Diarrhea after 2nd insulin shot for newly diagnosed cat

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Jess and MrCat

Jess and MrCat

Member Since 2013
Hi!
My recent rescue, Mr. Cat, is a very big 13-year old tabby (13.9 lbs but not overweight, just large). He was just diagnosed with diabetes a few days ago. Before he started insulin, I immediately put him on a high-protein, all wet food diet, which he loves (up to that point, he was on a 70/30 wet/dry diet with the same wet food he gets now). After 4 days on the all-wet diet, he started insulin (Lantus) last night. 2 units at 9pm last night and 2 units at 9am this morning.

He just had his first BM today and it was watery diarrhea. He feels warm behind the shoulders, warm ears, warm paws and dry nose. I called the vet and left a message but no reply.

Any thoughts? Is diarrhea normal when first administering insulin?

I checked his BG today with a home monitor and it was 231. Last week, his BG at the vet (blood test) was 375.

Thanks for your advice!
 
It can be due to abrupt food changes.

You might try Forti Flora, or plain canned pumpkin, or 1/4 teasppon of unflavored Metamucil/psyllium powder in the food.
 
I did not change the food brand. He has been eating one 5 oz can of the wet food every day for 6 months. He used to eat dry food as a supplement. When I took him off the dry food on Friday and gave him only his wet food, his stools have been completely normal for the past four days.
Since his insulin last night and this morning, the stools changed to diarrhea.

I have some canned pumpkin, maybe that will help. Thanks!
 
Thanks, Squeaky. I appreciate the support!

Mr. Cat is such a sweet guy. I am sure we will both adjust. Thanks again!
 
Hello, and welcome Mr. Cat and your caregiver to the FDMB, the best little place in the universe to help your diabetic cat. What is your name?

I checked his BG today with a home monitor and it was 231. Last week, his BG at the vet (blood test) was 375.
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What time was that BG test in relation to the shot?

Wink was prone to diarrhea and UTI's when his BG (blood glucose) was over the renal threshold. Excess glucose provides a perfect nutrient rich breeding ground for bacteria. The pumpkin helped him. About 1 tablespoon per serving of food.

So I'm saying , the diarrhea could be a coincidence with starting the insulin last night.
 
Hi Deb & Wink-

Mr. Cat's first BG reading of 231 was 8 hours after his morning dose of insulin. It was my first time getting blood from his ear and it wasn't fun, but we did it. The lancet pen really helped.

He ate a good dinner tonight and is resting with me on the couch so.... I think we're OK for today. Mr. Cat was definitely not fed properly for his first 13 years (previous owner fed him only dry cat food) so we have a little catching up to do. Hopefully, Mr. Cat will feel better soon!

Thanks to everyone for the support. This site is just great!
 
Ok, test at +8. So Mr. Cat was probably headed back up. Thank you for letting me know

We suggest getting a pre-shot test. That one is key, to know if he is high enough to give the insulin. We recommend a no shoot threshold of 200 for beginning members.

Would you please add the insulin (Lantus) and the meter you are using to your signature? Food brand and style (i.e. pate, sliced) is good to see. Any history of DKA? or complicating medical conditions? Like CRF or IBD. These are all nice to see in the signature.
 
What wet food is it? Some wet foods are too high in carbs if your goal is remission (achieved in 84% of cats with a good low carb diet, a good insulin like lantus and home testing).

To keep mr cat safe and get a better idea of whats going on we recommend four tests a day if you can manage it

1. always test immediately before the shot. You dont want to shoot if he is too low (initially thats under 200 until you have data to know what shooting under 200 does) and low preshots are likely as he gets regulated
2. Mid cycle - 5-7 hours after the morning shot to see how low he goes on the dose. Thats about peak lantus action time.... although cats do vary
3. before bed - 2-3 hours after evening shot to see what his overnight plans are

Then we track results on a spreadsheet to watch for changes and trends and you can share it with your vet and us if you want more eyes on it and advice Heres how: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Wendy
 
Hi Wendy-
Thanks for the tips! It has been one week since Mr. Cat started Lantus. Testing has been very difficult, so I stopped trying to test until today.

After he ate breakfast (1/2 can of Trader Joe's wet Chicken) and before his first Lantus shot this morning, Mr. Cat tested at 197. I had not yet read your post about the 200 mark, so I gave him his regular morning shot of Lantus (2.0 units). 2 hours later, he tested at 137. Should I also test at +4 and +6 hours or can I just wait until 6 hours?

As a follow-up to my initial post, Mr. Cat's diarrhea cleared up the next day and he's been fine ever since. He seems to have more energy and, best of all, his pre-diagnosis red and bleeding gums have cleared up almost entirely (the bleeding gums were the reason I took him to the vet and that's when I found out he was diabetic). Overall, he seems happier and has more energy. :)
 
If you can get a +2 or 3, that'll let you know if he is diving. And if he is diving, you may need a spot of food to steer the numbers from going below 50 mg/dL.
 
