Biscuits neuropathy and insulin change pending

[Karen & Biscuits]

Hi everyone!
I hope you all had a great Thanksgiving. Ours was typical, busy but nice. I wanted to share with you that Biscuits is not doing well at all with her glucose levels and now her neuropathy is worse. Tonight she was attempting to eat and couldn't even sit up long enough to do so. Her back legs just gave out. She lays down to eat most of the time but a few minutes later, she got up to use the litterbox and "ran" as fast as she could to get into it, did her business and ran out, if you can call it running, because she knows she can't stand up and support herself properly to use the litterbox. It's breaking my heart to watch this and I feel so powerless. I have begged the vet for a prescription for ProZinc, and I'm getting mad because someone isn't doing their job. I don't know if it's the vet or the receptionists but I've called 5 times this week to get the Rx sent to my e-mail so I can submit it to Diabetic Cats in Need because there is no way I can afford the ProZinc and Vetsulin (for Skittles) too. They are waiting on the prescription so they can either approve it or not. I was at the vet today with 4 sick kittens who have URI's and my focus was on them at the time because 2 are very sick and I completely forgot about asking for the Rx while I was there.
I keep reading on here that the cobalamin won't do much good if her sugar isn't regulated, so I feel very stuck right now and in the meantime, my cat is suffering and wasting away before my eyes. I have done her spreadsheet, I hope I did it right. I'm not sure what some of the abbreviations mean, so didn't know what to put in there (ie:TR and SLGS?). You can see that her sugar is super out of whack, very high most of the time and I know this is what is causing the neuropathy and I feel so bad that I can't help her.
What do I do?

 

[Chris & China (GA)]

(ie:TR and SLGS?)

Those stand for Tight Regulation and Start Low Go Slow which are 2 dosing methods used with Lantus, Basaglar, Semglee and Levemir so don't worry about it right now. If you do get the ProZinc, then you'd start on the ProZinc SLGS method first and then possibly move to the Modified ProZinc Method (MPM) which is like TR is for the other insulin types.

At the dose you're on, I'd strongly urge you to ask for Levemir instead of ProZinc. It's usually a much better insulin for high dose cats (anything over 6U) and DCIN has that to send you directly. Also, if you stick with the ProZinc, you might ask how much they sell it for at your vet. If the price is comparable to Chewy or Allivet, we will pay for it directly from your vet. (about $110...and if they charge more than that, you should ask if they will price match the Chewy/Allivet price)

You might want to call around and see if you can find a vet that's a little more flexible. I ended up calling 5 before I found one willing to give me the insulin I wanted.

Have you thought about getting him tested for acromegaly and IAA?

 

[Bron and Sheba (GA)]

Hi.
Looking at your spreadsheet, it is only up to the 11/5. Do you have data after that?
Also I can see you have no data for the pm cycle at all.
Are you able to get some tests done during the pm cycle? Even a before bed test in every night would be helpful. Then if that test is lower than the preshot BG I would set the alarm and get up and test again later to see the BG had not dropped too low.

While most of the BG are very high I can see a blue BG in there which might indicate he is dropping lower ant times and bouncing up again. But without more test we can’t really tell.
I notice you are using an alphatrak meter. They are very expensive to run. You can buy a ReliOn Prime classic meter for about $9 and 100test strips for 17.88 from Walmart which is much cheaper.

I see Chris has mentioned swap to Levemir insulin. That is a very good idea.
I see you are feeding the m/d dry food. That is high carb and could be contributing to the high BGs. A low carb wet diet is much better, but if you get rid of the dry, monitor closely as the low carb could drop the BG significantly.

The medication you need for the neuropathy is not cobalamin but Methyl B 12. It is sold as Zobaline at lifeline.com
It is also true that getting the BGs back in more normal numbers will help the neuropathy.

 

[Karen & Biscuits]

Those stand for Tight Regulation and Start Low Go Slow which are 2 dosing methods used with Lantus, Basaglar, Semglee and Levemir so don't worry about it right now. If you do get the ProZinc, then you'd start on the ProZinc SLGS method first and then possibly move to the Modified ProZinc Method (MPM) which is like TR is for the other insulin types.

