Frustrating!!! Many Questions

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miaomi

Member Since 2013
Hello Every one, my cat Mao has been on insulin for 39 days, her number has been all over the places. My vet first told me to give 1 unit every 12 hours, after 17 days, the vet let me increased to 2 unite. After 10 days for 2 unit, I thought 2 maybe too much, so I reduced to 1.5. Since Mao had big fluctuation in BG numbers, the vet told me to decrease to 1 unit. Today is the 3rd day to give 1 u, her reading has been high. The vet said that I need to keep 1 u for 5 days, the thing is that Mao suddenly does not want to finish her food from yesterday to today, she wanted food, but did not want to eat. She was starving all the time before. And she vomited 4 times all in the mornings, sometimes with food, mostly just liquid, I saw she lip licked like she is nauseous. She lost more weights, she has not gain any weight back since back home from hospital. I checked her ruin and no ketone. She drinks lots water. My questions are:
1. Do I have the correct insulin does? What should I give?
2. Do you think she is insulin resistant? What to do?
3. Why she suddenly doesn't want to eat? What should I do? Should I give her Pepcid ac? Should I worry?
4. Is she pancreatitis? What's the cost to find it out at vet? Is pancreatitis requires immediately attention?
5.Do you think she needs emergency care? ( already spent $3800 for hospital stay, I cannot afford it anymore )
6. Her ears are red and hot sometimes, do you think they are infection, maybe too much tests? Any solution?
I am frustrating and helpless. Mao is very important to me, I just do not know how to help her! Any suggestion is appreciated! Thank you!!!
 
Her dose has been all over the place; no wonder the glucose is jumping around.

Her initial dose should have been calculated as follow:
Take the lower of her current weight or ideal, in kilograms (pounds/2.2)
Multiply by 0.25
Round down to nearest quarter unit.

Then, the same starting dose should have been continued for a minimum of 5 days, up to 7 days.
Next, tests in the +5 to +7 hours after a shot will show how low the cat is going - the nadir.
If the nadir is above 150 mg/dL, a dose increase of 0.25 units would have been appropriate for most cats.

Every time a dose is changed for most cats, the change is 0.25 units at a time. Too big a change may miss the best dose for your cat. Also, you keep the same dose for at least 6 shots/3 full days minimum.
 
If she does not eat for 2 days -> vet
If she cannot stop vomiting -> vet

1/4 of a 10 mg tablet of Pepcid AC may help; give 30 minutes before feeding.
 
miaomi said:
She is 6 pound, so what the does should be?
Click to expand...

6 lb / 2.2 * 0.25 = 0.68,
rounded down to nearest quarter unit = 0.5 as a starting dose of Lantus.

Then you have to give that at least 3 full days (if it were the very 1st dose, you would wait 5 days) to know how it is working when you test 5 to 7 hours after the shot.
 
If you give too much insulin, the body releases stored glucose to keep it from going too low.

I think you may have been giving too much insulin.

Any time you get a test < 50 mg/dL, it is an automatic dose reduction of 0.25.

Have you read and understood the instructions in the Lantus Tight Regulation forum?
 
She is on insulin for 39 days. The first does was 1u, then 2u, 1.5 u, now 1 u. I do not know if I should keep the 1 u or not because her number is high.
 
Go to the Lantus Tight Regulation forum, read, and if needed, print out the Stickie posts on how to use Lantus properly.

Come back and ask about anything you do not understand in the tight regulation protocol.

You were treating an infection at the start; that raises glucose.
She had good green numbers on 1 unit.
You increased to 2 units and got higher numbers.
So stick at 1 unit for 3 full days (6 shots) and you may get lower numbers.
Test at +5 to +7 on shot 7.

Any < 50 mg/dL = reduce dose 0.25.

You change doses by too much; only change 0.25 units up or down.
 
I will do that. Thank you for replying. Her pmps number was over 400, I just reduced the does to 0.5 u.
 
Hold it there at least 3 full days, maybe up to 7 days to get it really stable and let the depot drain.

Depot: Lantus forms small crystals under the skin. These slowly dissolve, releasing insulin molecules. A small amount may remain at the next shot time - this is the depot.

Back on 12/2/2013, she got a 38 after 2 shots of 1 unit; this earned her an automatic reduction to 0.75 then. You kept giving her 1 unit.

When you skipped the next shot, the low number caused stored glucose (glycogen) to be released, raising the glucose very high. Lows, plus too much insulin, appear to have kept her in high numbers, with occasional drastic drops.
 
For now, just hold at 0.5 units unless below 50 mg/dL
Also check for urine ketones (tips in my signature link secondary Monitoring Tools).

Practice with colored liquid and a used syringe.
Fill to 0.5 units
Squeeze out equal sized drops 1 at a time and count how many you get.
Practice until you can do the same number of drops, the same size, each time.
 
Don't blame yourself, many vets are a bit out of date with diabetes. I would try and get a before bed test (2-3 hours after pm shot) for the next few days at least. It will let you know if he is dropping low at night. Many cats do. If the before bed test is lower than the preshot test then set the alarm for another test a few hours later.

