Discouraged and worried...

[brickyard]

Hello,
This is my first time posting and I am hoping for some wisdom from those more experienced. My 10 year old cat was diagnosed with diabetes a year ago and I've never been able to get her blood sugar remotely regulated. I'm really worried about her, and don't feel like the vets I've taken her to take it all seriously enough or can explain why she isn't responding.

She used to be quite overweight, and in retrospect she was always hungry and drank a lot. She was tested last year and her BS levels were around 350. I put her on Hill's MD first, then after a month or so and reading around I decided to switch her to an all meat and lower carb food. She started on ProZinc and at first it seemed to help and I saw numbers down around 70 (I home test). But for every good day with low numbers there three or four where she never went below 300. I can't remember all the details honestly, but after two months or so, I stopped seeing the low numbers and she was usually between 500-250 even as I increased her dose. During this time she also had recurrent bouts of diarrhea with blood in it. In the fall I had a test done for pancreatitis, which was inconclusive, and in January another test that I forget the name of but it was pancreatitis related and checked something with her intestines - it came back fine. Her bloodwork (full panels) have all been ok too other than her glucose. The last test was probably in January. Back then her cholesterol was extremely high (the Instinct wet food I was using was high fat) so she was put on Hill's WD. Her cholesterol has gone back to normal and I'm wondering if she should come off the WD now to something lower carb, but also low fat - but I'm not sure what would be a good option. She seems very sensitive to changes in diet too - she ate some oat grass that I grew for her a couple weeks ago and had intense intestinal upset the next day. Her diarrhea kept being a problem and finally (!) the vet decided to send her sample to a lab for a test that checked DNA for whatever they found and would tell me what she had.

So, in the last month I found out she had clostridium enterotoxin and coronavirus in her intestines. She just finished 3 weeks of metronidazole and I give her FortiFlora daily and once a week B12 shot and sub-q fluids. She still has unhealthy look stool with blood in it, though it's better formed than it had been. In January she was switched to Lantus and is now on 5 units of Lantus twice a day. Generally it seems to move her blood sugar no more than 100 points down from her pre-shot high, and some days it just stays within about 20 points of that number. And on bad days it just goes up and stays up all day. (Sorry - my testing data isn't organized right now - just on note paper all over the house.)

She is very skinny and no matter how much I feed her she doesn't gain weight. Her blood sugar is completely unregulated. No matter how much I give her - 1/2 unit or 5 units her blood sugar is erratic and can be anywhere from 500 to 170 in a day. Increasing the dose honestly doesn't seem to have much effect - she stays in that range with low and high doses! (I usually don't use the Lantus for more than a month before getting a new vial.)

I don't know what to do. I've gone to three vets and a specialist and no one has been able to help her. The only good thing is that whenever we've tested her she has not had ketones. Other than that she is wasting away and it is so hard and frustrating to keep trying to help her and to keep having nothing get better. I'm not sure what my next steps should be. I feel like I need to find a way to get her to gain weight (She's about 7 pounds down from about 11 last year), but I don't know why the insulin isn't helping more and I don't know if it's her diabetes or intestines that are keeping her from gaining weight. She eats 2+cans of WD a day, and is always hungry.

Sorry for so much info, but I really hope someone has had success in dealing with similar issues and can offer advice. I love my kitty so much and want her to live a long and happy life.

thank you,
belle

 

[MommaOfMuse]

Hi and welcome to FDMB

Well part of the problem very well could be the WD you are feeding her, as it is a whopping 26% carbs, most of us here try to stay below 10% carbs and many of us find that 7% carbs or lower even better for our sugar cats. Not only that but it is highly over priced for the quality of ingredients that it contains. There are much better options available on the commercial market that will also be much less expensive and probably help a great deal in getting your little girl at the very least regulated, if not off insulin altogether.

Many of us fed Fancy Feast classics, Friskies pate on the lower priced side of things, but where you also have to worry about the fat content you might want to also consider things like EVO or Wellness as they tend to be higher in protein and lower in fat. Now here is the good news...you don't have to try to figure out the carb/protein/fat content yourself...we have a handy dandy chart that has it all figured out for you. :lol: Binky's List. Hopefully someone else will be along with a link to the other chart we have around here that I can't find at the moment. But Binky's will give you a good start on finding her a better diet.

