulin that doesn't last long. Are you giving 1u twice/day? Can we get you to set up a spreadsheet? It will help you, your vet and us to see more clearly what's going on.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
If you need help, please ask and someone will help.

 

[Julia & Bandit (GA)]

It sound to me like insulin just isn't working well for him. This is very common with Novolin and Vetsulin, which is why they aren't recommended insulins for cats. I would talk to your vet about getting him on Lantus or Levemir, or failing those Prozinc. These are the insulins that work well in cats, because they have a longer duration of action (cats have metabolisms twice as fast as people or dogs, which is why Novolin and Vetsulin don't work).

Lantus seems really expensive, but if you order economically it actually works out to be less money per month than Novolin. You just get the script from your vet, and you can order online from Canada where it is way cheaper than in the US. The best deal is to get a 5 pack of pens, which will cost about $170 after shipping. Those will last you a year or more with good handling. You draw the insulin out of the pen with a syringe just like a vial.

If you need Veterinary literature to convince your vet to make the change (many vets aren't quite up to date on feline diabetes treatment), come back and post and I can give you some articles to print out.

Are you home testing for ketones (with urine ketone test strips)? If not, I would strongly recommend picking some up with his history. I would also try and get the insulin changed asap if there are ketones in play.

 

[MClarke087]

I'm so sorry Dennis is having problems. You said the vet did some tests two weeks ago. Was that because his BG's had started going up? What tests were done? Is he eating? I don't know much about Novolin, but it is considered a fast acting insulin that doesn't last long. Are you giving 1u twice/day? Can we get you to set up a spreadsheet? It will help you, your vet and us to see more clearly what's going on.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
If you need help, please ask and someone will help.

Thanks for the response. Great questions! Two weeks ago he had a fructosamine test and a test for various kidney issues. Coincidentally that was the same day his BG started to sky rocket. The vet told me that based on the test results it looked like Dennis was almost ready to come off insulin- BUT then they changed his diet from W/D to D/M. The vet swears the change is not what's causing the BG spike, and she strongly advised me to keep him on the D/M.

Yes, he was on 1u twice a day

Thank you for the link- I will set that up tomorrow. I keep track of his BG on a chart I quickly created in Excel, but the chart you linked seems much better.

 

[MClarke087]

It sound to me like insulin just isn't working well for him. This is very common with Novolin and Vetsulin, which is why they aren't recommended insulins for cats. I would talk to your vet about getting him on Lantus or Levemir, or failing those Prozinc. These are the insulins that work well in cats, because they have a longer duration of action (cats have metabolisms twice as fast as people or dogs, which is why Novolin and Vetsulin don't work).

Lantus seems really expensive, but if you order economically it actually works out to be less money per month than Novolin. You just get the script from your vet, and you can order online from Canada where it is way cheaper than in the US. The best deal is to get a 5 pack of pens, which will cost about $170 after shipping. Those will last you a year or more with good handling. You draw the insulin out of the pen with a syringe just like a vial.

If you need Veterinary literature to convince your vet to make the change (many vets aren't quite up to date on feline diabetes treatment), come back and post and I can give you some articles to print out.

Are you home testing for ketones (with urine ketone test strips)? If not, I would strongly recommend picking some up with his history. I would also try and get the insulin changed asap if there are ketones in play.

Thank you! I really feel that it's an insulin issue so hearing that from someone else is really helpful. I'm going to ask his vet if we can try a new insulin. Yes, I test him with a dual strip that tests for glucose and ketones. The ER suggested I buy them (the human version) however, Dennis' regular vet has told me they're not useful/reliable.
Thank you for responding. If he ends up in another ER situation I truly won't be able to afford the healthcare, so all of your advice helps.

 

[BJM]

We often use Low carb over the counter canned or raw diet, such as many Friskies pates rather than expensive prescription diets.
See Cat Info for more info. If already on insulin, you must be home testing before changing the diet. Food changes should be gradual to avoid GI upsets - 20-25% different food each day until switched. There are 2 low carb, dry, over the counter foods in the US - Evo Cat and Kitten dry found at pet specialty stores and Young Again 0 found online.

 

[jayla-n-Drevon]

Hi and welcome !
I am not a advice giver but just wanted to encourage you and there is tons of experience and support here.
I have used 3 insulins and wish I had started with lantus.
Fancy feast classics are pretty widely used here. You want under 10% carbs.
Keep asking questions as members are more than helpful !!

 

[jayla-n-Drevon]

Also there is a member that did manage dka at home
Not easy but he did it. I will tag him.
@Photorecon

 

[MClarke087]

Also there is a member that did manage dka at home
Not easy but he did it. I will tag him.
@Photorecon

Thank you so much! It's really helpful to know that there are people here that are going through this too, and that understand! It can be overwhelming and frustrating. Thank you for the help!

