cannot stabilize after a week at the vet clinic

Status
Not open for further replies.
aochoa

aochoa

Member Since 2014
My Bruno, orange tabby, 13-14 y.o. (he was taken from the street as an adult, been with me 13 y.) was diagnosed with diabetes last March. His usual vet made analysis and we started with PZI insulin, fist 4 units for a week, then we changed to 6 and in the end we got 8 units. Still he was not good, and tests ( I only tested at the vets) were not consistent (23 first time, 16 after 2 days with insulin, 12 after a week, then 25 after another week, then 9.5 after 2 more weeks and 2 weeks ago 20.5) Then is when I realize that the treatment might not be correct. I started reading on this blog, and decided to try another clinic where there is an endocrinologist. I live in Ukraine, so you can imagine that there are not too many private clinics with good doctors. Anyway, they decided that he needed to stay at the clinic for a week to test glucose every 4 hours and look at his behavior.

First thing they did was change to Lanus, then try to determine the , apparently he's good with little less than 1 unit. The problem is that after a week, his glucose is still jumping like crazy: 25 in the morning, then going down to 2 during the day and the insulin effect is lasting for 12-14 and sometimes even 16 hours. The vet tried pills but made him vomit. After a week, the vet doesn't know how to stabilize him, and I am extremely stressed. Yesterday, he got the insulin injection of Lanus (o.8 units) at 8 am, but by 8pm his level of glucose was under 1 and kept going down and he refuse to eat and move or do anything, vet tried to feed him by force but he threw up food and bilis (the yellow thing), so vet injected glucose straight in the vein and after 2 hours glucose test mark 6.5

I bought the glucometer that the vet recommended and used it for the first time yesterday at the vet to start training for testing at home and my glucometer (new) marked 1.1 while the vets marked 2, is this normal?

Vet also said he needs to take medicine for the pancreas, any of you have heard something similar?

I work and live alone, so I am extremely worried that when er go home, he'll still has this jumps and something might happen when I'm not home.

Any recommendations? Does it seems like the vets are doing the right thing? I feel helpless!!!
 
That sounds really scary. I'm not used to the world numbers for glucometers but it sounds like you got a test or two of under 20 :shock:

It sounds like you need to lower the dose.
 
What food is he eating. With that low of a dose, it may be possible that a change of diet is all that is needed. Are they feeding him a low carb canned food or is he eating dry food?

If he is not feeling well due to pancreatitis that can raise his glucose levels. Plus just being at the vet's office can also raise it significantly. Since you have a meter and can test at home, you may want to consider bringing your cat home from the vet and see if that helps. For newbies, we recommend not giving insulin if the BG reading is 200 or less. This would convert to about 11 on your meter. Feed him canned food and no dry.
 
He's eating Royal Canine for diabetic. But vet said that he's not ready to control only with diet.

Yes, I'm scared, specially because I do not trust completely doctors in Ukraine :(

Thank's for the support, and I welcome all your advises.
 
I suspect your vets may be unfamiliar wwith the optimal way to use Lantus.
We have 2 protocols which may be followed.

Here is the Tight Regulation protocol for Lantus, based upon the Roomp and Rand research.

Vs.

Start Low, Go Slow says:

After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve ...
follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Click to expand...
 
I agree with Dyana, the Lantus dose is too high. Anything below 2.8 (50) means the dose should be reduced. It might be better to bring Bruno home and do the testing yourself. He'll be less stressed and more likely to eat at home. Stress can increase numbers and not eating enough can lower them.

You asked:
I bought the glucometer that the vet recommended and used it for the first time yesterday at the vet to start training for testing at home and my glucometer (new) marked 1.1 while the vets marked 2, is this normal?
Click to expand...
It can be normal, depending on what type of glucometers you and the vet have. Most of us here just use a glucometer designed for human blood, and the protocol takes that into consideration. And the test strips are much cheaper for the human glucometer. If the vet has a pet specific meter, the latest research paper by Roomp and Rand says that the pet specific meter is about a 1 (18) point higher at the lower range of numbers than a human based one.
 
