HEEEELLLP!!!

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Shara

Shara

Member Since 2019
Hello,
I have a 10yr old Manx named Nugget, that was diagnosed a little over a year ago with diabetes. I have not been able to regulate him AT ALL. Over the last year I have tried foods, 3 different insulins, and numerous tests. Nothing is helping and to be quite honest my faith in the vets in this area are diminishing very quickly. He has been tried on Vetsulin , Prozinc and he has now been switched to Lantus for the last month in a half. He is on Purina DM food. He has had routine bloodwork done numerous times (with no significant findings) , he has been tested for acromegly, ( did not have ) and I just sprung him from the hospital 2 days ago after being on IV's for his sodium and Potassium being out of whack. They also tested him for cushings.. that also was negative. I was a vet nurse for 19 years in California, so I check his glucose regularly and curve him when needed. He runs between 500 -700 ALL THE TIME. his drinking and urinating are literally out of control and I can get no help from the vets around here. NO ONE can tell me what is wrong with my cat and why he cant regulate. you guys are my last resort, am I missing something?? Unfortunately , even though his only real "symptom" is drinking and peeing 5 gallons a day, I feel my options are running out and that his time is limited. Any suggestions??
Thank you!
Shara
 
Welcome! I think a lot of us can relate to how you’re feeling right now.. I too tried for over a year to get my cat regulated and I was so lost until I joined the FDMB :cat:

It’s great that you’re already home testing - that will help a lot! We use a spreadsheet here to keep track of the home testing data, which will make it easier for people to give you advice. Here is the link with instructions on how to set it up

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I definitely recommend checking out the lantus forum. There are sticky posts at the top of the page with info about lantus and how it works, which might be helpful to you. Once you have a spreadsheet set up, you can also post there to get specific dosing advice. Here is the link to the lantus forum

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Lastly, it will also be helpful for you to set up a signature with relevant info about Nugget, such as age, insulin type, food, the meter you use, etc, so others will know how to advise you. To do that, go to the top of your page and click on your username, then “signature” on the left side.

Please ask as many questions as you have!
 
Hi and welcome Shara and Nugget to the fdmb.:)
I am sure we will be able to help you.
Just a few questions to gather information.

Can you tell us how much insulin Nugget is now on please.?
How did you increase the doses?
Did you go up in 1 unit increments? We recommend only going up in 1/4 unit increments each time.

Are you feeding any dry food at all?
We recommend only feeding a low carb (10% or under) wet/canned food.

If you have any blood glucose levels you could share with us in our spreadsheet, that would be very helpful for us to try and find out what is happening to Nugget.

Do you test before every insulin shot and again during the cycles to see how low the insulin is taking Nugget.?
Have you been increasing the dose based on the preshot or the nadir (lowest point)?

Sorry about all the questions
Sarah has given you the links to the SS and the signature. If you could set those up, that would be great thanks.
Here is a link for new members about how they can help us help them.
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216680/

Keep asking lots of questions. And reading all the yellow stickies at the top of the various pages.
We are always happy to help you.
Looking forward to hearing back from you.
 
Hometesting is the best tool that will help you get Nuggets glucose under control. By testing before every shot (preferably before eating) and also doing your own curves you can determine if his dose needs to be adjusted. The problem with relying on testing at the vet is that stress can significantly raise a cats glucose levels. So the number your vet may be getting probably is higher than what you would see when you test. Using the spreadsheet to keep track of your tests results and dose will help us guide you and recommend if the dose needs to be changed.

Also diet can contribute to higher glucose levels. You said you are feeding him Purina DM. is that the dry or canned food? Dry food is usually higher in carbs and that is why we recommend a low carb canned food diet instead. If it is the canned DM, according to the food charts, it has 6% carbs, which is a good number.
 
