How do I know when my kitty is in remission

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Ok you are making sense. I guess it is a marathon, not a sprint. I know all of you have been through this and you know how I am feeling, wanting to get to the finish line so our fur babies can be healthy. And, I think I'll have to go back to work tomorrow, but since I live only 3 blocks away I can slip out over lunch +5 and be home by +9.5. Next week will be tricky since I will be having P/T conferences, but I think I still make it home to check on them at +5 and +9.5. It'll be trickier on Thursday when I have conferences through the injection time. My hubby can give the injection, but he doesn't test :(. Then, I'll be home for 4 days a week from this weekend!

Would you keep Buzz on the w/d also?
 
Because they couldn't get his high number down to under 150. Looking back I am wondering if he was hypoing there. I wanted to bring him home, but I hadn't found this site. And I was trusting our vet because, you know, he's the educated one. And I had just lost my dear 18 year old Pom, Kosmo, just 2 weeks before and the vet had taken such good care of him for 16 years! I took Woody in because he had a huge lump on his back and it was acting funny. So they removed that, cleaned his teeth, cleaned his anal glands, and I brought him home for 1 1/2 days. On that Saturday morning I woke up there were at least 7 piles of vomit. I rushed him back to the vet and they ran tests. That's when they found his BG was in the high 400's. They kept him for the 12 days to get that high number down. I started questioning them if we needed to start thinking about his quality of life because he looked awful at the vets. Then, low and behold his number met the threshold. After I found this site I suggested I do home monitoring and his wife said the numbers would be all over the place and wouldn't be useful. They did give me the canned food! And now I am stuck!
 
You are not stuck! You have us here to help. ;)

Often vets think home testing is a waste of time but you have proven them wrong numerous times in the past few days with both your boys because without home testing you could have lost one or both of them! There is nothing like hard evidence to convince a vet to reconsider their position on testing at home and you now have that in spades.

As Julie said, most vets are general practitioners who have to know a little about a lot. That doesn't make them experts with anything but the most common of ailments they see day in and day out. Diabetes is not one of those every day situations. Every cat is different...so is every guardian and treatment/care has to be tailored accordingly. Unfortunately, vets are used to telling clients what to do so they continue to use antiquated methods of dealing with diabetes. Frankly they probably just don't see/treat many diabetic cats. And sadly too many are not willing to admit they are out of their element!

My cat is a prime example. My vet has experience with diabetes and several diabetic patients. She started her career in an emergency vet setting so she's seen her fair share of diabetics but my girl is a rare cat and she has my vet totally flummoxed! But my vet admits it! My vet tried to discourage me from testing Menace for IAA saying it's highly unlikely and so rare that it would be a waste of money to test. But when I told her I didn't care about the money but wanted to get to the bottom of what was going on, my vet immediately agreed. I think it's important to have a vet who is willing to work with you and understand that you are on the front lines 24/7 and they only see the cat for short visits all of which are stressful for the cat. With diabetes, that stress usually means the vet has a false view of what the BG levels really are. In short, what you do when at home to keep your boys safe and sound and healthy is entirely up to you no matter what your vet says!
 
Mum of two felines said:
My hubby can give the injection, but he doesn't test :(
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I think if I were you, knowing how these guys have been dropping into dangerous numbers, it would be wise to consider missing a shot if no pre-shot test can be taken on Thursday. You've got a few days to watch and see how the boys are doing so no decision needs to be made right now but I just wanted you to know this is an option with the insulin you are using as long as there are no ketones in the picture. If ketones are present, then perhaps a reduced dose would be in order but I'd get dosing advice here before doing that!
 