Thank you, Wendy. Regarding the glucometer, vet and me, we use the same (for humans) and even same brand just different model.

Yesterday, he was more or less stable and ready to go home but again at night, numbers jumped from 9 to 19 in 2 hours.

Then here is another question... the vets (I´ve seen 2 different) they all say the norm for cats is no more than 6 or 7. But I see on the charts that you measure with other numbers around the 100´s?

Seriously, I feel lost with this disease, also complicated since I need a translator to talk to the doctor and I think maybe I´m missing some important things in the way.

Thank you all again, for the advises.
 
U.S. meters are calibrated differently so your 6 is our 108 (6 x18) and your 7 would be our 126 (7 x 18). So in our terms your doctor is saying that normal is between 108 and 126 on U.S. meters. Does that make sense?

I am so sorry that you are going through this. The care for this disease is overwhelming at first BUT it is totally manageable as we have been doing with our sugars. We can help you get there with knowledge and hand-holding and experienced advice. Hang in there.
 
Since you have a meter, how about bringing Bruno home and caring for him in his home environment. Cats cannot be stabilized or regulated in just one week and certainly not at the vet office. The stress alone is enough to keep him going crazy.

Lantus is a good insulin and there are plenty of people on the lantus forum who can help guide you.

Do you think you could bring him home, test him and start feeding him low carb wet food? I realize the vet may not approve, but unless he is in hypo or has DKA - home is the best place for him.

Think about it this way - a human diabetic doesn't stay in the hospital to get regulated or stabilized - rather they are home and go about their normal routine.....it should be the same for a cat.
 
I agree with Hilary, Bruno would do better at home as long as there are no other medical conditions other than diabetes. If you can do blood tests at home, we'll be able to help you get Bruno better regulated.

Some cats just take longer to get regulated. My Neko is an example, but she has an underlying condition that made it trickier. One day early on I saw her go from 11.9(214) to 22.5(405) in one hour after a day with the majority of time under renal threshold. It's not uncommon for newly diagnosed cats to have their blood sugar zoom up at the end of the cycle. And not a reason to keep the cat at the vet.

As for meter difference, manufacturers are allowed to have blood reading differences with up to 20% variation.
 
Hilary and Neko, thank you! I agree I want to take him home, I have the glucometer and I learned how to test him at home. I´m tired of the vet saying she will "try" something different and after 2 day, then "try" again something else.

I know I am not a vet, but now I read so many literature about diabetes in cats, that I think at least I understand what is going on and what are the signs to be worry about.

It´s been 10 days at the vet today! And they still don´t know what to do. The vet wants him on a Flexible Protocol of Lantus but I live alone and work (sometimes 10-11 hours a day) so I know it will be very difficult for me, impossible, to measure glucose every 4 hours as the vet wants. This is the only thing that worries me. On the other hand, the first vet that diagnosed him, he sent him insulin (PZI Protofan) injections every 12 hours, and even he said that one hour difference from time to time is not to die for. And he was doing better.

I already asked also at vets office if there is an organization or people you can hire to do the test at home while I´m not there, but apparently in Ukraine there is not such thing.

In any case, I do appreciate all your advises, I will push the vet to send him home and try to get a copy of his clinic history to share in another forum, I´m sure there will be many other advises.

Thank you all,
 
Here is the thing - many of us on this board work and are away from home for many hours at a time. You test as often as you can when you are home, such as when you wake up in the morning, before leaving for work, coming home from work, before you go to bed, if you wake up in the middle of the night to pee....see you find the opportunity.

When you are not working and are at home, you can test more often.

Minimally you want to test before giving insulin.
Ideally you want to also test 1-2 hours after giving insulin - why so you can see how fast the insulin is working and if he drops low and you need to monitor and prevent a hypo incident
Then you want to test one more time during the 12 hour cycle - just to see what the BG is doing.

If you are gone for 11/12 hours at a time - you can still treat at home, you will just need to adjust some things is all - such as have a bigger window of when to give insulin - Ideally we say to try to keep within a 30 minute window - well if you need to stretch that to an hour - so what...you stretch it.

