Diabetic Neuropathy Update

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bigdogmom1

Member Since 2013
About a month ago I posted regarding my 16 year old Siamese Simon having symptoms of diabetic neuropathy and received lots of information about Methyl B12. I saw my vet about a week after receiving the information on M B12 and he said he had never had a cat in his 25 years of practice that had DN. He read the information I copied about M B12 and he agreed it was worth a try. Since starting Simon on M B12 about three weeks ago his condition has become progressively worse. His back legs are so bad now that he constantly walks on his hocks and kind of "bounces" along. He only walks a short distance and will lie down. His back is humped up constantly also. His condition has gone from a slight DN to full blown crippling DN. I am so worried about him because he is in such bad shape.
Simon is still a happy cat, plays with toys, loves attention, eats well and has no problem with receiving his insulin twice a day, every twelve hours. I do not do home BG testing on Simon. I take him to the vet every two to four weeks and have him tested and weighed. The vet is happy with the results and feels that his blood sugar is under good control. While I am impressed with the people on this board in their vigilance of their cat's blood glucose levels, I feel that my vet knows best for me and my cat and I really feel that I should adhere to my vet's recommendations at this time.
In short - all the information I read about Methyl B12 gave me so much hope for Simon's recovery. I know three weeks isn't so long but what really worries me is his quick progression to being nearly crippled by diabetic neuropathy even with the M B12. Is this normal? Should I increase his dose - I'm giving him 5 MG a day - should I give him a second pill in the evening?
Thank you all for your help in the past and thank you today before hand. I am so worried about this guy - he is my 84 years old mom's cat and I think it would just kill her to lose Simon. She is as worried as I am and I would love to give her some encouraging news about our Simon. Again, thank you for your help, Linda and Simon (and Mom, Mae)
 
i am sorry to hear your cat is having issues with his neuropathy. Methylcobalamin takes a good 4-6 weeks to work but you really need to have the blood glucose under control too.

Here is info on dosage : http://www.laurieulrich.com/jasper/#dosage but I think Simon is probably getting enough. Also check your pills dont have any sugars or xylitol in them.

Can you start home testing? We can help advise.

Wendy
 
I agree with Wendy. Simon's diabetes must also be on the road to control for the MB12 to work at its peak efficiency.
I gave my Trouble a pill (5mg)in every meal. I crushed it up to a fine powder and mixed it well into his food. It did take a good 5-7 weeks to work.
Best wishes,
jeanne
 
My vet is happy with Simon's blood glucose levels and I really want to adhere with my vet's advice about testing his blood sugar levels at home. We do a fasting blood sugar at his office, a weight and then a chit chat about the results. Simon is on Prozinc, 3IU every twelve hours. We started with 2IU 2X a day, tested, then bumped it up 1/4 IU until we arrived at the 3 IU. As I said, my vet is finally happy with the results and Simon has been on 3 IU for a month now and doing very well on it.
My main concern is how quickly his neuropathy has progressed even with taking the M B12. could it have a counter effect on some cats? Could it actually be working against his system since he has gone so far down hill in only a month?
And JT - how many meals a day does Trouble get, meaning how many 5mg doses a day does he get? I spoke to my vet about the M B12 just yesterday and he suggested bumping his dose up the 10 mg/day. So would you advise that? Would you advise any more than 10 mg? There was nothing in the literature about the benefit of giving more than 5 mg a day is why I ask. I know that the "unused" portion is excreted in the urine so I probably couldn't overdose him on the M B12.
So the question now is - will increased M B12 possibly help AND shouldn't his neuropathy have at least been arrested with the M B12 even if it didn't "cure" it? I mean really, he has gone from a cat with just a little walking down on his hocks to being barely able to walk at all in one month (which I think is a really quick progression of the DN), and with three weeks of that one month on the M B12.
Thanks Wendy and JT for your quick answers. Linda and Simon and Mom
 
Please tell us what your vet considers to be good BG numbers. Can you provide all your test results with a date associated with them.

How is the testing done? Only a single test at the vet clinic? With a glucometer? or a fructosamine test? How many hours after insulin is the test done?

If the numbers are above the renal threshold still, then the nerve damage is ongoing, thus making the neuropathy worse.

My foster Wink had horrible neuropathy when I started to foster him. Walking exclusively on his hocks. Stopping every 3-5 steps to rest because DN is painful. Couldn't jump, couldn't run, couldn't play, difficulty with the stairs.

