Hello From Sue and Spike (at the end of our ropes)

[Spike the magnificent]

Hi lovely kitty people,
I've been lurking here for the last three months, and picked up lots of wonderful tips. But I need to talk to someone so I am reaching out to you guys. Sorry this is so long. I'll try to go back and do an intro post in a bit.
Spike the Magnificent is my guy. He's a wonderful black and white kitty. But he's an old guy 15.5 years old and he's had chronic health problems for years:

1. Inflammatory bowel disease, Dx 2003, with cholangohepatitis x 1 and pancreatitis a few times. After years of dietary management he has been steroid dependent for 3 years. He was on Hills Z/D dry (more about this later). He started having more problems with vomiting and nausea and his dose of budesonide got upped to 0.5 mg daily around Christmas 2016.
2. Cardiomyopathy and cardiac arrhythmia diagnosed in 2011. We tried treating it but nothing worked and all the meds made him vomit so we just left it alone and it seems to be stable. He gets an echo every year.
3. Hyperthyroid. He got radioactive iodine and his thyroid status is normal (the one bright spot) in this tale of woe.
4. Bladder "sludge" blood in urine and possible small stones on ultrasound. Blood in urine started a year ago, (no ITI, at that time no crystals never been blocked) . Had an Ultrasound in January showing stones.

So this is what happens. GI symptoms gradually get worse, budesonide gets increased in Dec/Jan to 0.5 gets pepcid b.i.d. and I can't lower budesonide or he has nausea and vomiting, cat gets an ultrasound and his food gets changed from Hills Z/D dry to Royal Canin multifunction urinary to try to dissolve the stones. Cat starts drinking and peeing even more than he usually does on steroids (sugars had been good up til this point) and he gets diagnosed with diabetes.

3/26/17 Glucose 526 in vets office start Lantus 1 u bid, I start lurking, buy an Alphatrac meter and start testing. preshot numbers run around 500-600
3/31/17. (after 5 days on 1 u) increase to 1.5 u.
4/5/17 (after 5 days on 1.5 u) BG = +4 = 355, + 6 405, so increase to 2u
4/10/17 (after 5 days on 2 u) BG = +1 = 621, +4 = 506. +6= 519, +9 = 476 so increase to 2.5u
5/5/17 (3.5 weeks on 2.5 units) BG +0.5 = 551, + 4= 427, +6 = 398 so increase to 3 u
5/14/17 (start of week 8 of trying to regulate) cat starts vomiting. start cerenia 4 mg daily get a BG + 4 of 206 but its because he wasn't eating. pee is bloody but he has stones.
5/19/17 lethargic, not eating well give 1.5 u am and PM. go to vet, start baytril oral, shot of convenia, white count is 30,000! presumed pylonephritis. start mirtazapine 2 x week to stimulate appetite. when he starts eating well resume 3 u
5/26/17 BG AMPS + 617, +5 = 556, + 9 = 511 increase to 3.5 units.
6/3/17 eating well much perkier. stop cerenia
6/5/ 17 start atopia for elevated PLA. Cat barfs it up. wont eat, food adverse. cerenia, appetitite stimulant yadda yadda.
6/1o/17. PMPS running high 300- mid 400 Say to hell with the royal canin multifunction renal food, because cat has decided he wont eat it start transition back to z/d and transition to wet z/d. doing well
6/14/17 Cat barfs before breakfast. cerenia, appetitite stimulant yadda yadda. presumably pancreatitis (again). PMPS = 396 so gets 3.5 units.
6/15/17. Today. Ate adequately overnight but peeing like crazy, very thirsty, BG+ 6 = 709 (!!!!!).

So. I feel like I am losing this battle. Between the IBD and the pancreatitis and the diabetes and my work schedule (I'm a med school professor and I have to travel a lot but the cat dad gives insulin and can do a BG if he has to ) and the recent (7 weeks ago) unexpected death of my dad, and my mum being hospitalized yet again (and she is in Canada a long way away) , I'm losing it. Enough to unload all this on a bunch of people who have never met me and haven't heard a peep from me up until now.

So questions. Why the 700 BG? I checked it twice, and symptomatically it is consistent. I don't think there is any way he could go hypo overnight with a PS of ~400, and he ate enough he should have been fine. Could one fur shot do this?
Is my Lantus toast? I'm still on the original bottle, but I have a new unopened one in the fridge.

Thoughts and support appreciated.

 

[Red & Rover (GA)]

Welcome from Canada.
There are a few people here who are dealing with or have dealt with multiple issues. Hopefully, they will chime in before too long.

One of the reasons why the BG numbers are not coming down is the high carb food. If you look at this chart (scroll down to Rx diet food p 60-), you will see that the food is 23-28% carbs. A diabetic cat should be eating less than 10% carbs.

If you have any lab reports, it would help to post them.

 

[Red & Rover (GA)]

Tagging @Wendy&Neko to have a look at your post.

 

[Spike the magnificent]

I don't think I can go anywhere with the food thing because of the food allergies and the IBD. We tried novel protein diets at first but the eventually stopped working and we had to go to a hydrolyzed diet. The best I can do is try to convert to a wet hydrolzyed diet. But I'll have a look. Thanks.

 

[Wendy&Neko]

I don't think there is any way he could go hypo overnight with a PS of ~400,

Neko did her first under 50 (earning a dose reduction) starting with a preshot of 430. I have seen cats go lower starting at 500 - yes it can happen if the dose is too high. Or if he went lower than he is used to and his liver dumped glucagon into his system. Most people here keep their data on a shareable spreadsheet so we can comment on the dose.

Which novel diets did you try? Dry or wet food? I had two IBD cats so lots of experimenting.

 

[Kris & Teasel]

Another hello from Canada. Poor you! It's hard enough to regulate a cat that doesn't have all those other issues! I suggest you post on the Lantus forum where there are many very experienced people to help, including those whose kitties have a variety of other health conditions.

 

[Spike the magnificent]

I reposted on the Lantus forum.