Tragicomic
Member Since 2016
Hello everyone,
(Long post alert.) I just posted an introduction in a separate thread. I have some questions.
Background. My cat Hobbes is 12 years old. My husband and I adopted him from a shelter here in India when he was about 6 weeks old and he is a beautiful, darling, lovable, black-nosed purring machine. For ten years, he was generally healthy. Then last year in February, he got constipated and was diagnosed with intestinal motility issues, which we are managing by using pumpkin puree and Miralax, as well as medication (Mosapride, an analogue of Cisapride). Since he was 1 year old, he has had tiny tumors on his skin which five vets we showed him to said should be left alone. Last year, two of the tumors started acting up, and the vet surgically removed six of his nine tumors. Four more have cropped up this year.
Recent developments. One of his mast cell tumors was inflamed early last month, and the vet prescribed 0.3 ml of Depo Medrol injections every 3 weeks. After his third steroid shot, he started losing weight and going downhill fast. He weighed 7.2 kgs (15.8 pounds), which is his ideal weight, on September 30, and 6.6 kgs (14.5 pounds) on October 26. On October 27, he had blood tests, urinalysis, x-rays, and ultrasound done. His blood values are normal except that his blood sugar level came back as 280, after 8 hours of fasting (he had to be sedated for the tests). His urine showed sugar and ketones (3+). The vet asked us to start him on 3 units of Lantus insulin s.i.d. using a Solostar pen and monitor his blood sugar at home using a glucometer.
Current situation. I brought him home and did some reading. Per my understanding, 3 units of Lantus would have been too much to start him off on, so I contacted the vet, and we decided on 2 units of insulin to start off and 1 unit 12 hours later. (Please see table below). (Separately, the vet has a history of overdosing both cats. Unfortunately, she is the best vet in our city, and we have no option of going elsewhere. As far as diagnosis and surgery go, she has always been brilliant. It is only in dosage that we have to adjust what she prescribes according to each of our cats' needs.)
Here is what his dosage and blood glucose values have been:
10/28: Diabetes diagnosed with a blood glucose reading of 280 at the vet's clinic. Had to be sedated for tests. Started eating only on 10/29 morning since he took so long to come out of sedation.
10/29: 2 units of Lantus at 3 PM after a meal of 25 grams wet food
10/30: 1 unit of Lantus at 4:30 AM after a meal of 25 grams wet food
10/30: Blood glucose was 84 per the human glucometer we used at 4:55 AM, half an hour after a meal of 25 grams wet food
10/30: 1 unit of Lantus at 5:40 PM after a meal of 24 grams wet food (unable to test blood glucose)
10/31: Blood glucose was 63 at 4:40 AM two hours after a meal of 25 grams wet food, so we skipped the Lantus shot we had planned to give every 12 hours.
10/31: Tried to check blood sugar again at 10:40 AM but couldn't get enough blood. Visual confirmation on the strip shows blood glucose between 30 and 80.
The vet says to keep him on 1 unit of Lantus once a day for now, so we are supposed to give him 1 unit at 5:40 PM today (India time).
Questions. The vet has asked me to give 1 unit of insulin every 24 hours for now. What do you think looking at the values above? I will try to get his blood glucose again in 6 hours. I am afraid if I cannot get the reading and still give him a unit of Lantus, I risk hypoglycemia. What do you think his dosage should be until we are able to check his blood glucose consistently? As mentioned above, he currently weighs 6.6 kgs (14.5 pounds) and is underweight. His ideal weight according to body shape is 7.2 kgs (16.6 pounds). I have dry food, tuna water, and honey on hand in case of hypoglycemia. We are taking turns to monitor him 24/7 these first few days/weeks until we are more confident of his insulin requirements and blood glucose patterns.
Here is some additional information.
