Heart failure and diebetes

[Astrid]

I am wanting some advice my boy is diabetic he was diagnosed in july last year, and is in CHF which was diagnosed 4 weeks ago. He only starts to drop in the afternoon and gives me lower preshot numbers than the mornings. He is on 3.5u of prozinc now. He started on caninsulin and he was having the same sort of cycle. Any advice would be so helpful. This is such a hard journey

 

[Astrid]

Edgars Readings

 

[CORKY]

@Suzanne & Darcy

 

[Suzanne & Darcy]

I am wanting some advice my boy is diabetic he was diagnosed in july last year, and is in CHF which was diagnosed 4 weeks ago. He only starts to drop in the afternoon and gives me lower preshot numbers than the mornings. He is on 3.5u of prozinc now. He started on caninsulin and he was having the same sort of cycle. Any advice would be so helpful. This is such a hard journey

Hello and welcome to the FDMB!

When did he begin with ProZinc? What is he eating and when do you feed him during the cycle? Although I am having a hard time with your spreadsheet because there is no U.S. tab on there where I can see the numbers, I can still see that he is quite high most of the time. We can get your spreadsheet updated to our format later. Don’t worry, you will still be able to enter your world numbers on the world tab.

What other medications is he taking for his heart. What kind of heart disease does he have: hypertrophic, dilated, obstructive?

 

[Astrid]

He started prozonc on the 10 of Jan. I have atttached some documents of his meds, readings and daily routine as well as his info from the first heart scan (i am still waiting for the vets to send me the report from last weeks scan). Feeding will be at +3 and +6.

 

[Suzanne & Darcy]

Regarding the diabetes, I would take him up to 4 units. Your nadirs are very high with mostly in the 300s and occasionally in the upper 200s so a .5 unit increase is warranted.

 

[Suzanne & Darcy]

Okay. It looks like you are giving several of the most important medications. I am glad to see Pimobendan is one of them.) Does the vet’s report mention that fluid is present in the pleural space (pleural effusion) or inside the lungs (pulmonary edema) or around the heart? What about “smoke” or spontaneous echo contrast? What is his resting respiratory rate? Hopefully you will get a more detailed report from them soon. Has he had to have any fluid removed at this point?

I am feeling very sorry that you are going through this with Edgar. I have experience with diabetes and heart disease in my cats and it’s not easy. It’s good that you are staying organized. I had a very detailed spreadsheet for all the meds I had to give.

Just so you know, if the Lasix (furosemide) isn’t keeping the fluid away, there are other diuretics that can be used such as Torsemide, which is longer acting as well. Also, as my kitty’s heart disease worsened and she had an even greater risk of a blood clot, the cardiologist had us add a second blood thinner (Xarelto). She never had a blood clot. I also gave her some supplements like Nattokinase and Rutin, but that is another story.

I can send you a study about the safety and efficacy of using Rivaroxaban (Xarelto) in conjunction with Clopidogrel.

 

[Suzanne & Darcy]

With regard to your feeding schedule. It seems okay for now. Generally I advise the first small snack (tablespoon of low carb wet food) to be given at +2 when the ProZinc onsets, but I don’t see Edgar’s BG consistently dropping at this time. His cycles are irregular.

Why are you feeding medium carb at breakfast and dinner? That looks like it’s giving him a substantial food bump in BG. The way to test this is to give breakfast and test before (obviously) and test again in 30 minutes to an hour. If the BG has risen quite a bit then it’s the food. By +2 we really should be seeing the BG starting to go down.

Feeding much food after nadir also can raise BG prematurely as the action of the ProZinc is starting to wane.

 

[Astrid]

Sorry i must have attached the wrong screenshot, i was feeding meduim card wet as his ketones were rising but he is now just on the low carb food and i monitor ketones daily

 

[Astrid]

Okay. It looks like you are giving several of the most important medications. I am glad to see Pimobendan is one of them.) Does the vet’s report mention that fluid is present in the pleural space (pleural effusion) or inside the lungs (pulmonary edema) or around the heart? What about “smoke” or spontaneous echo contrast? What is his resting respiratory rate? Hopefully you will get a more detailed report from them soon. Has he had to have any fluid removed at this point?

I am feeling very sorry that you are going through this with Edgar. I have experience with diabetes and heart disease in my cats and it’s not easy. It’s good that you are staying organized. I had a very detailed spreadsheet for all the meds I had to give.