At the dose you're on, I'd strongly urge you to ask for Levemir instead of ProZinc. It's usually a much better insulin for high dose cats (anything over 6U) and DCIN has that to send you directly. Also, if you stick with the ProZinc, you might ask how much they sell it for at your vet. If the price is comparable to Chewy or Allivet, we will pay for it directly from your vet. (about $110...and if they charge more than that, you should ask if they will price match the Chewy/Allivet price)

You might want to call around and see if you can find a vet that's a little more flexible. I ended up calling 5 before I found one willing to give me the insulin I wanted.

Have you thought about getting him tested for acromegaly and IAA?

Thank you for your reply. I am willing to try anything for Biscuits as long as it gets her glucose levels down, because this is scaring me and it's so hard to watch her suffer like this. She has always been a strong, independent cat and she's only been diagnosed this year and is already in far worse shape than her brother Skittles, who was diagnosed several years ago. He has never had issues like this and his sugar stays fairly low most of the time. He's on 4.5 units of Vetsulin and doing fine with it. What's weird is that they are from the same litter, they are the same age and yet her response to the Vetsulin is completely different than his.
For the ProZinc, I believe the vet quoted me about $125 per vial. The cheapest I can get it is from a cat sanctuary nearby that can get it for $85.00, which is a bit more reasonable, but still high. I pay $35 for the Vetsulin which is quite affordable in comparison. I am happy to ask them if they would be okay with giving her Levemir. Does that come in pen form or in a vial like the Vetsulin? The lady I take care of has Levemir in pen form and she just turns the dial to the dose she needs and it makes it so much easier than having to measure it all the time.
I would love that for Biscuits!
As for calling around to other vets, we live in a very small town, only 2 vets here and this one we have is the best one around. The others are all 25 miles away or more and I don't drive so getting to any of them in another city is very difficult. The vets at this clinic are flexible about the insulin, my issue is getting them to actually write the prescription and as I said earlier, I don't know if it's the vet at fault for not writing it out or if they aren't getting the message from the front desk. The vet I saw today was really great with the kittens that are so sick, so I may try to reach her tomorrow and see if she'll take care of this once and for all.
I did discuss acromegaly with the vet who has been taking care of Biscuits from the time she was diagnosed and she doesn't think that's an issue. I can't remember why she said that, but at the time, she didn't feel that testing for that was necessary unless things changed, which they have now. I will also ask about that when I speak to them tomorrow.
I also do have Methyl-B12, it says methylcobalamin on the bottle but it's not the Zobaline brand. It comes from Nutricost and it's 2000 mcg. I haven't tried it yet because the vet said to me that human type of methyl B-12 is different than the veterinary type and she felt it would be detrimental to Biscuits to use this right now with her sugar being so high. She said that we need to regulate her sugar first and then talk about using this stuff. I'm frustrated because I think sometimes they think I'm a bit wonky when I talk about what people here have said and how they use it on their cats and the results they are seeing. I mean, everyone here has a diabetic cat, and I'm quite sure that nobody here wants to harm their own cat and yet when I explain to the vet that people on this board are using methyl-B12 they look at me like "oh she googled it and believes everything she reads". That's obviously not the case, I'm not that stupid and I would never go against veterinary advice, but at the same time, if people are getting positive results from using this stuff, why shouldn't I try it for my cat? I understand that it's important to get her sugar to normal levels for the methyl-B12 to be effective but they bucked that idea right off the bat. I just want my baby to get better. She is my soulmate and I miss the cat she used to be before all this happened.
I will let you know what I find out from the vet tomorrow and see if Levemir is an option for her. Thank you for telling me about that.

 

[Chris & China (GA)]

The lady I take care of has Levemir in pen form and she just turns the dial to the dose she needs and it makes it so much easier than having to measure it all the time.