Hi guys, thank you so much for your quick responses.. I will have to sit down an actually read this spreadsheet thing, its a little confusing and I need a few to get it complete.
in the mean time this is a small run down...
Right now he is on both the wet and dry DM - he has stomatitis so I'm afraid to go full wet because of his teeth. He is on 2units of Lantus twice daily and has been since November 1st.
I did a curve on 10/26/19
6am - 533 Gave his 2 units of Lantus
8am - 606
10am - 403
12pm - 504
2pm - 509
5pm - 510
6pm -402
8pm - 398
10:45pm - 415

I did a few more checks the next morning cause they were trying to determine if he had the smogi effect.
10/27/19
6am - 401 Gave 2units of Lantus
8:45am - 449
6pm - 701 Gave 2 units of Lantus

But lets go back to the beginning - so checking my records ( its actually been a little under a year ) he was started on 2.5units of Vetsulin every 12 hours at the end of December. His first curve was done on 1-28-19
I have always done the curves at home, he is a very docile cat but I know stress causes glucose to raise, so the vet has never done a curve.
That curve was 8am to 8pm - 382 , 313, 343, 332 , 400, 382, 332 the vet had me keep him on this and check "every now and then". Sporadic BG's over the next 2 months showed him low 400's but creeping up. she then started him on 3 units every 12 hours on 3/18/19 and had me check a curve on 4/11/19 - those numbers …. 521 , 631, 515, 602, 500, 622 . she then had me raise him to 4units every 12 hours. The AM and PM pre glucose checks were now in the 500's. she jumped me to 5units every 12hours on 5/2/19 no change in BG levels. Finally after bugging for a month she switched me to ProZinc on 6/20/19, 4 units every 12 hours . on 8/1/19 his curve was 533, 484, 580, 521, 578, 670. she said that wasn't changing so lets try Lantus. he started the Lantus 9/1/19 , 2 units every 12 hours. His first BG Curve on the Lantus was 10/1/19 - 521, 503, 523, 542, 596.
He has been tested for the Acromegaly and was just tested 2 days ago for Cushing's. Everything came back normal. And all routine bloodwork's ( cbc and diag profiles ) have all came back normal except for this last stint a few days ago when he quit eating. That's when his potassium and sodium went all out of whack and he was hospitalized on fluids for 2 days. he literally shows no symptoms other then the excessive drinking and peeing. he is not huge ( 15.9lbs ) , he doesn't have any issues with his eyes, he is not "down in his hocks". you would not know anything was wrong. The doctors here have no clue what to do nor do I think they care to find out. After being in California... and I hate to sound mean... but the doctors in my area are hillbillies. I have two cats, they are littermates and unfortunately are SUPER bonded. They have a 42 x 36 covered tote that I cut a hole in for their litterbox. I put 40 pounds of liter in at a time ( since there are two of them ) and I used to be able to get away with cleaning it every 4 MAYBE 5 days. I have had two clean it every other day for the last 4 - 5 months. I came home today and literally had to dump the entire box and start over because it was one giant block of pee. THAT IS RIDICULOUS FOR ONE CAT TO USE UP 40 POUNDS OF LITTER IN 24 HOURS!!

I am also afraid that the doctor has put me on so many different insulins and dosages that I have done permanent damage.

Thank you guys for taking the time to follow up with me. hopefully someone can see something that these doctors are not catching!!

Thanks again!
Shara
 
If you need help with the spreadsheet just shout and someone can help you get it set up :cat: I believe @Chris & China (GA) can help you get it set up pretty quick if you need!

Diabetics do best on low carb food and it’s possible the dry is contributing to higher numbers. Sophie started on SIX units twice a day, which was due to a combination of poor choices by her former vet, one of them being dry food. Once I took her off it, she was down to 0.5 units twice a day! If you’d like to keep Nugget on some dry food, Dr. Elseys and Young Again are two brands that are low enough carb for diabetic cats. Another issue was raising the dose in full units, which it seems your vet also does. Cats are very small and a whole unit is a lot! Doses are typically increased here by only 0.25 or 0.5 units at a time to make sure the optimal dose isn’t passed up.
 
Thank you for the info!! So unfortunately the u-100 syringes are not "small" increment friendly if you know what I mean! Lol. But I will definitely try it. How long and what do I do between increases?? Do I do like 1/2 unit for a week or 2 weeks check insulin then go up again?? What are the guidelines on that??
 
There are a few brands of syringes that come with half unit markings, I know the ReliOn brand from Walmart is one of them, so those might be helpful!

There are two protocols for Lantus, Tight Regulation (TR) and Start Low Go Slow (SLGS), and the protocol you choose will dictate how long you hold the dosage, when you increase or decrease, etc. I believe if you’re feeding dry food you’re limited to SLGS and the dose is held for 7 days before increasing unless your cat goes too low. Here is the sticky for more info on the protocols, and others who are familiar with Lantus can provide more info than I can :cat:

http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Thank you guys so so much. You have helped me more in 4 hours then the vets have in a year. I will get on this and keep you guys posted!!
Thanks again!!
 
