Hello from Margaret and Mackenzie

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plaidabby

Member Since 2016
Mackenzie is 3 1/2 year old blond kitty. He was diagnosed in Jan 2016 with diabetes. Mackie has been in and out of our emergency/medical clinics in NM over the last 4 months with Insulin resistant diabetes with ketoacidosis as a complication. He is now on Levimir 20 units 2 X dailey plus 5 u of humulin R. Our internal med vets have been working on getting him stabilized but it hasn't happened so far. This is his 3rd insulin. I am not concerned with diabetes as much as the fact that randomly his BG will drop and he gets ketoacidosis almost immediately and ends up in the hospital on IV's. Has anyone out there had this kind of problem?
 
I'm puzzled when you say
plaidabby said:
the fact that randomly his BG will drop and he gets ketoacidosis almost immediately
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When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.

julie & punkin (ga) said:
Ketones, Blood Ketone Meter, Izzy
Ketones, Tigger; Barsa 4/3/15: and Barsa 4/7/15
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What are you using to test for ketones?

Are you hometesting his blood sugar?

The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
 
Here is some more info on DKA - some of it overlaps the links I just gave you.

Here is some info on acromegaly and insulin autoantibodies - it's been kept up to date with the latest research that we've seen.

We have a lot of experience with high dose cats, Margaret. It's good to know what the cause of the insulin resistance is. We encourage people to get their cats tested (blood draw by your vet, blood mailed to Michigan State University). Links for the testing are in the last link above on acro and iaa. We encourage people to get both tests done because we see both conditions - sometimes only one or the other, but it's not uncommon to see both.

Can you get a spreadsheet going so we can see whatever info you can get into it? The spreadsheet is an essential tool for us. There are directions here on the "Basics: New to the Group?" yellow boxed sticky that is located in the Lantus/Levemir Insulin Support Group.

Usually people get started on Main Health, learning to test and getting a spreadsheet going, and then move to the support group for their particular insulin. You'll find the most experienced people in the use of Levemir (which is an excellent choice for Mackenzie's situation) in the Lantus/Lev ISG. I think you need to be posting over there as soon as possible. The high dose group has been inactive since about 2011, so cats with high dose conditions have remained in the Lantus/Lev group. There are many. There are also a lot of people with experience with DKA in that group.
 
julie & punkin (ga) said:
I'm puzzled when you say


When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.



What are you using to test for ketones?
julie & punkin (ga) said:
I'm puzzled when you say


When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.



What are you using to test for ketones?

Are you hometesting his blood sugar?



The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
Click to expand...
julie & punkin (ga) said:
I'm puzzled when you say


When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.



What are you using to test for ketones?

Are you hometesting his blood sugar?

The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
Click to expand...

Are you hometesting his blood sugar?