Yes, Levemir comes in a pen, but we don't recommend using the special pen needles like your lady friend uses because it limits you to only being able to do dose changes in whole units. We recommend using regular U100 insulin syringes and pulling the insulin out of the pen..using it like a "mini-vial". If you pull the cap off, there's a rubber stopper just like on a vial.

It also requires "priming" which means wasting 2 units each time you use it with the pen needles as well as holding it in for 10 seconds (with the pen needles being so short, he wouldn't have to move much to have the needle come out of his skin and not give the complete dose).

Maybe if your lady you're caring for doesn't use it all, she'd let you have any extra (we have a lot of people who are diabetic and using Lantus or Levemir and share it with their cats)...of course it would matter if she has any left over too! DCIN would at least want your vet to be on board with using Levemir. You can get that info to DCIN by either a picture of a script or from Biscuit's treatment file noting that he is using Levemir.

I don't know if it's the vet at fault for not writing it out or if they aren't getting the message from the front desk.

You might need to just pop in and sit in the waiting room until they hand you the script! Shouldn't have to do that though but it sure seems like there's a breakdown in communications somewhere!

I also do have Methyl-B12, it says methylcobalamin on the bottle but it's not the Zobaline brand. It comes from Nutricost and it's 2000 mcg. I haven't tried it yet because the vet said to me that human type of methyl B-12 is different than the veterinary type and she felt it would be detrimental to Biscuits to use this right now with her sugar being so high.

That's total B.S.....my only concern with what you have now is that (if I remember right) it contains rice flour which is a carb. There's NO reason you need to spend the extra money to buy the brand name Zobaline. It's all Methyl B-12. The Zobaline is 3000mcg and the usual dose is 1 tab per day but we have had people here give it twice so that would be a total of 6000mcg.

A lot of people use this Methyl B-12 from Amazon. It's a 4 month supply for $25 and each tablet is 5000mcgs instead of the 3000mcgs in the Zobaline. You just crush the pill and mix into food. It's tasteless. (and it doesn't contain rice flour). Since it is 5000mcg, you'd only need to use 1 per day and you'd still be giving more than the Zobaline dosage recommendation. B-12 is a water soluble vitamin so any the body can't use is just peed out. Yes, it will work better if you get the blood glucose down, but there's no reason you can't go ahead and use it now.

The B-12 used by vets is usually a different form called cyanocobalamin. It's an injectable form that's useful for improving energy, appetite and just sometimes help give a cat a "boost" but doesn't work on diabetic neuropathy. Most vets don't know there's a difference (and although it might not have anything to do with it, it's possible your vet wants to make the money giving you the injections)

 

[Diane Tyler's Mom GA]

Hi I think I mentioned this on one of your other posts
For the neuropathy a lot of members use this one and Chris is right the one you have has rice flour in it, good memory @Chris & China (GA)
I looked back at some of Karen's posts and found it

A lot of us use the Vitacost brand
14.49 for 100 capsules , give 1 a day, just open the capsule and mix it in with the wet food and add water, you can start it now, and its tasteless
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
I have given it to Tyler when he had neuropathy, once his numbers started to improve I started to see a big difference in about a month and a half, but each week I would notice he was walking better . The neuropathy is totally gone. He's back to running and jumping .
He's been in remission since 1-24-2021
I still give it to him every now and then

 

[Sienne and Gabby (GA)]

The methycobalamin will have a quicker effect once Biscuits' numbers are lower but that doesn't mean it will be ineffective until his numbers have dropped. Frankly, I agree with Chris -- I don't think your vet knows much about diabetic neuropathy.

If you've not already done so, please consider changing Biscuits' diet. The M/D dry food is very, very high in carbs. I suspect you will need far less insulin if you change your cat's diet. If your vet has told you that a prescription diabetic food is necessary, I suggest you look over this article by a vet, Lisa Pierson, DVM who has studied feline nutrition. There is nothing that requires a "prescription" in diabetic food. You will save a fortune by feeding your cat Fancy Feast or Friskies pates that are in the 5% carbohydrate range.