I think the first place to start is getting her on a lower carb diet and personally I would take her dose down to 1u bid, while checking her often for ketones(you do know you can do that at home as well, right?) since you are home testing (Congrats on that one that is the best tool you have in helping her out and keeping her safe) you will be able to tell right away if the change in diet is helping or not. The biggest problem is that 5u bid is a whopping dose of Lantus if she isn't IAA or Acro, which is why I suspect that at least part of the problem is the 26% carbs in her diet. Especially if she is eating tons and not gaining weight. The other part of the problem could also be too much insulin that has her in chronic rebound. The only part that truly sucks is that too much and too little insulin can look exactly the same, but from what you are saying without hard data it sounds like you probably have at least a two fold problem. As too much insulin is a lot of times seen as a day or two of low numbers followed by the cat jumping right back up into the high numbers and then staying there which usually makes the human raise the dose of insulin which instead of solving the problem only makes it worse...sort of like throwing gasoline on a fire to try to put it out.

The thing that will help us the most to help you and your girl out is if you can either get a spreadsheet set up or until you get to the point to give us your data like this since we are spread out over all kinds of time zones and even countries.

amps (reading before morning shot)
+1
+2 (number of hours after insulin that the reading was taken)
+3
etc
pmps (reading right before evening shot)

Also don't know if your vet has told you this about Lantus or not so please bear with me if I repeat something you already know but want to make sure we have the basics covered. Lantus works off a shed/depot so the dose needs to be consistant and held for at least a week before changing the dose unless of course you get a very low near hypo number. Dose increases are based off the nadir (the lowest point in between shots usually around +6-ish for most cats) reading not the preshot numbers. And both increases and decreases are done in very small increments no more that .5u at a time and usually .25u at a time to keep from passing the ideal dose.

I think that covers everything that I can think of at the moment, although I'm sure I have missed something but knowing the folks around here if I have someone will jump in and fill in the blanks. But for now I need to run, got to go poke a kitty and feed the herd of furbabies here before I am breakfast..lol

Mel, Maxwell, Autumn & The Fur Gang

 

[brickyard]

Thanks Mel for the thoughtful reply so early in the morning! I agree that her found is a problem. I do want a low carb food again, but Evo really seemed to disagree with her when I tried it last year.
Also, unfortunately I had her on low carb food for about 6 months (Evo 95%, Instinct, and FF Classics) and I was seeing the same BS numbers, both on ProZinc and Lantus (I tried Lantus last August for a month). And for most of the last year her dose was down between .5 and 2 units, it's only been in the last 4-5 months that I became frustrated and bold enough to gradually increase to the 5 we're currently at (increased by .5 units about every 2 weeks after 24 curves). I even took her off insulin back in December for a week to see if she needed it because I was convinced the poor regulation was from the rebound you're describing, but her numbers were still the same as now, and they stayed that way all the way through .25, .5, 1, 1.5... And during that phase she was still on the low carb food. I think the biggest difference I saw with the food was that her BS goes up dramatically after eating and takes longer to come down, but the curves aren't that different now.

I really feel like something else is going on - that she is somehow not able to consistently use the insulin. She is so skinny that I wonder where the insulin even goes when I inject it since she doesn't seem to have any fat. And I wonder if it's possible to get rid of the intestinal bugs while she's under so much stress (and worry that the coronavirus will take the opportunity to move into her organs!).

The weirdest thing is that her curves and averages don't really change much from no insulin, little insulin, and 5 units. When I first started her on ProZinc last summer she had some good numbers (I was trying tight regulation) and I had days where she was within normal to 250 all day, but it stopped happening when her diarrhea got bad and even when that's seemed under control, the good BS hasn't come back.

 

[Julia & Bandit (GA)]

FYI--Evo and Wellness are incredibly high in fat, not low, so if fat content is a problem I would stay away from those foods.

https://docs.google.com/file/d/0B8Uu8g1u8Su9YTgxNGE1MDItM2MyMC00Y2Y3LWI4ODMtMzhkYTkxOGM4NThk/edit

Three very good low fat, high protein foods that do not contain byproducts (so you have control over the protein source) are Merrick's Cowboy Cookout, Merricks' Surf and Turf, and Merrick's Grammy's Pot Pie. Cowboy Cookout has beef as the main ingredient, Surf and Turf is mainly Beef with a bit of seafood (but not much), and Grammy's Pot Pie is chicken based. I would start out with the Grammy's Pot pie, and if she takes to that, try the Cowboy Cookout and see if she tolerates the Beef ok. If not, you might want to just stick to the Grammy's pot pie. Remember to give her a week or so to adjust to the diet change--some cats are very sensitive and they have runny poo until their GI system has time to adjust to the new diet. Fortiflora (a probiotic for cats) helps a great deal with this. You can get it from your vet or on Amazon (where it's cheaper than the vet). Here's a link to help you find Merricks near you: http://www.merrickpetcare.com/where-to-buy.php

Bandit has mild IBD and does not tolerate high fat foods very well, and he does fabulously on the Merricks, but we get runny poo if I feed EVO. However, there are a ton of things that can cause GI upset. It could be the fat content, or it could be a food intolerance. You'll have to do some trial and error to figure it out. FYI, the most common food intolerances in cats are grains, fish, and beef, in that order. You can't sort out the problem with foods with byproducts, because those byproducts could contain anything.