The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
Click to expand...
plaidabby said:
Hi Sharon, First thank you! Mackie has had multiple hospital stays because our docs haven't been able to control the ups and downs in his BG and when that happens he developed DK almost immediately needing IV fluids. He has had an MRI for Acromegaly which showed no tumors but some fluid) multiple tests, X-rays, scans. His blood test for Acromegaly which was not considered high enough to diagnose and hyperthyroidism which was negative. They have just sent off the blood work for Cushings to U of Tenn. I don't know what IAA stands for yet. Both of the vets working on Mackey are internal med vets and are working with veterinary endocrinologists around the country with the main ones at U of Mich and Texas A&M. They are both are attending a internal med meeting early June and hope to talk to more endrocrinologists at that point. Right now he is in the hospital again after DK again. BG was in 200's last night and 300's today. I just skimmed the articles/ threads you sent me and look valuable so will be going back to take a read. At home we now test for BG and ketones routinely and give him his insulin shots and do mucho research. I will checking out the suggested mom's and their cat babies too.
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plaidabby said:
Hi Sharon, First thank you! Mackie has had multiple hospital stays because our docs haven't been able to control the ups and downs in his BG and when that happens he developed DK almost immediately needing IV fluids. He has had an MRI for Acromegaly which showed no tumors but some fluid) multiple tests, X-rays, scans. His blood test for Acromegaly which was not considered high enough to diagnose and hyperthyroidism which was negative. They have just sent off the blood work for Cushings to U of Tenn. I don't know what IAA stands for yet. Both of the vets working on Mackey are internal med vets and are working with veterinary endocrinologists around the country with the main ones at U of Mich and Texas A&M. They are both are attending a internal med meeting early June and hope to talk to more endrocrinologists at that point. Right now he is in the hospital again after DK again. BG was in 200's last night and 300's today. I just skimmed the articles/ threads you sent me and look valuable so will be going back to take a read. At home we now test for BG and ketones routinely and give him his insulin shots and do mucho research. I will checking out the suggested mom's and their cat babies too.
Click to expand...
Sharon14 said:
Hi Margaret, welcome to you and Mackenzie! 20u is a lot of insulin. Has Mackie ever been tested for acromegaly, IAA or cushings? These are conditions that can cause high doses. My cat has Acro and is on 15.5u 2x/day. @julie & punkin (ga) or @Wendy&Neko are experienced in high dose kitties. Hopefully they can give you some insight. In the meantime read this thread to see if anything sounds familiar
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
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julie & punkin (ga) said:
I'm puzzled when you say


When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.



What are you using to test for ketones?

Are you hometesting his blood sugar?

The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
Click to expand...
I hope I am replying to the correct location as this is getting confusing
 
Yes it's a bit confusing at first, but you'll catch on! It sounds like you've gotten great care for Mackie. I've never dealt with DKA, so don't know much about it. He's so young to have had so many problems. I hope you can get to the bottom if it soon. Does Mackie have a good appetite?
 
Okay finally a reply box. It didn't show up at first. I mistakingly wrote that when his BG drop when actually I did mean that they go up. I am using a Abbot meter that is for Ketones as well as BG. Seems to work well. Can't use the strips for Ketones since we have 3 kitties and 3 litter boxes. He is on Hills md dry, Royal Canin moist and dry and Purina propane dm moist. Right now he likes the RC dry and Purina moist. No infections have been seen for a couple of months since first major incident when it was pancreatitis and bladder along with the DKA. We have been keeping a log book of everything since we started which goes with him to vet visits and hospital stays (we live in Los Alamos and 24/7 hospital is 90 miles away in Abq.) I think the spread sheet is a great idea and will be looking at starting that too.
 
Sharon14 said:
Yes it's a bit confusing at first, but you'll catch on! It sounds like you've gotten great care for Mackie. I've never dealt with DKA, so don't know much about it. He's so young to have had so many problems. I hope you can get to the bottom if it soon. Does Mackie have a good appetite?
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He is young and was really healthy which is why we are all surprised by this. We also have his litter brother who thankfully hasn't got this problem. When he feeling good (as in no DKA he eats like a horse) but right now he is down 4 lbs. I hope we can get to the bottom of this soon too as it is so hard to have him so far away (plus the costs are like buying a small car)
 
Welcome to FDMB.
Some things you can monitor, in addition to blood glucose, are in my signature link Secondary Monitoring Tools. Dehydration checks, and monitoring food and water intake and output, as best you can with multiple cats, may help alert you when he isn't doing well.
 
Hello Margaret and Mackenzie. Sounds like you've both been through a lot. :bighug: IAA (which Neko also has) is insulin auto antibodies - think of it like an allergy to the injected insulin. The antibodies grab onto the injected insulin, leaving less for the blood stream. Could you tell me what his acromegaly blood work (IGF-1) score is? We've seen a number that were lowish but still acrocats. And usually a CT scan is attempted first, before MRI, to detect the pituitary tumor.

We have another member in Los Alamos @rhiannon and shadow (GA) .

I see Maceknzie is on dry food. That is part of the problem. Diabetic cats do best on low carb wet or raw food. It does not have to be veterinary food, and in fact there is a lot of better quality food available on the pet food store shelves.