 

[Sharon14]

I think a new insulin is a good idea. You may also want to have his teeth checked and maybe check for a UTI since the high BGs are sudden, it's possible he has an infection somewhere. Is the Purina D/M food canned or dry? The canned is ok, but the dry is high carb. It's important for Dennis to eat and have plenty water to flush any possible ketones. It's good to mix as much water into his food as he will tolerate. Let us know how he's doing and the results of the fructosamine test.

 

[Misterbeesmom]

i dont have any suggestions - i'm still trying to figure FD out with my cat. i just wanna say i empathize with you - its scary business watching our furry friends not doing well. i hope dennis gets on track soon.

 

[Julia & Bandit (GA)]

Thank you! I really feel that it's an insulin issue so hearing that from someone else is really helpful. I'm going to ask his vet if we can try a new insulin. Yes, I test him with a dual strip that tests for glucose and ketones. The ER suggested I buy them (the human version) however, Dennis' regular vet has told me they're not useful/reliable.
Thank you for responding. If he ends up in another ER situation I truly won't be able to afford the healthcare, so all of your advice helps.

The human ketone strips are fine--they are useful in detecting whether or not the cat needs to go to the vet for the ketones (anything more than trace means go to the vet immediately). They help because if you can get him to the vet early, the ER treatment isn't going to be as pricy because he's not going to be in as critical condition.
They're not going to help you for any purpose beyond that, except for maybe peace of mind if they're negative.

I agree that getting rid of the dry food is going to help--and add a bit of water to his food, as much as he'll let you and still eat. Keeping him hydrated is very important. Is he eating ok? Typically, DKA cats have a perfect storm of three things brewing in them--infection, high BG, and anorexia. If you're seeing signs of all three of these, he needs to go to vet ASAP.

At the risk of sounding like a broken record, I think the next immediate steps are to 1. get rid of all the dry food (you can tell the vet he won't eat it and return it for a refund, even if it's opened), and make sure he has plenty of low carb canned food on hand to eat (it doesn't need to be prescription--if you read the ingredients of the Purina DM canned and a can of Fancy Feast pate there's practically no difference), and 2. try and get the script for a better insulin ASAP (if you order the Lantus from Canada it will take at least a week to arrive).
Here's some of the documents I was referring to last night to share with your vet (I was on my phone, so I didn't have them handy, then!).

Bandit's been diabetic for 7 years now, and he's never been on a prescription diet. Seriously, all you're paying for is the label. This is some good reading on prescription diets: http://www.catinfo.org/#Prescription/Therapeutic_Diets_


American Animal Hospital Association Diabetes Guidelines: https://www.aaha.org/professional/resources/diabetes_management.aspx

And another article specifically about treatment with Lantus and Levemir, linked below.

 

[MClarke087]

I think a new insulin is a good idea. You may also want to have his teeth checked and maybe check for a UTI since the high BGs are sudden, it's possible he has an infection somewhere. Is the Purina D/M food canned or dry? The canned is ok, but the dry is high carb. It's important for Dennis to eat and have plenty water to flush any possible ketones. It's good to mix as much water into his food as he will tolerate. Let us know how he's doing and the results of the fructosamine test.

Thank you for the input. His fructoseamine came back elevated so the vet wants me to increase him from 1u to 2u, 2x a day. I think that may not be enough, but we will try it. I'm doing an at home curve on him next week. He also had his kidneys checked for any issues, but that test came back normal.
I think you're right that his mouth could be an added issue. He has unusually horrible breath and he certainly needs a teeth cleaning...I've been holding off because I'm flat broke from the diabetes.
He's not on purine, he's on the canned science diet. I mix a decent amount of water into his food, but I'll start adding more.

 

[MClarke087]

The human ketone strips are fine--they are useful in detecting whether or not the cat needs to go to the vet for the ketones (anything more than trace means go to the vet immediately). They help because if you can get him to the vet early, the ER treatment isn't going to be as pricy because he's not going to be in as critical condition.
They're not going to help you for any purpose beyond that, except for maybe peace of mind if they're negative.

I agree that getting rid of the dry food is going to help--and add a bit of water to his food, as much as he'll let you and still eat. Keeping him hydrated is very important. Is he eating ok? Typically, DKA cats have a perfect storm of three things brewing in them--infection, high BG, and anorexia. If you're seeing signs of all three of these, he needs to go to vet ASAP.