Also don't assume the nadir is +6, cats do vary. Maybe get a few spot checks during the day to see.

Hold the dose for a few days like BJ says and do a bit more testing like I suggested and we should get a better picture of what's going on.

Wendy
 
Your vet hasn't lived with day to day, home monitoring of a diabetic cat or two. And it is natural to trust the vet. With what you learn here, you will be able to help your cat be safe and healthy on or off insulin. And maybe, you will be able to share what you've learned with your vet and others.
 
OK. I'll do more tests. She ate 2.5 oz of food this morning much less then before, she ate 7oz three days ago and 18 oz a day. Thanks BJ and Wendy!
 
She may need to eat 1/2 to 1 ounce of canned food per pound of ideal weight so a 12 pound desired weight could need as much as 12 oz food per day, divided into 2 or more meals.
 
She has not eaten much for three days, she ate 5oz so far today. She has not gained any weight back, even she ate 18 oz a day for a month. She pooped lots.
 
Until her BG (blood glucose) levels are better regulated, her body can not process the food she eats properly.

You may need to do a bit of assist or syringe feeding, to get her to eat more.

Can't advise you on the digestive enzymes.

Looks to me from viewing your SS (spreadsheet) that you are making too many changes in the insulin dosage, too rapidly. You need to find a dose you can give twice a day and get those BG numbers down.

You may want to go over to the forum for the ISG for the Lantus TR group and look at the stickies at the top of the page. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 Good explanation here on holding the dose and making increases/decreases in the lantus dose based on the lowest reading or nadir.
 
She ate 3oz this evening, I am very happy. It's too bad that I have not find the right does for her, I just reduced the does to 0.5U last night, the nadir was 206 today. I will see how it works on her.
 
With a low or nadir of 206, I would not have suggested you reduce the dose. The protocol we use doesn't reduce the dose until the cat goes <50 mg/dL on a human glucometer.

The depot takes a minimum of 3 days or 6 cycles to usually see an effect from a dose increase. Slightly shorter time to show a change with a dose reduction.

Since Lantus has a depot or storage effect, you need to be more consistent on the dosing. Here is the sticky over from the Lantus TR forum on the depot and what it means. STICKY: LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?

Please, stay with this current 0.5U dose for a minimum of 3-5 days. With the frequent changes you have been doing, Mao has been bouncing all over the place BG wise. Let's see how this 0.5U dose does.
 
You said she pooped lots.
- Were the feces formed well, or more like pudding dropped on the litter?
- What color were they?
- What kind of odor did they have - normal, really awful, or other?
 
Yellow? Most feces are a brownish color, often a dark brown.

It is possible there may be some damage to the part of the pancreas which makes digestive enzymes. This can happen in pancreatitis (inflammation of the pancreas, lack of appetite, vomiting). There is a fPLI test that can be run when the cat has fasted for 8-12 hours which can test for this. Discuss this with your vet about using the enzymes.
 
That's what I am concerning. I don't know if she has pancreatitis, my vet said the treatment is somewhat non-specific and supportive. The vet can give me anti nauseous pills. Do you know how much for the Pli test?
 
Hi :) I had my cat tested for the fPLI (the quick test) in November that was $28. When it came back abnormal it was sent off for the PLI which was $112. I take my cat to UPenn vet school so their charges may be a bit higher. Not sure what the norm is. My vet doesn't send off for PLI unless fPLI comes back abnormal.
 
Also, you can discuss with your vet treating the cat 'as if' it has enzyme deficiency. This is called empirical therapy - basically if it looks like that coulc be correct, you treat it that way.

The risk is that you are giving an unnecessary treatment which could make the cat sicker. As the digestive enzymes are over the counter, I would guess the risk to be small ... but please ask a vet.

And if you are looking for a new vet, see my signature link Vet Interview Topics.
 
I am gonna call the vet and get her fPLI test done.
I always believed that Mao has digestion problem because she passed out all she ate, never gained any weight but lost more. I told you the odor of her stool was normal, but I'd like to say that actually the odor somehow had wired smell to me.
 
Yellow poops 2-3 times a day and weight loss sounds like Exocrine pancreatic insufficiency to me. Ask your vet about that too. You treat with digestive enzymes and will know if it works when you hit the right dose as the poops will become brown and less frequent.

Wendy
 
Do I need prescription to get the digestive enzyme? Mao doesn't have appetite, she pooped lot even she ate little. I' d like to give her syringe feeding, where can I buy this kind syringes?
 
Mercola makes over the counter digestive enzymes for pets. Check our shopping partner Amazon.
 
Her Numbers are much better, I am glad I reduced the does to 0.5U. Thank you! We'll see the vet on Monday. Mao is loosing weight, she is very skinny now.
 
Let's hold this 0.5U dose for at least another day, maybe 2 days and then reevaluate how Mao is doing. She may need an increase in the dose, but we want to get past the bouncing first.