You do the best that you can and it will work itself out.

Some cats can go into remission fairly quickly and not need insulin and just be controlled by food alone. Some cats never go into remission and are on insulin the rest of their lives.

What is your vet going to do - keep your cat in the office in a cage forever?

Diabetes is not the same as having a cold. It doesn't just go away with some meds in a few days. It's a lifelong disease.

I was fortunate, Maui was a transient diabetic (meaning food and steroid induced) and went into remission in 3 months and stayed in remission for the next 4 years until she died of something unrelated to diabetes. She did continue to eat the low carb food however, and I made sure that she never received steroids again.

If you want to use PZI instead of Lantus - you can - they are both decent insulins - they do work differently and you may find with your schedule that using PZI may be easier. But here is what I suggest - since Bruno is currently on Lantus - how about continuing with that and with our help we can help you manage the process and see how well it works for you and Bruno.

If you find that it is too stressful and Bruno's BG's are not where they should be, you can always change insulin and go back to PZI.

What do you think? If you know how to test and you have the insulin, bring your cat home. There is no reason to be without your cat and leave him at the vet's office. He belongs home with you, again this is assuming there is no other reason the vet is keeping him - such as DKA, hypo, etc.

And when Maui and I started this journey - I was told the same thing by my vet - that I had to take her and leave her at the vet for at least one week to get regulated. I found this board and learned otherwise. Thank goodness, cause this board saved her life and me.
 
Thank you, Hilary! You are absolutely right. Even at vet´s office I made time to stop by before work and stay with him for an hour or so and after work I also spent at least 4 hours with him at vet´s office. This is more complicated, and I found the time to do it. I´m sure I can do better at home and so will Bruno.

I spoke to the vet and we are going home tonight!

Very excited and very grateful to found this chat and the support from all of you!

Once again, thank you
 
Great! I know he will do much better at home with your love! when you get him - make sure to get a copy of the vet records with the testing and dose information.

you can then make a spreadsheet and add this information -- here is a link to creating a spreadsheet and how to link it to your signature - this way, we all can see it and help better guide you.

viewtopic.php?f=6&t=18207


if you need help with it or have questions, just ask
 
I have been posting on Lantus relaxed but I need input. Bruno came home on June 6, but still now after almost 2 weeks I cannot avoid the jumping on his numbers.

I understand now that he cannot be without insulin (as vet suggested). Even this 0.5 Lantus 2 times a day makes a lot of difference, but I´m not sure what to do next to make him more stable since his numbers are even worst that when he was first diagnosed and when he was taken to stay at the vet for a week. Numbers around the 250's, when sometimes he jumps now to 500's!.

As I saw his numbers, and decided to give Lantus 2 times a day, same doses as the vet recommended 0.5. we started with 423 and 488 as pre-shot numbers. After a day we were down to 300's, even 100's during peak of insulin.

Problem started when we got pre-shot numbers on the 100's. Since I am not home during the whole day, I am afraid to give him the normal shot and that he might become hypoglycemic ( he already became like that once at the vet's at 31 and got glucose injected in his vein), on the other hand if I skip his shot, he jumps again to the 300's.
Trying to follow the recommendation on this forum, I can skip the shot, gave him a token dose or feed him and check again later. Since last option is not an option, first one, doesn't work since his numbers jump high (even from 117 in the morning to 556 at night), giving him a token doses seems like an option, but even using 30u syringes, measuring 0.25 is very complicated.

Any advises? I'm lost again.

https://docs.google.com/spreadsheet/ccc ... ring#gid=0
 
Have you looked at some of the spreadsheets of the long time Tight Regulation users? Very often, they shoot low to stay low. If you can get some mid-day tests on a day off when he is low to shoot, you may be able to determine how he handles that. If he gets to the point you have to steer the numbers and you're not generally home to do that, Tight Regulation may not work for you. You might, however, pick up some good tips from those long term users to help you out.
 