It was only when I got the BG's under better control, under 200 with every test, that the neuropathy showed signs of improvement. Yes, he was receiving methylcobalamin injections 0.25 mg once a week. but it was the BG numbers, low BG numbers that did the trick.

I say it was the low BG numbers, because Wink was not on the methyl B-12 long enough, it takes 6-8 weeks, to see improvement.

He is running, jumping, playing and getting into mischief as if nothing was ever wrong with his legs.
 
The testing is done at the vet's office, I don't know what type of blood glucose test. It is done about 12 hours after Simon's last insulin injestion and about a ten hour fast. His last BG was 252 and since Simon is totally shook up visiting the vet, my vet says he gives him about 50 points for high stress, so in reality it would be around 200. His weight has been consistent for about 3 months, he no longer has "swampy" pee and doesn't consume huge amounts of water any more. Linda
 
So to clarify, your vet does a single BG (blood glucose) test when you bring your cat in. Not multiple tests.

ETA: What was the date on that BG of 252? How long ago?

Do you have any more BG ( blood glucose) numbers and the dates those numbers were taken that you could share with us?

I really want to adhere with my vet's advice about testing his blood sugar levels at home.
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Does this mean you do no home testing?
 
The 252 BG was just this past Thursday. Before that all BGs were right around 300 give or take a few points. After each 300 bg the vet increased his dose of Prozinc by 1/4 IU. When Simon was originally diagnosed with diabetes he had a full day of BGs scheduled for every couple of hours but because he was so stressed and wouldn't eat any of the food I brought from home he didn't get the full range of tests done. As a matter of fact his BG went very low by hour 8 because he wouldn't eat.
My vet didn't arrive at three IU of Prozinc by chance. We started at 2 and bumped it up by 1/4 IU after each of the BGs that were around 300 and then retested after 2 weeks to see how his BG was. I have tested Simon a couple of times at home when I thought he was hypo (he actually wasn't) so I do know how to test. I have my own glucometer so we share. But no, we don't do charts and graphs of his blood sugar levels. My vet feels that Simon is well under control finally and doesn't feel a need to raise his insulin at this time but will continue to monitor it every couple of weeks.
So back to my original question - Simon's BG levels indicate he is finally in control so - is more better in the use of Methyl B12? Would a larger dose, say 5 mg in the morning and evening feed help him? Are there cats who either don't respond or have an adverse reaction to the M B 12? Thank you
 
So back to my original question - Simon's BG levels indicate he is finally in control so - is more better in the use of Methyl B12? Would a larger dose, say 5 mg in the morning and evening feed help him? Are there cats who either don't respond or have an adverse reaction to the M B 12?
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I have never heard of a cat that has had an adverse reaction to the methyl B-12. Someone else may know differently.
I don't know if there are cats that don't respond to the methyl B-12. Someone else may be able to answer that question.

Some side effects of methyl B-12 are itching, a rash, diarrhea, vomiting, loose stools, headaches, fever, loss of appetite.

You might want to do some research on the internet to see if larger doses are helpful or harmful.

I know that methyl B-12 is often used in human diabetics for the neuropathy. I don't know if any studies have been done to find overdose amounts in cats. It is a water soluble vitamin, so any excess will be excreted in the urine.

My answer on the dose increase is, I really don't know if this would be positive or negative.

If you decide to increase the dose, watch for side effects. If your cat develops some of those side effects mentioned above, especially the diarrhea, vomiting, loose stools, loss of appetite you may want to back off on the dose.

My reasons for asking about what your vet considers good, regulated numbers, was to see if that agreed with what other people on the board have referenced and what research has shown to be good numbers.

Your cat is just barely in regulated numbers. And that is only if your vets' method of subtracting 50 points for stress is anywhere near accurate. You have only been getting those better numbers for a week. It takes longer than that, 3-4 weeks minimum , to see if the lower BG numbers are helping with the neuropathy. Even though the numbers are a bit lower, more downward motion in the numbers will help to control the neuropathy.

A more accurate assessment of the actual BG numbers, can be made in a less stress free environment, in your home. I would suggest taking a few BG readings at home before your shot times to see how the numbers are trending. You do not need to fast your cat for 10-12 hours to get these readings. A test done without food 2 hours before, before you have given the shot of insulin will give you a good picture of what is occurring.