MrWorfMen's Mom said:
But when I told her I didn't care about the money but wanted to get to the bottom of what was going on, my vet immediately agreed.
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And that is exactly how I often get around my vet too. They think things won't work, but as long as there's no potential for harm and it's only my money at stake, I tell them that as it's my money and there's no risk to the cat I want to try anyway. Quite often I can get agreement for things that they would never generally recommend (often because of cost or limited effectiveness in a majority of cases) that way. I don't mind having to be the front line on researching things as long as I can persuade them to work with me, not against me! :)
 
There are a number of tricks folks use but you have to be a stealth Mom! As April said, clean aquarium gravel is one option. Some folks can actually hold a ladle under kitty's butt to get a sample. :woot: (I'd like to see that happen in my world! ) Others put plastic wrap into the litter box and hope kitty pees on it. Of course with two cats it means either following them around to see who has gone or separate them with a litter box shortly after eating because that's usually when pee happens! I'm not gonna tell you it's easy but it can be done.
 
Mine won't even go if I'm anywhere close. If we happen to walk up on them they'll glare at us. There is no where around here that sells aquarium rock, I'll have to wait til I go to Walmart Saturday.
 
manxcat419 said:
I'm lucky - Rosa will usually try and pee on either the vet or the tech at some point during an appointment. They know now to catch as much as they can when she does that! Other than that, clean aquarium gravel in a litter box works as long as you don't need a sterile sample.
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To check the ketones do I need a sterile sample?
 
MrWorfMen's Mom said:
My inclination food wise would be to not change anything for a couple of days while holding the dose at 1u. That way you can see what that dose is doing and whether any further changes in dose are needed without having the food situation complicating things further. Once you know what 1u is doing, then you could slowly start transitioning them over to a higher ratio of Friskies to w/d until you have them on Friskies exclusively.
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I would almost agree with the above. I would not start a food transition until the infection is resolved. If holding the 1 unit dose while the infection is unresolved I would also watch out for any major upward trend in NADIR BG levels while holding the dose (worry of DKA). If the dose is held and nadirs trend higher over a number of cycles, post for advice about dosing before increasing.

Mum of two felines said:
Because they couldn't get his high number down to under 150. Looking back I am wondering if he was hypoing there. I wanted to bring him home, but I hadn't found this site. And I was trusting our vet because, you know, he's the educated one. And I had just lost my dear 18 year old Pom, Kosmo, just 2 weeks before and the vet had taken such good care of him for 16 years! I took Woody in because he had a huge lump on his back and it was acting funny. So they removed that, cleaned his teeth, cleaned his anal glands, and I brought him home for 1 1/2 days. On that Saturday morning I woke up there were at least 7 piles of vomit. I rushed him back to the vet and they ran tests. That's when they found his BG was in the high 400's. They kept him for the 12 days to get that high number down. I started questioning them if we needed to start thinking about his quality of life because he looked awful at the vets.
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[Emphasis mine]

Please think back: Did your vet ever mention diabetic ketoacidosis, DKA or ketones to you when Woody was hospitalised? Was Woody given any other treatments during the 12-day stay? (If yes, which treatments?? This is really important. Can you let us know as soon as possible, please?


Mogs
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Critter Mom said:
I would not start a food transition until the infection is resolved. If holding the 1 unit dose while the infection is unresolved I would also watch out for any major upward trend in NADIR BG levels while holding the dose (worry of DKA). If the dose is held and nadirs trend higher over a number of cycles, post for advice about dosing before increasing.
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Good points Mogs!
 
Can you explain what is happening in my kitties bodies? Why did Woody's BG go to 451 and then dropped to 86? And how high do let his BG go before I get worried? It scared me at 451. And what is NADIR
 
Mum of two felines said:
Can you explain what is happening in my kitties bodies? Why did Woody's BG go to 451 and then dropped to 86? And how high do let his BG go before I get worried? It scared me at 451. And what is NADIR
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I think Woody was bouncing from the very low numbers he'd had for a few days. Bounces are his body's reaction to those low numbers and can make a cat run high for up to 6 cycles (3 days). There can sometimes be one extra-high reading right before the bounce breaks and they come back down. High numbers long-term aren't the best for him, but it's much safer to have them run too high than too low. The damage from high numbers doesn't happen as quickly where the damage from low numbers can be fatal within minutes if not treated correctly with high carb food/syrup/honey etc. Nadir is the lowest number they get to during the cycle.