Took a look at your spreadsheet. In my opinion, I think he needs more insulin. I see you gave .75 and then saw the 100 reading and got scared and backed off, gave nothing and he shot to 500. Then you went back to .50.

There is a saying on this board, that sometimes you have to go up in order to go down. What that means is that you need to raise the dose in order to get the numbers to drop down.

My recommendation would be to give .75 for the next 3-5 days (giving the insulin twice a day). Even if his preshot is in the 100's that is OK, you can still give this amount.

For the times that you are home and can test mid-cycle - do that and let's see how it is working. Getting a +2 is a great test because it helps to see how quickly he is dropping from the insulin dose. It also will help to guide you on what kind of food to leave out - such as low carb, let him go along as he is, or a medium carb to slow/decrease the BG drop.

Another trick for when you will not be home and the pre-shot is in the 100's - is to leave out medium carb food for him during the day. This will allow him to graze as needed and not drop too quickly while you are not home to monitor.

You can also freeze the canned food. Just add water to the food, put in a plastic container, ice cube tray even plastic food storage bags (if you have those) and freeze. Once frozen, put out before you leave the house and it will thaw in about 2-4 hours and be ready for eating. This will give him fresh food to eat during your absences.

You may also want to start posting on the tight regulation lantus forum, as there are more people on that forum, who can really guide you.
 
Thank you, Hillary. I also think, that he needs more insulin, 0.75 at least but, as you said, I get scared around the 100´s.

So far he´s eating Hills Prescription Diet Feline w/d, he was having Roya Canine diabetic, but tried this at the vet and now he doesn´t want the RC. I also have RC dry food for diabetic, but I notice that even if it is for diabetic, his numbers run up when he eats this, but actually is the food that he prefers even over wet food.

I will follow your advise during the weekend and start posting on the Tight Regulation group instead of the Relaxed.

Keep your fingers crossed ;-)
 
Of course cats prefer dry food over wet! We call it kitty crack! If you can get him on wet only, he will be much better off and his numbers should get better too.

I don't know what food options you have in the Ukraine, but if you can purchase regular canned food, you can save lots of money not paying for the prescription foods, which is not better quality and sometimes higher in carbs than what you really should feed.

We do have food charts, US and European ones and some of the low carb options may be available where you are. viewtopic.php?f=28&t=64843
 
Hi Ana and extra sweet Bruno!

I agree with Hilary that you need to go to .75 every 12 hours and hold it to see how he does, but I see some other things on your spreadsheet I wanted to mention/ask about.

You say you're giving him 1/4 tab of "Antral" occasionally. I know drugs are called different things in different countries but I'm not having any luck finding what this medication is. Is it the anti-nausea medication the second vet put you on? Is there another name for it?

On the 15th, you say you gave him "Glucofax" (like Metformin)...We don't ever recommend giving the diabetes pills because they make the pancreas work harder...and in cats, the pancreas can heal, but it needs to be rested..Not worked harder! Please just stick to the Lantus since that will give Maui his best chance at remission

The big swings in his numbers looks like "bouncing" to me....His body has gotten used to living at those higher numbers, so when the insulin brings it down into "normal" numbers, his liver thinks there's a problem and releases stored sugars and hormones to bring it back up fast. For example:

On the PM cycle on 14/6 he dropped down into the 100's (144 to be exact)....his body is used to living in the 300-500 range so when he dropped to 144, his liver thought he was too low and panicked, releasing sugar and hormones to bring him back up....and he "bounced" to 405 during the next cycle on 15/6 (plus, you didn't give any insulin that morning) Then you got a 292 for the PM pre-shot, gave .5 but didn't get any more tests in during that PM cycle (most cats go lower at night, so it's important to get those PM tests when you can). I'd bet that he dropped lower again, and so you got a "bounce" to 508 the next cycle (AM 16/6). By PM Pre-shot, he'd dropped to 310 and you shot the .75 again and he dropped to 117...and again, between his liver panicking and you skipping the insulin on the morning of 17/6, he "bounced" to 556

Today, he looks like he's starting to clear that last bounce, so it's important now to give the insulin every 12 hours (as best you can) and try not to let those pre-shot numbers scare you too much. If he's only in the 100's and you're scared to shoot, it might be better to go ahead and give a token dose, or just shoot the scheduled dose and leave some higher carb food down so if he does start to drop too low, he can get a snack. Do you have anyone (neighbor, friend, cleaning lady?) that could possibly check on him during the day when you're not able to?