Studies in humans have found that numbers above 140 continue to cause organ damage and pancreatic damage. I don't believe any similar studies have been done for cats, but much of what we have learned from human diabetes is being applied to cats. We just don't know enough yet.
 
I get that you want to go with your vets advice. That leaves you with the responsibility of doing some homework because no vet is going to know everything about every condition for every species, including diabetes.

If you choose to learn more about feline diabetes which differs somewhat from human diabetes, the Americal Animal Hospital Association Guidelines are a good place to start. I encourage you to print them out, read them, share them with your vet, and discuss them.

We aren't vets; we do, however, live with or have cared for feline diabetics 24/7, monitoring their glucose levels and doing our best to keep them as well controlled as possible. Many of the cats have gone into diet-controlled status by following the information provided here.
 
Regarding the Methyl B12 - giving more than 5 mg daily isn't going to help your cat's neuropathy improve any faster. The body can only absorb up to 5 mg per day and what the body doesn't absorb will be peed out. If you give more than 5 mg you are just wasting it.

The Methyl B12 works in conjunction with insulin and reducing the glucose levels. Like everything else, it takes time for it build up in the body and start to work and depending on how severe the neuropathy is before starting the B12, depends on how long it will take to stop the deterioration and/or reverse the neuropathy. It can take weeks, even months.


Is the only reason that you don't want to test your cat's glucose levels at home is because the vet is happy doing it at the office?

How much money are you spending for each of these office visits? Are you really prepared to pay that amount indefinitely and not see any real improvement in your cat?

Let me ask this another way - if the patient in question were you or your mother - would you inject insulin based solely on the doctor taking a blood test while in the office? Or would you be encouraged to test your or your mother's glucose at home (like every human diabetic does) to make sure it is safe to give insulin?

Then why is it different because the patient is a cat? I am sorry, I just don't understand.

If you are afraid to test or don't know how. We can help you. Even your vet can teach you. If there is some other reason, please share because I just don't understand.

My former vet actually forbade me from testing Maui and told me that if I did, she refused to care/treat her ever! When I pushed her on this - she finally told me that she did not want to be sued if I did something wrong! All she was concerned with was being sued, not the well being of my cat.

I found a vet who supported home testing and thanks to the people on this board they got me started and showed me how.
 
@Hillary - Wow, just wow... I can't believe you would have the nerve to put YOUR "expertise" above that of my vet and your attempt to bully me into doing things YOUR way is quite nervy. You have in fact allienated me from this board, thank you very much.
I will address the "issues" you raised one by one for your information.
Just to let you know - it is absolutely none of your business how much money I spend on having tests done on my cat. NONE. And if I want to spend every dollar I have on it, it's still not your business. And where did I say there has been no improvement in my cat? If you were to READ my posts instead of thinking up ways to bully me into doing things your way, you would see that my vet has taken a conservative approach to treating my cat's diabetes by starting with a relatively low dose of insulin and after testing, bumping it up over time to get at a level that is right for him - him meaning the cat.
You say "Is the only reason that you don't want to test you cat's glucose levels at home is because the vet is happy doing it at the office?" Nice subtle slur on the veracity of my vet whom you don't even know. Could it be that I don't want to stick my old cat 8 to 10 times a day like some of the people on these boards? Could it be that I don't want to continue to hurt him multiple times in a day? Perhaps that is ok with you and others of your ilk but unless a person has a brittle diabetic cat there should be no need for these multiple sticks and it's just plain cruel IMO. Which channels right in with your "if it was your mother" question - I dare say my mother would know what was happeniong to her and she could either submit to the testing or not, her choice. These poor cats having their life blood pricked out of them drops at a time multiple times a day have no idea why their owners are treating them thus. People do. And BTW - I am a diabetic and I do not test myself multiple times a day and sometimes not for days at a time because I am regulated by my medication, I know when certain events will raise or lower my blood sugar and don't need to test until those events happen and then I adjust my medication.
You also say -" If you are afraid to test or don't know how..." Again, I refer you to my posts which you have obviously cherry picked so you can somehow impart your obviously superior knowledge to me - I said I have tested several times when I thought there was a problem with hypoglycemia. And you know, it's not rocket science, so no, I don't fear sticking the cat any more than I would fear sticking myself.
I initially appreciated the information I received on this informational board and I realize everyone here has a diabetic cat and has learned how to cope with their cat's illness. There are a lot of people with a lot of information which is a good thing but when you, all of you, insist of putting your own experience over that of a qualified vet's expertise, I actually find that quite shocking. To suggest possible approaches to different problems people are having with their cats is great and has probably saves some cat's lives. But to bully and demean and cast aspersions is absolutely uncalled for and it actually borders on a "too big for your britches" complex. You all seem to be so caught up in your diabetic cat's lives that you forget that not everyone MUST DO THINGS YOUR WAY.
In closing I would like to thank Jeanne and Wendy for giving me the information I requested. But especially to you Hillary, a big "how dare you" for trying to bully me, for casting aspersions on my vet and for just, well, getting ugly when you didn't have to. You might find that you don't need to bully, insult, demean and insist that people follow your rules.
 