Challenges/goals. (1) I am not very good at pricking him and don't get enough blood despite heating the ear. My husband holds him and I talk to Hobbes to calm him while pricking his ear, but he still cries. It will take a few days for all of us to get better at this, and I hope to be able test 4-5 times a day then to figure out his insulin needs better. I have only been able to test twice until now. (2) He doesn't eat more than 25 grams of wet food over a 3 hour period and we will have to give him at least 12 grams of dry food daily to meet his calorie requirement. I will track his carb intake and try to keep it below 10% (ideally 6%) every day. (3) We plan to start collecting a urine sample once every few days to check for sugar and ketones. This will take some learning as well for him and me. (4) We are looking for a U-100 syringe and will print out a scale so we can start adjusting his dosage in units of 0.25/0.5. We are only able to find U-40 syringes, but we will figure something out. But until then, we will only be able to dose him in units of 1 directly from the Lantus Solostar pen. (5) No more steroid shots for him! We will try to use antihistamines alone to tackle his mast cell tumors but this can be difficult since he does not tolerate Benadryl, cetirizine (Zyrtec) or cyproheptadine.
Food. Hobbes is fed every 3-4 hours. He used to have 2 wet food meals and 4-5 small dry food meals through the day. But since the diabetes diagnosis, we have moved him to 6 wet food meals through the day and 2 dry food meals just to meet his calorie requirements, which we are unable to do only on wet food. We will try to keep his carb percentage under 6% and track his food and carb intake. He has a number of food allergies for which we had an IgE test done in January. He is allergic to chicken, lamb, carrots, yeast, potatoes, per the blood test. He has been much less itchy since we took him off these foods. We have to order all his food from Amazon UK and Amazon US since nothing available in India suits him. This can be a challenge because of delivery costs/issues sometimes.
Other medication. Hobbes is on 2 mg Mosapride b.i.d. for his intestinal motility, 2.5mg Atarax (hydroxyzine) s.i.d. for his mast cell tumors, and 1/6 Ranitidine b.i.d. because of his mast cell tumors. He is also on 1/4 tsp Miralax for his motility issues. This I'm told should not affect his blood sugar, since the Miralax does not get absorbed. He is very good at taking his pills and comes himself when called and sits on the couch/bed to take them. He gets a B-12 shot every 2 weeks.
Sorry about the long post but I wanted to give all the information. Thanks for your time and any advice you can give two worried cat parents.
Cheers,
Neha
(Long post alert.) I just posted an introduction in a separate thread. I have some questions.
Background. My cat Hobbes is 12 years old. My husband and I adopted him from a shelter here in India when he was about 6 weeks old and he is a beautiful, darling, lovable, black-nosed purring machine. For ten years, he was generally healthy. Then last year in February, he got constipated and was diagnosed with intestinal motility issues, which we are managing by using pumpkin puree and Miralax, as well as medication (Mosapride, an analogue of Cisapride). Since he was 1 year old, he has had tiny tumors on his skin which five vets we showed him to said should be left alone. Last year, two of the tumors started acting up, and the vet surgically removed six of his nine tumors. Four more have cropped up this year.
Recent developments. One of his mast cell tumors was inflamed early last month, and the vet prescribed 0.3 ml of Depo Medrol injections every 3 weeks. After his third steroid shot, he started losing weight and going downhill fast. He weighed 7.2 kgs (15.8 pounds), which is his ideal weight, on September 30, and 6.6 kgs (14.5 pounds) on October 26. On October 27, he had blood tests, urinalysis, x-rays, and ultrasound done. His blood values are normal except that his blood sugar level came back as 280, after 8 hours of fasting (he had to be sedated for the tests). His urine showed sugar and ketones (3+). The vet asked us to start him on 3 units of Lantus insulin s.i.d. using a Solostar pen and monitor his blood sugar at home using a glucometer.
Current situation. I brought him home and did some reading. Per my understanding, 3 units of Lantus would have been too much to start him off on, so I contacted the vet, and we decided on 2 units of insulin to start off and 1 unit 12 hours later. (Please see table below). (Separately, the vet has a history of overdosing both cats. Unfortunately, she is the best vet in our city, and we have no option of going elsewhere. As far as diagnosis and surgery go, she has always been brilliant. It is only in dosage that we have to adjust what she prescribes according to each of our cats' needs.)
Here is what his dosage and blood glucose values have been:
10/28: Diabetes diagnosed with a blood glucose reading of 280 at the vet's clinic. Had to be sedated for tests. Started eating only on 10/29 morning since he took so long to come out of sedation.