One last thing..I see on 15/6, you gave Bruno a small shot of Lantus at 3pm because you saw that higher 405, then shot him again at his scheduled time of 8pm. If you don't shoot at your "scheduled" time, please don't give insulin in between times. It's just not safe. We know it's hard to see those high numbers and not do something, but that's just not how Lantus works

The dry food will just make getting him regulated a lot harder (or impossible) since it's too high in carbs. It's like trying to put a fire out by pouring petrol on it. It just doesn't work. If you can find some of the low carb foods on the lists Hillary gave you, it'll be a lot better for Bruno...as well as cheaper for you than those prescription foods!

Look forward to seeing you over on the Lantus Tight Regulation board! You'll get a lot of experienced eyes watching out for you there, even if you don't use the TR protocol!
 
Just to add on to what Chris wrote, there are some cats that do receive three or four shots a day. While this is not recommended procedure for all cats, some cats do need an extra small amount in between the two main doses. This is only done AFTER working the protocol consistently and still finding the BG's going up too much.

So while this is not the normal protocol or recommended, with understanding of how everything works, knowing your cat and what all the numbers mean, if necessary, it can be done. not many people know how to work insulin this way.

Like Chris said, at this point don't give additional doses during the cycle. let's see if we can get him regulated and into safer numbers.
 
Thanks Chris and Hilary,

To answer some of your questions, since I get just the prescription from the vet and a brief explanation from a translator (I do not speak Russian well) I see from the box than Antral is something for the liver, as well as Keron 10000. The Keron he just refused to have it, if I gave it to him with his food, he started to refuse to eat, even for an entire day, until I put new food without the medicine. Antral, he takes more easily also with his food. But, as I read already some of the posting in the Forum I do not see anybody giving other medicines besides the insulin, so I am not sure if this is really needed. It´s worth to mention that while at the vet´s for 10 days, he was tested for everything, they made ultrasound of his organs, and everything seemed to be well, besides a "small problem with his renal function" as the vet said, but she also mentioned it was not very important and that many cats suffer from this problems.
I took a look of the list of food that Hilary gave me, but none can be bought in Ukraine, I saw one store on the internet that sells Leonardo, but besides that, we have the whiskas, sheba (just the normal food), and the "expensive but not so good" as they are called on the list: hills, science diet, royal canine.
I saw some other brands that are not listed, one German, Dr. Clauders, and an Italian Aptum Alta Qualita, that supposed to have "50% of quality meat".

I also think, as Chris said, that Bruno has now get used to the high numbers, with high numbers 300-400's he's purring and happy. Once he reaches the 100's he barely moves, don't want to eat much and he seems unhappy.

Unfortunately, I do not have anyone to rely on during the day, and I do have a girl that helps at home but only once a day. I was thinking to try to get someone during the week to help me with him, and ask at the vet's if they know a service of pet sitters or something like that, apparently there is not such a think in Ukraine.

Also I tried to at least buy an automatic feeder, he had one in the US for many years and it worked, but again, you cannot buy one here. I'm trying to see if I can buy in the US and have it shipped here, I'm sure it's possible, just not sure about how much will that cost, not cheap for sure, but this will solve the problem. I will also try to follow the recommendation on frozen food left out, and see if he eats that. Thank's for the idea.

I will also try to measure more often, now is 1am here, for example, it's just that I know it's necessary but brakes my heart that he heats the testing process, I pet him, talk to him, but as soon as he sees me preparing the glucometer and the strips he runs to hide, and he gets so nervous. I must also mentioned that while at the hospital (10 days) they measure on the inside part of the ear, every hour, every 2 hours the most, leaving him with very big crusts and purple spots on his ears. I was actually, measuring the same until I saw the video on how to make the puncture on the outside of the ear, and we are more happier now, but it seems like something very traumatic for him (and for me also).