Can you set up a spreadsheet with what data you have? Here's instructions on how to do it: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. Without seeing your data, it's very hard to tell what (if) the problem might also be the dosing. One thing that can happen with Lantus, even when you're testing regularly, is that if you're not getting at least 3-4 tests each day (before each shot and then the nadir, which is usually about 6 hours after the shot), then the numbers can be misleading and you can get into an overdose/chronic rebound situation. If you haven't been getting daily mid-cycle numbers, overdose my or may not be an issue, but it's really impossible to tell until the diet is changed and you start collecting those numbers. Like Mel said, even .5u increases can be too much depending on what her nadirs are like.

My guess is that the food is your biggest problem right now. Make sure you are testing frequently and lowering the dose when you change to a low carb diet! you can have a deadly hypo situation on your hands otherwise.

 

[Dale 'n' Chip]

The only thing I can add is I third the motion to get off the w/d.

And watch closely you may need to reduce the dose since that *food* is very high in slow release carbs. I doubt any cat should ever be on it. I fed half a case of w/d to one of mine by accident and I'm not sure he is over it yet.

I really like the Merricks, I only wish my diabetic Chip would eat it. I am trying to avoid beef out fear of developing intolerance.

 

[Julia & Bandit (GA)]

Beef intolerances are far less common than grain or fish intolerances. Most cats can tolerate beef fine. If your cat does not currently have a problem with beef, the risk of developing an intolerance to it is low enough where I wouldn't worry about it, especially if there is a medical reason that you would want to feed the Cowboy Cookout (e.g. the need for a low fat food to manage GI issues, or the need for a high protein, low fat food for a senior cat to help prevent muscle wasting or encourage weight loss in an overweight cat). Of course, if your cat is unlucky enough to develop an intolerance, then you certainly do want to avoid beef foods.

 

[Dale 'n' Chip]

Beef intolerances are far less common than grain or fish intolerances. Most cats can tolerate beef fine. If your cat does not currently have a problem with beef, the risk of developing an intolerance to it is low enough where I wouldn't worry about it, especially if there is a medical reason that you would want to feed the Cowboy Cookout (e.g. the need for a low fat food to manage GI issues, or the need for a high protein, low fat food for a senior cat to help prevent muscle wasting or encourage weight loss in an overweight cat). Of course, if your cat is unlucky enough to develop an intolerance, then you certainly do want to avoid beef foods.

That's good to know since the only thing Chip will eat right now is Fancy Feast Classics flavors with either beef or fish.

He doesn't seem to show any intolerance (he's only 7 years old) but he did eat the dry Hills products for 5 years. My 18 yo (a very close blood relative to Chip) seems to be intolerant of almost everything including beef. So eventually I'd like to get Chip off fish and beef before he gets constipation and/or IBD because the family tendency may be there.

 

[rhiannon and shadow (GA)]

I should be careful saying this.
The vet might not appreciate being bombarded with many people but.....
on www.catinfo.org

Dr Lisa Pierson says she is available for phone consultations. Her email is at the bottom of the page.
I emailed her requesting a consult but I only had a short question so instead of calling me, she emailed me back very quickly.

I think you just email her and give her your phone number and request a consultation.
Yours is definitely not a quick reply and she seems to know her stuff for diabetic cats.

 

[Sienne and Gabby (GA)]

Seeing what Shadow's BG test results look like would be very helpful. What you're referring to as "erratic" numbers may be the result of your cat bouncing off of lower numbers. Bounces are not unusual and the more time your cat is able to spend in lower numbers, the less your cat will bounce. Without knowing how you got to your current dose and how Shadow is responding makes it hard to put all of the pieces of the puzzle together.

The only thought I would add is that you might want to consider a switch to Levemir. Lantus forms its insulin depot in fat tissue. If your cat is considerably underweight, it may effect the the way that Lantus is being utilized or stored. Unlike Lantus, Levemir binds to albumin, a protein, in order to form its depot. While the two types of insulin act in very much the same way, their pharmacology is different. It may be that switching will help with BG levels until you can sort out the GI issues.

I would also second the suggestion to consult with Dr. Pierson. My sister's cat was having a number of health and weight issues with her cat and she found a consultation with Dr. Pierson to be very helpful.

If you do look on Dr. Pierson's website, you'll note she is a strong advocate of a raw food diet. There are a number of people here who's cats were experiencing GI issues and the switch to a raw food diet had a very positive effect.