10/29: 2 units of Lantus at 3 PM after a meal of 25 grams wet food
10/30: 1 unit of Lantus at 4:30 AM after a meal of 25 grams wet food
10/30: Blood glucose was 84 per the human glucometer we used at 4:55 AM, half an hour after a meal of 25 grams wet food
10/30: 1 unit of Lantus at 5:40 PM after a meal of 24 grams wet food (unable to test blood glucose)
10/31: Blood glucose was 63 at 4:40 AM two hours after a meal of 25 grams wet food, so we skipped the Lantus shot we had planned to give every 12 hours.
10/31: Tried to check blood sugar again at 10:40 AM but couldn't get enough blood. Visual confirmation on the strip shows blood glucose between 30 and 80.
The vet says to keep him on 1 unit of Lantus once a day for now, so we are supposed to give him 1 unit at 5:40 PM today (India time).
Questions. The vet has asked me to give 1 unit of insulin every 24 hours for now. What do you think looking at the values above? I will try to get his blood glucose again in 6 hours. I am afraid if I cannot get the reading and still give him a unit of Lantus, I risk hypoglycemia. What do you think his dosage should be until we are able to check his blood glucose consistently? As mentioned above, he currently weighs 6.6 kgs (14.5 pounds) and is underweight. His ideal weight according to body shape is 7.2 kgs (16.6 pounds). I have dry food, tuna water, and honey on hand in case of hypoglycemia. We are taking turns to monitor him 24/7 these first few days/weeks until we are more confident of his insulin requirements and blood glucose patterns.
Here is some additional information.
Challenges/goals. (1) I am not very good at pricking him and don't get enough blood despite heating the ear. My husband holds him and I talk to Hobbes to calm him while pricking his ear, but he still cries. It will take a few days for all of us to get better at this, and I hope to be able test 4-5 times a day then to figure out his insulin needs better. I have only been able to test twice until now. (2) He doesn't eat more than 25 grams of wet food over a 3 hour period and we will have to give him at least 12 grams of dry food daily to meet his calorie requirement. I will track his carb intake and try to keep it below 10% (ideally 6%) every day. (3) We plan to start collecting a urine sample once every few days to check for sugar and ketones. This will take some learning as well for him and me. (4) We are looking for a U-100 syringe and will print out a scale so we can start adjusting his dosage in units of 0.25/0.5. We are only able to find U-40 syringes, but we will figure something out. But until then, we will only be able to dose him in units of 1 directly from the Lantus Solostar pen. (5) No more steroid shots for him! We will try to use antihistamines alone to tackle his mast cell tumors but this can be difficult since he does not tolerate Benadryl, cetirizine (Zyrtec) or cyproheptadine.
Food. Hobbes is fed every 3-4 hours. He used to have 2 wet food meals and 4-5 small dry food meals through the day. But since the diabetes diagnosis, we have moved him to 6 wet food meals through the day and 2 dry food meals just to meet his calorie requirements, which we are unable to do only on wet food. We will try to keep his carb percentage under 6% and track his food and carb intake. He has a number of food allergies for which we had an IgE test done in January. He is allergic to chicken, lamb, carrots, yeast, potatoes, per the blood test. He has been much less itchy since we took him off these foods. We have to order all his food from Amazon UK and Amazon US since nothing available in India suits him. This can be a challenge because of delivery costs/issues sometimes.
Other medication. Hobbes is on 2 mg Mosapride b.i.d. for his intestinal motility, 2.5mg Atarax (hydroxyzine) s.i.d. for his mast cell tumors, and 1/6 Ranitidine b.i.d. because of his mast cell tumors. He is also on 1/4 tsp Miralax for his motility issues. This I'm told should not affect his blood sugar, since the Miralax does not get absorbed. He is very good at taking his pills and comes himself when called and sits on the couch/bed to take them. He gets a B-12 shot every 2 weeks.
Sorry about the long post but I wanted to give all the information. Thanks for your time and any advice you can give two worried cat parents.
Cheers,
Neha
