Diabetes Has Returned- Advice needed for diabetes + HCM

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Skeseth

Member Since 2013
Hello everyone,

Once upon a time FDMB helped me tremendously with my recently diagnosed kitty, Snickers. I followed suggestions for diet and insulin and just generally the support helped me calm down enough to be able to care for her. She was diagnosed in September 2012 and spontaneously went into remission in November/early December. Now, it has returned with a vengeance and I have spent the last 4 days with her in the animal hospital that I work at. I literally slept there (though they were only 3 hours each day) and was terribly afraid for her. We have just returned home but I am closely monitoring her. Her history is as follows:

Remission in Nov/Dec. Bloodwork wellness check in Feb. revealed beginning chronic renal disease. March recheck had no change. Periodic blood glucose always remained around 120, but had not checked in last month from busy with house hunting/etc. Saturday morning, found her lethargic, not too responsive, and very dehydrated. Took back to work with me to check ketones, found trace ketones and left her there for treatment. Along with ~200mL SQ fluids and then the bolus and fluids they were giving her at the vet hospital, she was in heart failure by the late afternoon when I went to work. Pulmonary edema was bad and had to D/C her fluids and treat with lasix. This further dehydrated her and she was worse on Sunday morning. Ketones were negative 4-5 times after the first time we checked, but was more concerned with her heart failure and hydration. Slowly hydrated her, rechecked everything, was much improved. Today's echocardiogram revealed early stage of Hypertrophic Cardiomyopathy.

Basically, my main question and concern at the moment is not only trying to once again regulate her glucose, which is ALL over the place (400's at work last night, 54 right before I took her home and before I gave her food), but also what medication to start for her HCM. The best advice is advice from others that may have gone through with this before. I read that Atenolol is bad for diabetic patients but just how bad and which way? It is the recommended drug of choice by the internal med specialists at my hospital, but the other doctor that did the echo recommended dilacor. Research I did does say that Atenolol is best, too. I'm so confused and worried now, and I do have 4-5 doctors that I have spoken to and can continue to chat with, but personal experience with what others have done means a lot. My stress levels are definitely at their limit after being told her prognosis was so poor and she would be likely unable to ever get out of the hospital. While we are home now, she is eating and drinking and went and used the litter box but is just immediately laying on the floor. I suspect she feels so beat up after so many days away and being poked every 2 hours for 3 days straight... Not sure if I'm over-reacting with worry now. I would appreciate and love any advice, especially which of the two medications to give and if anyone has had experience with atenolol for their diabetes mellitus feline companion. Thank you!
 
You should get more responses tonight. The board is pretty quiet during the day. One thing you can do is to go up to the top of this page and choose the search function. Put HCM in the subject.. That should get you all the threads that have HCM in them. Might be some good info for you.
 
I realized that problem after I posted, heheh. I just became stressed calling around for prices and googling information about Atenolol and Diabetes. The vet doesn't want her to start for at least another day or two until her blood pressure goes up so I'm not immediately concerned about the answer.

Now I'm more worried about her glucose. I just took it again, 4 hours after the last reading and she has had some food, and it is now at 50. She was on 2.5 % dextrose in the hospital which was removed at 6am. Keeping an eye on her and pulling out the Karo syrup I bought ages ago just in case. She's been lethargic but still moving between litter box and water bowl. :/
 
What insulin? You want to test every 15- 20 minutes until you get 3 readings in a row that are going up. I would try regular food first and see if she comes up. If not, if you have or can get the gravy Fancy Feast, it is great to take the gravy off it and just have her eat that. Higher carb without filling her up.
 
I do not know if the vets that have seen her are board certified cardiologists, but if they are just IM specialists or regular vets, she needs to have a workup by a cardiologist who will then give you the correct meds and fluids, if needed, for her. I would not treat her with anything given by a regular vet. Only a specialist in cardiology should and work with her regular vet about the diabetes, etc.
 
I do understand that, and in the future will likely to her to a Cardiologist. Unfortunately they would not give me a discount like they have at the specialty practice that I work at and the referral to the IM specialist that understands echos. It is several hundred dollars in difference plus a long drive that my Snickers would not have taken well right after coming off fluids and being hospitalized :( I wish I had the money to afford the half grand it costs to go to a specialized cardiologist but I only just had enough for the other, considering I have to purchase her insulin again among other things.

Here's hoping someone here has used the medication in the past with their diabetic cat.
 
She is currently on Lantus, had gone into remission with it before. As far as how much, that is still undetermined. 150 last time I checked today and it is about 1 hour til I need to start giving her SQ insulin and start at 1U (she was up in the when she went without insulin 500s the last few days).
 
It sounds like she might have (or might have had) an underlying infection spiking her BGs and causing her ketones. Was she given any antibiotics? It could also be the other medical conditions wrecking havoc on her BGs, but I don't know enough about those to say for sure.

I do know steroids are notorious for spiking BGs, causing diabetes (often transient), and/or sending a cat back out I remission. I would see if there were other options first before using the steroids. If not, you treat the more serious problem with the steroids and use the insulin to counteract the high BG side-effect.
 
... And you just reminded me that after so many days, I forgot to get her urine to send out a culture :( I did a dipstick but the doctor accidentally got a flash of blood in the urine so that was hard to determine. Was going to send out a sample but for a day or two she was too critical that I forgot. One of the vets did not even think she would make it home...

Is Atenolol a steroid? I did not look that closely into the medication. At the moment her BG is most important to control and figure her new insulin dose... At least until her BP is up to start heart medication.

But thank you, I will be sure to get a culture done of her ASAP when I go into work in a day to see if it is a UTI. I cannot stress her out right now by returning.
 
To check for ketones, you can buy some ketostix at the store (any diabetic aisle should carry them for relatively cheap). We also have a few techniques for catching urine if you need help. I didn't see it anywhere, but are you also testing her BG at home?
 
Testing both at home, and she tested negative for ketones for the last 4 days thankfully. Glucose is still all over the place but now that she is not on fluids and 2.5% dextrose, trying to see how she really does. Was mid-400s just now post 1.5U of insulin. I will do a true glucose curve this weekend when she is less stressed, as she was tested every 2 hours for 3 days straight.
 
Not sure what's going on (either iPhone issue or user issue :lol: ) but I missed 2 entire paragraphs in your first post, so sorry for the redundancy!
 
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