He started this morning at pre-shot 197. His +2 was 137. He has a little food in his dish now and I'll keep an eye on him. Thanks!
 
By the way - Did you get the nutrition values for the foods being given on the food chart at Cat Info?

Just checking.
 
You are off to a great start. Make a few tweaks and maybe we can tweak him into remission...

1. The freestyle lite meter isnt a great choice unfortunately . Its inaccurate at anything above 200 - it tends to show numbers lower than they actually are, giving you false comfort. If you are in the US I would recommend going to walmart and getting the cheaper Relion prime or confirm!

2. Trader joes is a little too high carb at 11% calories from carbs .See here http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf ) - you really want under 10% calories from carbs (not % carbs by weight or volume). which flavours of the natural choice are you feeding? many of them are too high carb too. Thats why many of us prefer the fancy feast classic pates, friskies pates or wellness grain free. See the link for more choices.


Wendy
 
Pre-shot but post-breakfast (Trader Joe's) =197; +2 =137; +4 =100.


I have been giving him Natural Choice duck and chicken pate with 12% protein and 3% carbs so I think it's OK. I have a few cans of Natural Choice left (just ran out of Trader Joe's) and plan to use them. I'll get him some Fancy Feast classic later today.

As for the meter, I purchased it before I found this website and spent $250 at Rite Aid on the Freestyle Lite, 150 strips, lancets, etc. So.... I'm not really inclined to go out and buy another meter until I run out of strips (sorry, Mr. Cat). I will just have to remember that his BG may be lower than the meter reading.

Thanks for your suggestions! I am hopeful that Mr. Cat won't be on insulin for very long!
 
MrCat said:
...Pre-shot but post-breakfast...
Click to expand...

Within about 15 minutes, you test first, feed, and shoot.
Testing 1st makes sure it is safe for the cat to receive insulin.
You don't have to wait for him to finish eating before giving Lantus.
 
I will just have to remember that his BG may be lower than the meter reading.
Click to expand...

Do a 180 degree turn please. It's not that the True* and Freestyle meters read too low at low numbers. They read too low at high numbers. So if the meter reads 200, your cats' actual BG could be in the 300's or 400's. So you think your cat is under renal threshold but he is not.

Since you do not want to buy a different meter right now, you may want to buy ketodiastix. These test for both ketones and urine glucose levels. If your cat is over the renal threshold, excess glucose will show up in the urine.
 
It looks like his numbers are consistently below 200. Is the meter accurate below 200 or is it low?

I'll pick up ketodiastix. He is really good at giving me a urine sample so it will be no problem!
 
Mr. Cat's final numbers for today:

pre-shot=197; +2 = 137; +4 = 100; +6 = 124; +8=137; +12 (pre-shot)= 216

These numbers reflect only one week of treatment. I am working on the google docs so this will be easier. Thanks for any input or advice!

P.S. Wendy-Natural Choice is 3% carbs by weight, but that is a high estimate. The NC soft pate has no grains, no veggies, only meat, liver, broth, guar gum, vitamins, minerals. I only have a few cans left, so when I run out, I'll switch over to Fancy Feast pate.
 
MrCat said:
Mr. Cat's final numbers for today:

pre-shot=197; +2 = 137; +4 = 100; +6 = 124; +8=137; +12 (pre-shot)= 216

These numbers reflect only one week of treatment. I am working on the google docs so this will be easier. Thanks for any input or advice!

P.S. Wendy-Natural Choice is 3% carbs by weight, but that is a high estimate. The NC soft pate has no grains, no veggies, only meat, liver, broth, guar gum, vitamins, minerals. I only have a few cans left, so when I run out, I'll switch over to Fancy Feast pate.
Click to expand...

Jess, if you are still using the Freestyle meter, you may want to toss it. Way too many people discovered that their cats had much higher BG than they thought.
 
MrCat said:
As for the meter, I purchased it before I found this website and spent $250 at Rite Aid on the Freestyle Lite, 150 strips, lancets, etc. So.... I'm not really inclined to go out and buy another meter until I run out of strips (sorry, Mr. Cat). I will just have to remember that his BG may be lower than the meter reading.
Click to expand...

Deb & Wink said:
I will just have to remember that his BG may be lower than the meter reading.
Click to expand...

Do a 180 degree turn please. It's not that the True* and Freestyle meters read too low at low numbers. They read too low at high numbers. So if the meter reads 200, your cats' actual BG could be in the 300's or 400's. So you think your cat is under renal threshold but he is not.

Since you do not want to buy a different meter right now, you may want to buy ketodiastix. These test for both ketones and urine glucose levels. If your cat is over the renal threshold, excess glucose will show up in the urine.
Click to expand...
 
Thanks so much everyone!