At the risk of sounding like a broken record, I think the next immediate steps are to 1. get rid of all the dry food (you can tell the vet he won't eat it and return it for a refund, even if it's opened), and make sure he has plenty of low carb canned food on hand to eat (it doesn't need to be prescription--if you read the ingredients of the Purina DM canned and a can of Fancy Feast pate there's practically no difference), and 2. try and get the script for a better insulin ASAP (if you order the Lantus from Canada it will take at least a week to arrive).
Here's some of the documents I was referring to last night to share with your vet (I was on my phone, so I didn't have them handy, then!).

Bandit's been diabetic for 7 years now, and he's never been on a prescription diet. Seriously, all you're paying for is the label. This is some good reading on prescription diets: http://www.catinfo.org/#Prescription/Therapeutic_Diets_


American Animal Hospital Association Diabetes Guidelines: https://www.aaha.org/professional/resources/diabetes_management.aspx

And another article specifically about treatment with Lantus and Levemir, linked below.

Thank you so much! I spoke to his vet today and she really doesn't want to change his insulin. If upping his dose doesn't work then I think it's time I seriously push for a change in insulin.
The documents are so helpful- thank you!

 

[Julia & Bandit (GA)]

Thank you so much! I spoke to his vet today and she really doesn't want to change his insulin. If upping his dose doesn't work then I think it's time I seriously push for a change in insulin.
The documents are so helpful- thank you!

2 months is more than enough time to give Novolin a chance. If a cat doesn't see good control within the first 4 weeks on Novolin, it's never going to see good control. Note in the AAHA guidelines where it says (under insulin therapy in the cat):

"The insulin preparations with the appropriate duration of action in most diabetic cats are glargine (U-100) or the veterinary-approved human protamine zinc insulin (PZI U-40).31

This panel does not recommend the veterinary-approved porcine zinc (lente) insulin [e.g. Vetsulin, an insulin with a similar duration of action to Novolin-J&B] suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor.32 This insulin should be reserved for cats in which other insulin choices have not yielded satisfactory results."

I'm attaching one more study below for your vet, which is a direct comparison of Novolin (isophane) insulin to Lantus in cats, which strongly indicates the use of Lantus over Novolin. If your vet reads these and still won't give you the script for Lantus, I think it's time for a new vet. These are all peer-reviewed, published veterinary studies, not random internet stuff.

 

[Larry and Kitties]

His fructosamine came back elevated so the vet wants me to increase him from 1u to 2u, 2x a day.

That is a big increase. When on 1 unit most caretakers increase dose by 1/4 unit.
Do you have any specific BG values to share together with when they were taken after the shot?
Can you also share the value of the fructosamine test?
Further, if you are changing to a low-carb food insuin needs should decrease make a 100% increase if insulin dose dangerous.

 

[MClarke087]

That is a big increase. When on 1 unit most caretakers increase dose by 1/4 unit.
Do you have any specific BG values to share together with when they were taken after the shot?
Can you also share the value of the fructosamine test?
Further, if you are changing to a low-carb food insuin needs should decrease make a 100% increase if insulin dose dangerous.

I don't have the value of the fructosamine test, I didn't ask the vet for those numbers probably because I wouldn't have understood them.
When I take his BG before food and insulin he's in the 500-600 range. When I test him (at his new 2u dose) 6 hours later at his low point he's still in the high 300-400s.

I know I shouldn't alter his dose on my own, but when he was over 600 before eating two days ago, I gave him 3 units (that's the does he was on when he got out of the ER two months ago), and when I checked the BG 6 hours later he was down to 330, which is good but certainly not great.

How long is it supposed to take before the effects of his new dose become clear? Shouldn't his numbers come down with the first increased dose??

 

[MClarke087]

2 months is more than enough time to give Novolin a chance. If a cat doesn't see good control within the first 4 weeks on Novolin, it's never going to see good control. Note in the AAHA guidelines where it says (under insulin therapy in the cat):


I'm attaching one more study below for your vet, which is a direct comparison of Novolin (isophane) insulin to Lantus in cats, which strongly indicates the use of Lantus over Novolin. If your vet reads these and still won't give you the script for Lantus, I think it's time for a new vet. These are all peer-reviewed, published veterinary studies, not random internet stuff.

Thank you so much. What confuses me is that the ER put him on the Novolin and also on a W/D diet. When Dennis saw the regular vet a few days later she actually laughed out loud when I told her the type of insulin and food. She said we should stabilize him but eventually change him to a different insulin and food. We've put him on D/M 2 weeks ago, which is the same day his numbers began to rise.....but when I asked her about changing the insulin yesterday she said it has nothing to do with his numbers increasing, and that he should stay on the Novolin. Strange.

 

[Sharon14]

If you can get the spreadsheet set up it will help to see what's going on. Also try to get some tests in at other times during his cycle. Not all cats nadir at 6 hours post shot. Try some tests at 3-4 hours as well as 8-9. I would really push for the insulin change though. ProZinc, Lantus or Levemir are the best ones.