Buzz could also be bouncing from that 26 just 2 days ago - that was a really extremely low number on an Alphatrak. I notice you did give him insulin last night but at a higher dose than the one that took him down to 26. It's possible that some time during the gap in testing between the 221 on your sheet and the 149 he dropped low again because we know that even 0.5 unit can drop him extremely low and he had 1 unit last night. So that could potentially have triggered a new bounce, though there is no actual proof that that's what happened. I don't know whether I'd give insulin or not because I'm not familiar with Novolin - hopefully someone else can help you with that. But if you do give a dose, I would suggest it needs to be less than 0.5u.
 
How has my kitties stayed alive! Buzz came home and we were giving him 3 units. I kept reducing it because even befor home testing I was seeing him go hypo! Why wasn't my vet worried about that! They have gone through 2 tubes of NutraCal in a month! And half that time I wasn't home testing, just watching. Why didn't he tell me to back off on the insulin!!!!
 
Oh, I know, they told me to free feed because he was hypoing and to keep them separated because Woody was eating too much!!!! This was on their dry w/d. When I went to canned w/d they told me to keep the dry out for Buzz.
 
He was vomiting and peeing outside the litter box. His vomit was grayish, he is a black kitty, and I figured he had a UTI. He did and they kept him and ran tests. That's when they found his high BG. I believe his number was mid 300s and they kept him for 2 days. They said nothing about kidney function - they did say he was fine though. He was diagnosed in August. It scares me to think about how long he was on 3 before I started, on my own, reducing his dose. Looking back maybe Buzz's UTI and stress caused those high numbers? They were both free feeding on hills prescription diet w/d (the best cat food for overweight kitties I was told) efore he was diagnosed, then I wen to feeding 2 times a day. He dropped 2 pounds from August to January. He's gained a pound back after I started leaving food out because of their hypo symptoms. I think both have been hitting these 40 30 and 20'for awhile
 
Mum of two felines said:
Looking back maybe Buzz's UTI and stress caused those high numbers?
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That's what I'm wondering about, too, hence my question about the fructosamine test. The fructosamine test is used in the diagnosis of diabetes because it will provide a gauge of the average blood glucose levels for a week or more before the blood sample was taken. High blood glucose readings and/or high glucose levels in urine at time of initial examination at a vet's office aren't a strong enough basis for a diabetes diagnosis on their own - especially if a cat has an infection. Also, classic clinical signs such as excessive drinking, peeing and hunger are not exclusive to diabetes.

How long before Dx were they being fed the w/d dry? (It's like kitty cornflakes.)


Mogs
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They stay alive because you're free-feeding with a high carb food. And because of those bounces - that's a liver response to a too-low glucose level. The liver releases glycogen to bring the BG back up. It does tend to over-compensate which is why kitties bounce for days sometimes, but in this case that's a good thing. Vets often just don't quite 'get' it - the instructions I came home with the day Rosa was diagnosed were to not home-test, to switch her food to prescription DM from the very high-carb dry she'd been on. And that if she showed any signs of hypo to take rub karo on her gums and take her to the ER...none of that is really a good or safe management technique for diabetes. I'm just grateful I found this board before everything went horribly wrong! And now you've found the board too, you'll get your boys sorted out because you're dedicated and want them to be well.
 
Mum of two felines said:
How has my kitties stayed alive! Buzz came home and we were giving him 3 units. I kept reducing it because even befor home testing I was seeing him go hypo! Why wasn't my vet worried about that! They have gone through 2 tubes of NutraCal in a month! And half that time I wasn't home testing, just watching. Why didn't he tell me to back off on the insulin!!!!
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Believe it or not there are some vets who do not think cats go hypo or at least not very easily. While cats are resilient creatures with an ability to boost their glucose levels quickly due to stress/activity(hunting) etc. that doesn't mean they can't go hypo when receiving insulin from a bottle which cannot be controlled by the cat's normal biological mechanisms. I think this fact is often forgotten or not considered by some vets. The problem is that cats will compensate as long as they have the reserves to do so. If the reserve gets used up, and kitty can't compensate for those seriously low numbers, the results can be catastrophic. Once a cat goes into seriously low numbers, they can also be more sensitive to insulin for a time which is another reason why you need to be really careful about dosing right now.
 