Afer 24-hours on Natural Choice (no more Trader Joe's) Mr. Cat's first-morning BG measured at 166 today, 30 points less than yesterday. I live in a pretty isolated neighborhood and don't have a WalMart nearby, so I ordered an Accu-chek Aviva kit online for $15 through Amazon. I also ordered ketodiastix. I'm going to check the Freestyle against the Accu-chek when I have them both on hand, just to see if my Freestyle is really that far off. In the meantime, Mr. Cat is doing great. He's going to start on the Friskies pate today, which I am sure he will enjoy (he loves to eat anything new!).
 
BG of 166 for AMBG! Nice. Very Nice! Congratulations.

Still no insulin this morning?

(AMBG = morning BG if no insulin given)
(AMPS = morning BG if insulin was given)
 
MrCat said:
Thanks so much everyone!

Afer 24-hours on Natural Choice (no more Trader Joe's) Mr. Cat's first-morning BG measured at 166 today, 30 points less than yesterday. I live in a pretty isolated neighborhood and don't have a WalMart nearby, so I ordered an Accu-chek Aviva kit online for $15 through Amazon. I also ordered ketodiastix. I'm going to check the Freestyle against the Accu-chek when I have them both on hand, just to see if my Freestyle is really that far off. In the meantime, Mr. Cat is doing great. He's going to start on the Friskies pate today, which I am sure he will enjoy (he loves to eat anything new!).
Click to expand...

Way too many people found that the freestyle meters, with the butterfly strips did not give true numbers at the upper range....most tests were always in the 200s or lower and none at all were about 300.... when the Freestyle was compared with several other meters, if the cats had higher BG, all meters registered correct numbers except the Freestyle. i cannot say how reliable the Freestyle is at lower numbers though.

Since the signature, which seems important to many, has Freestyle Lite as the monitor, I would have expected someone to point out that they are switching to Accu-chek soon.
I think that note is more important than the cat's dose.

Gayle
 
Numbers so far today AMPS=166, +4 = 56

Even though the Freestyle apparently reads lower than a true reading (meaning, it may show 166 but he could have a BG of 200+) I still decided to lower his first insulin shot this morning to 1.5 units instead of 2.0 units. Glad I did! When I checked him at +4, his BG showed 56. He seemed great but I immediately gave him two ounces of Trader Joe's (for a few carbs) and a 3-oz can of Natural Choice pate. He ate most of it and was quite pleased (purring now)!

I will check him again at +6 and +12, but if his numbers are still low, I will skip his evening shot. From what I understand, Freestyle is more reliable in the 0-150 range. Even if Mr. Cat is not actually 56 and is more like 76 or 86, I still want to re-test before giving any more Lantus. I'll keep you updated!
 
The food will bring him up some. We don't have a lot of history on Mr. Cat to see how low this 1.5U dose will bring him.

I'd test again in 30 minutes if he were my cat. He still has a couple of hours to go before an average nadir time of +6. We want a safety zone to keep him above 40 if we can. Dropping into the 40's means time to pull out a little syrup and/or HC (high carb) food.

We could really use a spreadsheet setup for Mr. Cat.
 
Unfortunately, I have almost no history on Mr. Cat. He was diagnosed 10 days ago, so I followed my vet's instructions to give him 2.0 units of Lantus twice per day for 7 - 10 days and then bring him in and test at the vet clinic.

Well, Mr. Cat didn't want to go to the clinic yesterday, so I home tested him every 2 hours (see 7-22-13 below). Prior to that, I home tested him on the day after he started insulin, but I had such a hard time with him, I only tested once at +8 (BG 231) and then I gave up. I have a spreadsheet for him, but I just haven't set it up on Googledocs. His only history is below.
This is it:
07/15/13 (BG= 375 vet blood test Dx) , gave 2.00 units in evening
07/16/13 2.00 units in am, BG 231(+8) then 2.00 units in pm
07/17/13 through 07/21/13 - 2 units twice per day with no testing
07/22/13 AMPS 197, gave 2.0 units; BG 137(+2) 100(+4) 124(+6) 137(+8) PMPS 216, gave 2.0 units (changed from Trader Joe's wet to Natural Choice pate)
07/23/13 AMPS 166, gave 1.50 units, BG 56(+4) 81(+5)

Yesterday, his nadir time was +4 and it seems to be the same today. That's the best I know so far.
 
He doesn't have to be awake to test him. Some people test their cats when they are sleeping. :mrgreen:

With that low of 56 at +4, it's important to make sure he has not dropped too low, under 40. He could have dropped even lower. I strongly suggest getting that +5.

ETA: I see you did get a +5. Next test at +6 would be good.

Higher carb food can wear off and his numbers could go back down.
 
I just added Mr. Cat's Spreadsheet to my signature line. I think I might start a new post since the diarrhea issue is over. Thanks to everyone for your help! Please join me on the next post about Mr.Cat...... "Only 10 days on Lantus - heading to remission?"
 
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