Whoa! The written word, unfortunately, doesn't carry a lot of the nuances we use when speaking. It is possible you 'heard' that in a way that wasn't meant.

We have had folks with wonderful vets who bent over backward to help manage the diabetes. We also have had folks whose vets seemed to be interested only in how much money they could get from a cat with poorly controlled chronic illness.

We have had vets who were significantly out of date; some were interested in doing some continuing ed, some weren't. We have had vets who were on top of everything diabetes, including complex cases with other conditions which required modification of regular protocols.

As far as home testing goes - I did test before shots to make sure it was safe to give insulin and at nadir to make sure he didn't go too low, since I couldn't tell by looking at Spitzer if it was safe to give or if he was heading into a hypo. Even at very low numbers, he would look normal. Cats are good at hiding symptoms.

He would voluntarily come to me for testing when I went into the half bath. I never had to drag him out of a closet or from under a chair for testing. I don't think he would have come to me if it was torture.

Spitzer, like many cats, always found it very stressful to go to the vet and by home testing, I could avoid stressing him that way.
 
I did not bully you. If you took it that way, I am sorry. All I did was ask questions that any number of people on this board would ask. I cited examples and for instances as there are many that come onto this board and ARE AFRAID to test their cat in fear of hurting them.

A diabetic be it human or animal, needs to be tested. And I have yet to find a doctor that treats human diabetics tell the patient or caregiver, not to test at home, and to only bring the patient to the office for testing. I could have said if the patient were your child, but when I saw your profile it said you are 60 yrs old and you mentioned your mother being diabetic, so I used that example instead.

There are people who come to the board and are told they are not allowed to test at home. I was told this by my vet. And the reasons vary from liability to money. This is why I asked those questions.

I did not disparage you or your vet. If you want to be offended that is your choice. You stated several things in your post and I asked questions. I did not FORCE you in any way to do ANYTHING. You made assumptions. All I did was ask you questions to try to find out why and to see if we could help educate you, help you overcome any fears and help you to help your cat.

You are the one holding the syringe, you are the one to decide what you want or don't want to do. All we can do is provide information and help those that want our help. If you took offense to that - again that is your choice.

I will not communicate with you ever again. Good luck to you and your cat.
 
Linda,
I just wanted to relate one case I remember concerning Methyl B12 and neuropathy. You asked if 3 weeks was too short a time to determine if it was working or not earlier.

A wonderful lady, Lori, and her kitty Copper went through the same sort of thing it sounds like you are going through. Copper was in worse shape initially with regard to walking on his hocks (it sounds like your kitty was not so bad, but has gotten worse?). It used to make Lori cry to see how Copper walked, because he'd always been so active pre-diabetes. Anyway, Lori gave Copper the B-12 for nearly a year before he started showing real improvement. By that time, she also saw a huge improvement in his BG numbers and Copper was on a very low (less than 1u twice a day) dose. But eventually his neuropathy disappeared completely. Although he still needed two tiny shots a day, his numbers stayed below 200 most of the time, and he was just as energetic and active as he was before he developed diabetes.

So yes, I think 3 weeks is too soon to make a judgement. Like others said, I haven't seen or read about a kitty here who has had adverse reactions to the Methyl B-12. I have seen some who didn't seem to improve drastically and quickly, but some who did. And I also have seen more than just Copper who were on it a long time before things got lots better. So please don't give up hope. I do think that the improvement is largely dependent upon good control of the blood glucose numbers as well.