Are you still feeding only the Tiki chicken and Egg?

Hope the upcoming vet visit can confirm the suspected EPI (exocrine pancreatic insufficiency).

Please, keep us posted on what the vet says and how Mao is doing.

FYI: You need to fix the date on your ss for the most recent date. I think the 1/19/14 should be 1/10/14.
 
Mao vomited twice this morning, did not want to eat. I brought her to the vet instead of next Monday. Mao got fluid and B12 injection there and checked urian, no keystone and no infection were found. I discussed with the vet about all my concerns, the vet said they were possibilities, but it wouldn't be an accurate result if tested a sick cat for EPI or PLI.... Mao needs to be regulated. She wanted me to increase the insulin does to 1U because her numbers were still high. I have kept giving Mao 0.5U for two days and today is the third day. I will check her nadirs through the weekend, then I'd like to know if can increase 0.25U insulin in coming days.
I still feed her the TiKi Chicken, also Natural Verity Lamb & Beef. The vet thinks I don't have the right food, but those food are all low cab, right?
 
I still feed her the TiKi Chicken, also Natural Verity Lamb & Beef. The vet thinks I don't have the right food, but those food are all low cab, right?
Click to expand...
Hoping you mean the Nature's Variety foods? The Nature's' Variety Instinct Grain-free Beef is 3% carbs. The Nature's Variety Instinct Grain-free Lamb is 2% carbs. Those are both nice low carb options to feed a diabetic cat.

Are those Tiki Chicken foods you are feeding the Puka Puka Luau and the Koolina Luau? Those are both 0% carbs per the catinfo.org food chart.

What food does your vet think you need to be feeding?

Was Mao dehydrated, is that why the vet give her fluids today when you went to the vet?

Here is the part of the TR protocol that applies with the nadirs that Mao is getting.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
Click to expand...
Mao has been at the current 0.5U dose for 6 cycles, as of this morning. We are seeing nadirs >200 but <300, so the protocol says to increase by 0.25U. That would put Mao's dose at 0.75U.

I do think that holding that 0.5U dose for 6 cycles has given us some good information, but it's time to increase the dose to 0.75U.

You could increase at this evenings PMPS or wait until tomorrow. What do you think you would like to do?

It looks to me like Mao has been bouncing up higher at night. Would you be able to get a test at around +2 or +3 tonight? One last test before you go to bed would be very useful data to have. Do you think that would be possible for you to do on a regular basis?

Did the vet say why they thought Mao was vomiting so much? Is the vomiting food, or bile?

I know I've asked a lot of questions, but I'm trying to figure out what is going on with Mao.
I'm concerned that Mao is losing so much weight and she seems to be vomiting frequently. I think you need to assist feed, either syringe feeding or a feeding tube or hand feed her or something. I'm worried about Mao.
 
Thank you Deb! My vet didn't know those food brands; she suggested me the Fancy Feast Classic Chicken or Turkey Feast, said those have the carb below 5. I asked the vet if Mao needed the Fluid because she vomited and the B12, she agreed that Mao was dehydrated, also the B12 was always help. Mao vomited food once this morning and more liquid fallowing, most of time she had vomited just liquid. My vet thought Mao is not regulated yet, so the vomiting was related to that. Mao started eating since we have gotten home, maybe the fluid is working on her, but she pooped three times.
I am thinking if I can wait to increase the insulin does tomorrow, and like you said to get +3 and more tests tonight, I definitely can do it on regular basis.
Thank you so much for your concerns and help!!!!
 
You might want to give your vet a link to the food chart we all use. Here it is. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdfI certainly don't know all the foods off the top of my head and what the carb values are. I had to look up the ones you were feeding. We are very grateful for all the time and hard work that vet Dr. Lisa Pierson put into developing that food chart, and we rely on that information quite a bit.

Your vet is correct that the Fancy Feast pate style foods are also good foods for a diabetic cat. My Wink loved the Turkey and Giblet pate but will also eat the FF classic Chicken and some of the others. It's mostly the classic, tender, flaked styles in the Fancy Feast that are the lower carb selections.

Thank you for letting us know you will try for some more tests in the evenings. That will help us to see better what is going on.

Did the vet suggest anything like Cerenia for the vomiting? With the amount of weight loss, I don't think Mao can afford to keep vomiting up so much food, and something to help with the nausea would be good. You can't wait until she is regulated to stop the vomiting. I think it needs to be addressed now.

I'll be keeping my eyes out for updates on Mao. Glad to hear she wanted to eat after you got home from the vet.
 
She did not mention Cerenia, I did not get any pill from her; I probably need to call her on Monday. She let me get Adolfs Meat Tenderizer, said it's equal to Enzymes, also buy probiotic.
 
Adolf's meat tenderizer contains papain (enzyme). It also may contain unneeded salt, so check the label. Mercola makes a product specifically for pets.
 
Mao bounced high last night, she was starving again, I fed her food after each test. Should I hold the 0.5U wait for the bounce to clear? thanks!
 
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