Thanks for help I do need it, maybe you know any of the foods that I mentioned? I will start with 0.75 Lantus tomorrow and see the results, I can do more testings during the weekend.

Thank you again!
 
Can you get a first aid antibiotic ointment with pain reliever such as Neosporin? If yes, put a dab of that on a minute or two before testing to reduce discomfort. Wipe off well then test.

Also, after testing, press firmly on the puncture with a bit of tissue or cotton ball. This helps reduce bruising and scabbing.

If you can get the 'as fed' or 'dry matter basis' of the foods from the manufacturers, we can calculate the percent of calories from each of protein, fat, and carbohydrate.

You might see if a college/university student could help you with his care, or a veterinary assistant from a clinic.

Do you have a branch of www.Amazon.com where you are? Or a similar online company?
 
Check out Dr. Lisa's food list - Sheba and whiskas are on it and you may have similar ones that are on the list and low carb options to try. www.catinfo.org - go to the right of her page and click on the food comparison chart link.

Ask at the vet's office if there are any vet techs that you could hire to come over during the day. One of them may be willing and able.

You need to work on making the testing process fun for him. Always reward him after testing, so he has something to look forward to - reward can be food, pets, brushes (that was Maui's treat of choice), etc.

Just make it low carb food - such as a couple pieces of chicken, tuna, fish any kind of meat that you may have and he might like - don't know if you have deli meats out there - but my guys go beserk whenever I buy any cold cuts. Even a piece of cheese can work as a treat. Just be creative - stay away from dry food and temptations, whiskas lickins, etc. - that's just kitty crack.

As far as testing goes - either the inside or outside of the ear is fine. I always tested Maui's inside ear. And more recently, I had a houseguest and the rule for him was to test the outside of the ear. Whatever works for you and Bruno and gets the sample is the correct side to test.

So if you don't mind my asking - why are you in the Ukraine?
 
Thank you, Hilary. That´s a good idea to look for a student, it´s complicated here, but I´m sure there most be a way to handle it.

Why am I in Ukraine? Well, I am a Mexican diplomat, this is the reason that my working hours are from 8 to 12 hours a day, depending on many things. I got the Philadelphia, PA for for my first posting in 2001, where I adopted Bruno, close to Thanksgiving same year, well actually picked him up from Fairmont Park, were many street cats got together, close to a restaurant to the runners path. He seemed friendly and more likely to had a home once. After some years, we moved to DC, then back to Mexico. We´ve been here in Ukraine almost 7 years and I think we will move to our next destination next year.

Bruno and me, we have quite a path together, he has been my travel companion and my family everywhere I go. I need to get him better so that he will be able to travel to our next posting :-D

Ukraine has been a challenge for both for the language barrier and the poor quality of medical services for Bruno, since he´s no teenager life becomes more complicated, but we are up to the challenge.
 
thanks for sharing your background. I was born in Phila and grew up in the suburbs. I moved to NJ/NYC for a job (that I long since left). I can only imagine the challenges you and Bruno have in the Ukraine - but how wonderful to have him as your traveling companion.

Let's see how we can make sure he stays that way and get him regulated so you can breathe easier.
 
another idea that I have is if you are able to access facebook - there is are a couple feline diabetes groups on there (two are associated with FDMB - feline diabetes and lantus land

and another group - called feline diabetes support group - https://www.facebook.com/groups/207764985923899/

one of the moderators of this group is Gayle Charamburra, she used to be part of this group, but left for various reasons. she is one of the most knowledgeable people that I know in understanding not only diabetes but other cat issues. She doesn't talk in a flowery manner, rather is more direct and to the point ( and some people don't like that approach) but she is so knowledgeable. I turn to her for cat things that come up that have nothing to do with diabetes.

If you are able to (I know some countries ban access to facebook) please go on there and join this group - share your spreadsheet and tell Gayle that I sent you....The more help you can get the better.
 
Status
Not open for further replies.
Back
Top