I look forward to seeing your spreadsheet. That's a great tool that can help us help you and Mackenzie to get to a good dose where he is in better blood sugar numbers.

And I can relate to the costs of a small car. I've taken Neko to Colorado State University for treatment for her acromegaly twice, and my vet jokes I could have bought a car with that. Of course, it wouldn't purr and cuddle like Neko does. :kiss:
 
Both the dry foods you are feeding are high in carbs and not really good for diabetic cats. Have you tried putting him on a strictly canned food diet? I'm sure that won't solve all your problems, but it is much better for him and may help lower his numbers some.
 
Hi Wendy &Neko, I don't know the number for the IGF-1 but I will get it from his doctor to add to the spread sheet and I will ask about the IAA too. I think that the endrocrinologist in ABQ suggested it. He didn't do well on the anaestiasia for the MRI and I didn't know you could do a cat scan for that. He really likes the purina pro food and we have a place here in town that sells " holistic" cat food that is low carb and high protein which I also use. I also need to find out what insulins he has been on, for how long and how much too. What I really want is for him to be able to come home stabile where we can monitor his BG and Ketones, Give him love, his injections, food and water and not have the ups and downs we have been having. If he has Acro or hyperthyroidism or Cushings or just won't work on regular insulins levels, will we able be able to have him at home, are there solutions to any of the above diseases, medicines he can take (in addition to the insulin).
 
For treatments it varies depending on the secondary condition, but usually the best thing you can do for them is get them to an insulin dose where they spend most of their time under renal threshold. We've had people with all the above conditions treat their cat's insulin needs at home.
 
Hi Margaret,
sorry to be late.... I wasn't online yesterday much.
I'm so glad you found us.... I'm here in Los Alamos. I am guessing your vet is Ridgeview.
I used the other vet and taught them a lot about FD. I think Ridgeview is the better vet for an FD cat.

Wendy and the others are better at advising you for acrocat , special conditions....so keep posting.
But I can certainly help you with the food lists and daily management.

I am sending you my phone number in a private message ...
I live over behind the golf course near Arizona and Woodland.
 
Was the IGF-1 test sent to Michigan State? I believe they are the only lab in N. America that does that particular test. If it went elsewhere, it may have been a different test. If the IGF-1 test from Michigan State for acro was less than 92, then it's considered negative. I don't think that hyperthyroid alone would account for this dose. It can raise the dose, but I haven't seen a cat over 6u per shot that wasn't either acro (most commonly seen here on FDMB), iaa (probably next most commonly seen) or Cushing's (least common.)

The dry food would cause a need for a higher dose, but if you change to the low carb canned, you need to do it gradually over several days to a week while you are hometesting. That change will reduce the amount of insulin Mackenzie will need.

The iaa test would be the most important step for you to take next, in my opinion. We've had iaa tests return as high as over 80%. It's normal for a diabetic cat to have some level of iaa because injecting insulin in the body is putting a foreign object there. Cats can develop some autobodies to it. Punkin's level was 7%, which is negative. Under 20% is considered normal.

In the lower part of the "Basics: New to the Group?" sticky that I linked above is also another link with info on high dose conditions:
  • 2014 ~ 39th Congress of the World Small Animal Veterinary Association (WSAVA)
    • Which Insulin in Cats - p 156
    • Management and Monitoring of the Diabetic Cat - p 160
    • Feline Diabetes - p 229
    • Diabetes Mellitus and Quality of Life - p 730
    • Acromegaly in Cats – p 733
    • Insulin Resistance – p 737 (description of mechanisms of resistance on p 738 under heading Pet)
    • Medical and Nutritional Management of Diabetes Mellitus – p 739 (description on p 741 of glucose toxicity and lipotoxicity)

Thanks for answering the onslaught of questions. The spreadsheet will help us as well as the dates/doses on the different insulins that you've tried so far. Any test data will be helpful, including blood sugar tests, endocrine tests like the acro or MRI results - just put things like that in the comments cell of the appropriate date.