Critter Mom said:
That's what I'm wondering about, too, hence my question about the fructosamine test. The fructosamine test is used in the diagnosis of diabetes because it will provide a gauge of the average blood glucose levels for a week or more before the blood sample was taken. High blood glucose readings and/or high glucose levels in urine at time of initial examination at a vet's office aren't a strong enough basis for a diabetes diagnosis on their own - especially if a cat has an infection. Also, classic clinical signs such as excessive drinking, peeing and hunger are not exclusive to diabetes.

How long before Dx were they being fed the w/d dry? (It's like kitty cornflakes.)


Mogs
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Would that test show up on my bill as a separate line item?
And they've been on w/d for years. Probably 3 if not 4 years. Before that it was purina indoor hair ball.
 
Critter Mom said:
The fructosamine test is used in the diagnosis of diabetes because it will provide a gauge of the average blood glucose levels for a week or more before the blood sample was taken. High blood glucose readings and/or high glucose levels in urine at time of initial examination aren't a strong enough basis for a diabetes diagnosis on their own.
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That is interesting because I never had a fructosamine done for diagnostic purposes. Here it's used like a human A1C to determine regulation status and quite frankly with my experience I wouldn't trust it for either purpose but that's a topic for another day.
 
Mum of two felines said:
Oh, I know, they told me to free feed because he was hypoing and to keep them separated because Woody was eating too much!!!! This was on their dry w/d.
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I've been trying to give your vets the benefit of the doubt but the above makes me really concerned about their level of understanding of diabetes; they should have advised you to reduce the dose.

@MrWorfMen's Mom - what are your thoughts?


Mogs
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MrWorfMen's Mom said:
That is interesting because I never had a fructosamine done for diagnostic purposes. Here it's used like a human A1C to determine regulation status and quite frankly with my experience I wouldn't trust it for either purpose but that's a topic for another day.
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I agree that it's pretty useless for regulation purposes because it shines no light on highs and, more importantly, lows. However, when diabetes is suspected and there's only a BG test (possibly influenced by vet stress) and perhaps a positive urine glucose test plus clinical signs upon which to base a provisional diagnosis the fructosamine test would provide some evidence of elevated blood sugars for a significant period and would therefore lend more support to a diabetes diagnosis. Otherwise you could end up in the situation where a cat has temporarily elevated BG levels due to, say, an infection and (to the best of my knowledge) in such circumstances insulin treatment would, I assume, be contraindicated as the BG elevation would be transient.


Mogs
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That's a bounce. He went low, and his liver kicked in and over-compensated with glycogen. Once you can get him settled on a lower dose where he doesn't drop so low, he won't go as high either. And please believe me, bounces are horrible to see because of the high numbers, but they aren't anything you need to worry about. In fact they're proof that he compensates well for low BG!
 
Critter Mom said:
what are your thoughts?
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re:"they told me to free feed because he was hypoing "

I'm not sure I can share my true thoughts in mixed company!:arghh::banghead::banghead::banghead::banghead::banghead: That has got to be one of the most ridiculous things I've heard from a medical professional and believe me I've heard some doozies! That's the equivalent of pumping gasoline onto a burning house! Seriously, if it were me, despite the hassles of changing vets and the distance you might have to go, I really think that unless your vet is willing to listen and learn, you'd be far better off without him/her because I wouldn't trust them with a field mouse at this point.

I highly suggest your next visit be made with the management document Julia provided a link to above in one hand and your spreadsheet in the other and have a heart to heart talk about them endangering your boys rather than helping them and see what kind of reaction you get. If they don't relent on their old ways, then it's time to move on.
 