My cat, Bob, suffered some of what looked like neuropathy. But in his case, that wasn't the problem. His problem was low levels of potassium, evidenced by overall muscle weakness. He needed potassium supplements to fix his problem, and once his levels were in the normal range, the symptoms went away. Can you find out from your vet if he's tested Simon's potassium levels, and if they fall within the normal range?
 
There are a lot of people with a lot of information which is a good thing but when you, all of you, insist of putting your own experience over that of a qualified vet's expertise, I actually find that quite shocking.
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I don't think it's accurate when you say "all of you", because all of us don't put our own experience over that of a qualified vet.

I put my own experience in dealing with feline diabetes with my cat above the experience of my vet. And honestly, I don't believe that my vet has any problem with that attitude. She's never had a diabetic cat of her own. She has diagnosed and prescribed treatment for more than 300 diabetic cats in her 30 years of practice. But she's never done the day to day management of the disease herself. Before Bob (actually including Bob), she routinely prescribed Hills Science Diet M/D canned and dry food for all her FD kitties. She doesn't any more. And the reason for that is because she "learned" from my experiences that Hill's food is garbage, and low carb canned food works best for diabetic cats. She wasn't offended by my insisting that Bob was only going to eat Fancy Feast classics. And my experience, which was gleaned from this site and from another FD site, is what led her to "change". And probably 20 or 30 cats that she has diagnosed since then have benefited because of what I learned, and what she was willing to consider from Bob's tale. She also overdosed Bob, and his dose went from 1u BID to 4u BID in four or five weeks, with little improvement in his BG numbers. Had I not come here, Bob would have continued to get higher doses, and there's a very good possibility that I would have come home one day to find him dead from a seizure because I was giving him too much insulin. After learning here - and I never once asked for, or received any dosing advice here - that I was overdosing him, I scaled back the doses, and I didn't tell my vet what I was doing. Really, it was none of her business. He's my cat, not hers. And lo and behold, the people on the internet were right. Over the next six weeks, I adjusted Bob's dose based on information found here. He showed improvement on the lower doses, and went into "diet controlled" status six weeks later. He remains off the juice today, and he's healthier at 14 years old than he was at 8 years old.
I think my vet is the greatest vet in the world. But she's not an endocrinologist, and never claimed to be.

I think you said that your vet initially prescribed a dose of 2u, twice a day. Well, that might seem like a low dose. But it's actually twice the amount recommended by the AAHA for a maximum starting dose. I have no idea what your vet's "specialty" is, or how many diabetic cats he's diagnosed or treated over the years. If he is a feline diabetes expert, that's tremendous, and you'd be one of the more fortunate people to have joined the board. I've only been here for two years, but in that time, I would say that many of the people here know more about feline diabetes, and managing the illness than most of their vets do. And again, that isn't a big deal. So what? Vet school doesn't make any vet an expert on feline diabetes. The real "experts" are few and far between, simply because it isn't a disease that is among the most common things they have to deal with. Honestly, I hope that your vet is one of the more experienced in the field, because that gives you a huge advantage over the overwhelming majority of people who find this site.

There's a really good conversation about "advice giving" in the Think Tank forum currently, and if you want to, please take a look at it. It discusses much of what you addressed. And your viewpoint, that of a member who recently joined and sees attitudes that make you uncomfortable would be something that would be perfect to add to the conversation. I've posted a few times in it myself. And I said this in one of my posts:
Vets are experts. Granted, a lot of them sure don't seem to be able to buy a clue when it comes to managing feline diabetes. But that also isn't what they get paid for. They get paid to provide "GP" care to every animal they accept as a patient. The average person here has more knowledge of how to manage feline diabetes than the average vet does. But I don't think I'd call any of you for a housecall if my cat needed to be spayed or neutered.
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http://felinediabetes.com/FDMB/viewtopic.php?f=22&t=92465

And that's basically the way I feel. Vets get paid for doing what they do. You would hope that you could call them experts. But they aren't experts about everything. Nobody's brain can contain that much information. Most regular vets are jacks of all trades. They have to be in order to remain in business. But yes, the average person here knows more about FD than the average vet does. I truly believe that, and I think most vets would probably agree with that if they were honest with themselves.

I understand you have been offended by some of the things you've read in this thread. I'm sorry that this is the case. But please don't bail out and quit reading here. You and Simon can benefit from the information here, and not just relating to feline diabetes. Most of our cats have "other problems" at one time or another, and I've yet to come across a website with as much information on cat health than this one.
 
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