By the way, you don't necessarily have to quote to respond. Lots of people do, but you can also just answer all the questions in the reply box and sometimes that's easier to do. It's up to you.
 
I heard from Margaret ....

I want to ask @julie & punkin (ga) @Wendy&Neko

Margaret said
are giving him his insulin Levimir 14u 2X daily and Humulin R (4 u 1 X daily), feeding him on a schedule, measuring his BG and ketones (with a strip at that time).
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and
he is now on 21u as of last night
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I am wondering out loud...
isn't that a lot of R ...dosagewise...

couldn't that be why he's having these fluctuations....

and I will nudge her to get the ss started....
i know you all need that dearly to help Mackie do better....

I would think she may also need to learn to do squids herself.... and I can help her learn that... from Marje's video.
 
I feel very unqualified to comment on the size of the dose for both the Levemir and the R. We don't have enough information about how he got to these doses or if he has a high dose condition. If he's currently in the vet's hospital, which I thought he was, I'd assume the vets are on top of things.

When a cat has DKA, that is an indicator that it isn't getting enough insulin, so it could very well be that he needs more. I can't see that we know enough to suggest anything about his dose at this point.
 
I've been watching this thread out of interest as I have a high dose cat with IAA. Just curious @rhiannon and shadow (GA) , you have quoted Margaret indicating Mackenzie was getting 14u of Lev 2X daily and 4u R 1X daily and then she says the Lev has been raised to "21u as of last night". Do you know if she means a 7u increase of Levemir all at once?
 
he is at the vet's...
and apparently they did that....

i guess they are working it to get an actual response from the insulin?
but i don't know....

the quote was from her describing to me what has been going on...
i'll post the whole thing....
something might be clearer from writing it all a second time.... or mentioned that wasn't before....

except for her address and phone...
the pro plan we are using is dm savory selects veterinary diet for diabetes (they call it for dietetic management) We have also fed them Hills dm wet as well as royal canin wet but they hated it! All 3 of them love the purina pro plan. The dry is Hills DM which Mackey likes and Royal Canin which the others like. We also use Pet Pangea for more moist food like Solid gold Tuna and Perfect Bistro (grammy's pot pie etc).
Which vet did you go to. we have used all of them but right now we go to Ridgeview but we used Animal Clinic of Los Alamos for years too and will still if I need to.
Right now Mackey is having a really terrible time (or is that me) becoming desensitized to his insulin levels. When it goes up by what seems like you look at him wrong, he developes ADK almost in hours and dehydrates. Best example he came home from Abq emergency vet hospital after a 3? week stay on iv fluids, change of insulins, adjustments etc etc, he seemed to be stabile enough to come home on Friday a couple of weeks ago. Everything was great, we are giving him his insulin Levimir 14u 2X daily and Humulin R (4 u 1 X daily), feeding him on a schedule, measuring his BG and ketones (with a strip at that time). Sunday evening things went sour. He didn't want to eat or drink (was fine at lunch) showed signs almost immediately of dehydration. Called Abq and talked to them. I had the choice of going for the evening to SF or wait until am and go directly to Abq which is what we did. He was then on IV fluids again to get ketones out of his blood as fast as possible making sure that they kept potassium and electrolytes in correct range. Since then, a week tomorrow, both internal med docs have had to increase his levemir a few times so he is now on 21u last night. Frustrating part is we (vets included) don't know why he is so sensitive to changes in BG that cause him to go into DKA so quickly. His diagnosis is insulin resistant diabetes but we still don't know what is causing it. He has been tested for all of the major ones (and probably a few minor ones) all so far are negative or low for whatever they are testing. Only test not back is one for adrenal. I do feel that our abq vets are doing a good job. One in particular who started with Mackey is the lead vet there and has been in touch with Endocrine vets in Mich, Texas, + more to numerous to list. They are going to a large internal med vet conference in Denver in early June and plan on finding all Endocrineologists there. I hope they find someone with more answers. Even though he is well loved down there by all staff members and taken out of his kitty condo all the time, I want to bring Mackey home.
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i will....
especially on dosing....