Shara I think the dry food could well be the culprit along with increasing in 1 unit increments.
We recently had someone here who arrived with the same story basically as yours.
Her vet didn't know what else to do and said the cat was most likely insulin resistant.
The cat was swapped from dry to low carb food and now 3 weeks later, the kitty is down to 1/4 unit of insulin and in good numbers.

If possible I think the first thing you need to do is transition slowly over to an all wet low carb diet if you can. Or if that is not possible with the stomatitis, then look at one of the low carb dry foods.
CAUTION.......when you are swapping over to the low carb food, you need to be testing the BG frequently because the BG can drop by 100 points or more and you need to be testing the BG to catch any drops and alter the insulin dose accordingly.
We can help you with this if you like.

I would do the swap over of food before deciding on a dosing method.
If you are going to continue to feed a dry food, you can only do the SLGS method.

With drawing up doses that are inbetween the unit markings, I found a magnifying glass was very helpful or some people use calipers.

Getting the SS up and running will help tremendously.
Test before every shot and then at least a couple of times during the cycles if you can.
We always recommend a before bed test to see if kitty might be going to drop low overnight. If the before bed test ( or a +2 test) is lower than the preshot number it is likely to be an active cycle and you might need to test again.

With the food, how often do you feed?
With the Lantus insulin, you need to feed before the insulin dose, then again a couple of times in the first half of the cycle. Most of us do that. Because the onset of Lantus is not for 2 hours, it is not necessary to feed all the food at once.
 
Welcome to FDMB!!

I'd encourage you to look over the sticky notes at the top of the Lantus board. Lantus is very different than either Vetsulin or ProZinc. Lantus is a depot type of insulin and dosing is based on nadir, rather than pre-shot numbers. Also, you do not have to have food on board for more than a few minutes before giving an injection. Unlike the insulin you're used to, Lantus onset is roughly 2 hours post-injection.

Why do you think transitioning to a completely canned food diet will have an effect on your cat's teeth? And, if he has stomatitis, it's possible that the pain may be what's inflating Nugget's blood glucose numbers. I would also think canned food would be easier for him to eat. If you are under the impression that kibble keeps a cat's teeth clean, it's the equivalent of an urban legend. It crunchy stuff kept teeth clean, we could all live on cookies and pretzels and never need to see a dentist! If you are not familiar with Lisa Pierson, DVM's website on feline nutrition, not only is it a good read, she has a food chart including the carbohydrate count, for most of the canned cat foods available in the US.

Like Bron, I'm also thinking that the dry food is the cause for high numbers. You do have some options for dry if Nugget refuses canned food. Young Again Zero Carb (it's not really zero carbs but it's about 5%) and there's a Dr. Elsey's Clean Protein that's lower in carbs. ZiwiPeak also makes an air dried raw food that looks like jerky-style treats and is low carb as is Stella & Chewy's freeze dried raw,. However, in the grand scheme of things, either canned food or a raw diet is species appropriate and good for your cat.

Please let us know if you have questions!
 
One thing to add to everything that has been posted so far- see if you can get in tests through the night too sometimes. Cats often do go lower at night.
 
Thank you guys so much! I so wish I would have thought about joining a message board a long time ago. You all are so helpful!! Everyone's knowledge is amazing! I am truly impressed!

I have always been told that hard food helps ( not keeps ) teeth cleaner then wet food. And I also know that diabetics do not heal as well. I am afraid of going straight wet food because I don't want his teeth to get worse and then he needs severe dental work which could be hard for him to recover from. But I am willing to try it 100%. I don't want to have to put him down. I have had him since he was a tiny kitten, and unfortunately it seems the vets around here seem to have the "well we don't know whats wrong so nothing more you can do" mentality.

I feed him twice daily and give his insulin as he is eating. I did not know that Lantus takes a couple hours for it to kick in. yikes.

So i guess my game plan should be... keep him on the 2u BID and switch him to a low carb wet food. Let him be on wetfood for like 5-7 days?? See where his numbers are at, then gradually increase the dose 1/2u every 10 days depending on his numbers??

Or should I get him switched to wet food and start from scratch with a different insulin? I somehow feel maybe Lantus isn't the best option??

Also, this Young Again and Dr Elseys food... where is the best place to get it??


Thank you!!
Shara
 
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