Just so you know, if the Lasix (furosemide) isn’t keeping the fluid away, there are other diuretics that can be used such as Torsemide, which is longer acting as well. Also, as my kitty’s heart disease worsened and she had an even greater risk of a blood clot, the cardiologist had us add a second blood thinner (Xarelto). She never had a blood clot. I also gave her some supplements like Nattokinase and Rutin, but that is another story.

I can send you a study about the safety and efficacy of using Rivaroxaban (Xarelto) in conjunction with Clopidogrel.

He has fluid around his heart and lungs. They havent removed any fluid. They havent mentioned anything about a echo contrast. His RR is usually around 28

 

[CORKY]

@Suzanne & Darcy

 

[Astrid]

Regarding the diabetes, I would take him up to 4 units. Your nadirs are very high with mostly in the 300s and occasionally in the upper 200s so a .5 unit increase is warranted.

With his lower preshots in the evenings would that not be concerning? I am assuming he is having a delayed reaction to the insulin since the blood isnt pumping properly around his body

 

[CORKY]

I tagged Suanne, I will also tag Sienne, she has an incredible knowledge on cats' illnesses

@Sienne and Gabby (GA)

 

[Suzanne & Darcy]

He has fluid around his heart and lungs. They havent removed any fluid. They havent mentioned anything about a echo contrast. His RR is usually around 28

Perhaps it isn’t enough fluid to remove. I am surprised that they didn’t discuss this with you. Frequently, my cardiologist would say that Ginger had “scant” fluid and that it wasn’t enough to warrant removing it. If the report says scant fluid you will know. You should have a very detailed report with heart measurements and blood flow measurements, etc. the stuff you shared was just “discharge instructions” type summary of what they want you to do at home. Nothing detailed.

 

[Suzanne & Darcy]

With his lower preshots in the evenings would that not be concerning? I am assuming he is having a delayed reaction to the insulin since the blood isnt pumping properly around his body

Well, let’s look at his spreadsheet — recent data shows two evenings where he had yellow preshots in the high 200s. You gave a 3.5 unit dose of insulin and he didn’t drop at all. In fact, his numbers rose. You also do an excellent job of testing so I know you will carefully watch those numbers. Having the high BG can damage blood vessels in the heart and lead to high blood pressure and increased risk of heart failure. I think that is why your cardiologist was so adamant about getting the diabetes under better control. That is what I read in the paper you shared anyway. Did they check blood pressure and report it to you?

 

[Astrid]

Perhaps it isn’t enough fluid to remove. I am surprised that they didn’t discuss this with you. Frequently, my cardiologist would say that Ginger had “scant” fluid and that it wasn’t enough to warrant removing it. If the report says scant fluid you will know. You should have a very detailed report with heart measurements and blood flow measurements, etc. the stuff you shared was just “discharge instructions” type summary of what they want you to do at home. Nothing detailed.

They did not give me anything else besides that report. They did bloods the week before his scan which i have attached now

 

[Astrid]

Well, let’s look at his spreadsheet — recent data shows two evenings where he had yellow preshots in the high 200s. You gave a 3.5 unit dose of insulin and he didn’t drop at all. In fact, his numbers rose. You also do an excellent job of testing so I know you will carefully watch those numbers. Having the high BG can damage blood vessels in the heart and lead to high blood pressure and increased risk of heart failure. I think that is why your cardiologist was so adamant about getting the diabetes under better control. That is what I read in the paper you shared anyway. Did they check blood pressure and report it to you?

They checked it a week or so before the scan and it was normal

 

[Astrid]

Perhaps it isn’t enough fluid to remove. I am surprised that they didn’t discuss this with you. Frequently, my cardiologist would say that Ginger had “scant” fluid and that it wasn’t enough to warrant removing it. If the report says scant fluid you will know. You should have a very detailed report with heart measurements and blood flow measurements, etc. the stuff you shared was just “discharge instructions” type summary of what they want you to do at home. Nothing detailed.

I have attached the scan reports from the most recent scan

Perhaps it isn’t enough fluid to remove. I am surprised that they didn’t discuss this with you. Frequently, my cardiologist would say that Ginger had “scant” fluid and that it wasn’t enough to warrant removing it. If the report says scant fluid you will know. You should have a very detailed report with heart measurements and blood flow measurements, etc. the stuff you shared was just “discharge instructions” type summary of what they want you to do at home. Nothing detailed.