i can be of most help with learning how to manage it on her own...after they get some normalcy. ( whatever that's going to be)
and foods... and fluids... and testing...
and support...

she's going to need those experienced eyes....
 
julie & punkin (ga) said:
I think @Jill & Alex (GA) or @Libby and Lucy would be most qualified to help Margaret and Mackenzie.
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I can't speak for Libby because she has some other things going on right now, but I'm willing to help out. I'm not sure much can be done until we can see some dosing history in a spreadsheet and have replies to the specific questions Wendy asked about acromegaly/tests for high dose conditions.
julie & punkin (ga) said:
I feel very unqualified to comment on the size of the dose for both the Levemir and the R. We don't have enough information about how he got to these doses or if he has a high dose condition. If he's currently in the vet's hospital, which I thought he was, I'd assume the vets are on top of things.

When a cat has DKA, that is an indicator that it isn't getting enough insulin, so it could very well be that he needs more. I can't see that we know enough to suggest anything about his dose at this point.
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I agree with Julie.
I'm extremely hesitant to suggest anything about dose at this point because we just don't know enough to make any determinations or come to any conclusions... yet.
rhiannon and shadow (GA) said:
I know we really need to see a ss.....
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Exactly. A spreadsheet will be a big help. :)


Edited to add: It would be best to start a new thread on Feline Health - (The Main Forum). You'll get more eyes on your thread if you post over there.






 
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i spoke with Margaret a few minutes ago...
she is on her way to Albuquerque to visit Mackie....

so she and i will talk tomorrow as she says she will be home late....
i'll be encouraging her for that ss...

wanted everyone to know she's just otherwise engaged today....
 
i spoke with Margaret today....
Mackie was good and happy to see her.... doing fine at the vets....still in Albuquerque.

don't remember if her long intro spoke about him having a bladder infection but they've treated that and think it's gone.

She is really really really ( did I say Really) busy this weekend...
got a dance recital... sewing costumes... and about to go on a trip and I can't remember it all...

Mackie will be staying with the vet while they are gone just to be safe.

She does intend to get here and share more info... answer questions...
she's just so darn busy for the next few days...
and all her charts are at the vet with Mackie so she couldn't fill in a ss right now if she could stand still.
 
here's what Margaret texted me.....
" We leave Monday am (5/30) Fort Lauderdale then on to abaco next am. We miss the connections to abacos no matter which airline, bummer. Went down to visit Mackie on monday, have some cuddles and love, grooming and playtime altho' he was ready to nap which he did on my lap.
Saw Dr. Hale his doctor there. She said he is up to 28 units of levemir so going up by 1 unit every other day.
Bg just won't regulate and staying there, but he is off iv's and subc fluids, no ketones, eating well, complaining to them when he wants food/attention.... gained some weight back. He is a medical fragile boarder there for next 2 weeks at $60 /day instead of $300! His doctors both internal med docs are going to a big international conference in Denver next week ( 4 days) . Both have all of Mackies stats, bg graphs, test results hoping one of these endocrinologists has some other ideas or suggestions. I am interested in the lady who teaches at u of Queensland in Australia. The papers she has written are dealing with cats with difficult to treat diabetes.
Well, that sure is Macster Caterer ( another nickname)
Here is a photo of our baby.
mackie_zpsulffymuc.jpg

mackie2_zpspwc8qbuo.jpg

mackie4_zpsu5qxtck2.jpg


mackie3_zps92dz1dhb.jpg
 
Thanks for the update Rhiannon. Glad to hear Mackie is ok and improving somewhat (no ketones, no subq flds etc.) When you "talk" to Margaret, tell her thanks for the pics. He is a very handsome little guy. Hope they can get him sorted out. He's such a young cat!
 
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