Mum of two felines said:
Right now I want to completely stop the insulin, clear up their infection, change to friskies totally and then see where thy are!!!!
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It's not quite that simple, especially for Woody. He is getting high numbers and he has an infection. I'm concerned about the risk of his developing ketones. If you change diet you run the risk of triggering a digestive upset and that could lead to lack of appetite. Lack of insulin, lack of calories and presence of infection is a trio you want to avoid like the plague at the best of times because they can lead to ketones and then very quickly to DKA.

Going back to Woody's 12-day hospital stay that's very unusual for just diabetes. It's more like the amount of time a cat would be hospitalised for DKA treatment. Of course, I am brainstorming here. It would be wise to enquire of your vet at the earliest opportunity whether Woody was producing ketones at that time. If he was then you need to be more vigilant for ketones on an ongoing basis, especially when there is infection present: cats with a prior history of producing ketones may have an increased risk of becoming ketotic again.

Mum of two felines said:
Woody just came in at 393 +10. Please tell me not to worry!
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393 @ +10 <<< This is frustrating and upsetting to see (and likely a bounce off the earlier low).

66 @ +3 <<< This is worrying and shows the dose is too high.


Mogs
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That's exactly what I am going do! They have been our vet since the kitties were kittens. And like I said earlier they were my Pom's vet for 16 years and pulled him out of bronchitis and swollen trachea 5 years in a row. But, maybe I am seeing an equivalent of an ear nose and throat doctor instead of a heart doctor.
 
Hi all,

My thanks to everyone who has pitched in to help @Mum of two felines, Woody and Buzz. As most of you know I've got chronic health problems and I'm going to have to duck out now because I am absolutely shattered and I may not be around much for the next few days - I desperately need rest. I'm glad you're all here to keep an eye on things.

:bighug:


Mogs
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In all fairness to your vet, they may have provided excellent care to your Pom but probably don't see/treat that many diabetics and the treatment of individual diabetic cats is not as cut and dry as dealing with other ailments. But if they won't listen and work with you and most importantly, admit to their shortcomings in dealing with your boys, then it's time to move on. The sign of a true professional is to know when they are out of their element and admit it rather than blundering along putting lives at risk.
 
Mum of two felines said:
That's exactly what I am going do! They have been our vet since the kitties were kittens. And like I said earlier they were my Pom's vet for 16 years and pulled him out of bronchitis and swollen trachea 5 years in a row. But, maybe I am seeing an equivalent of an ear nose and throat doctor instead of a heart doctor.
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Some vets can be absolutely brilliant at most things but sometimes not so much with the diabetes. I hope you'll be able to find a way through this with your vets; you've got great history with them. Bear in mind that we can't see the whole picture (e.g. tests that your vet ran, etc.) so we can't fully appreciate the decisions your vet has made WRT Buzz and Woody's diabetes treatment (especially if DKA may have been in the picture earlier.) That said, I stand by my concerns about their advising you to free feed instead of reducing the dose. (And they could benefit from reading what Dr Lisa Pierson has to say about feline nutrition at catinfo.org. ;) )


Mogs
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T
Critter Mom said:
It's not quite that simple, especially for Woody. He is getting high numbers and he has an infection. I'm concerned about the risk of his developing ketones. If you change diet you run the risk of triggering a digestive upset and that could lead to lack of appetite. Lack of insulin, lack of calories and presence of infection is a trio you want to avoid like the plague at the best of times because they can lead to ketones and then very quickly to DKA.

Going back to Woody's 12-day hospital stay that's very unusual for just diabetes. It's more like the amount of time a cat would be hospitalised for DKA treatment. Of course, I am brainstorming here. It would be wise to enquire of your vet at the earliest opportunity whether Woody was producing ketones at that time. If he was then you need to be more vigilant for ketones on an ongoing basis, especially when there is infection present: cats with a prior history of producing ketones may have an increased risk of becoming ketotic again.


393 @ +10 <<< This is frustrating and upsetting to see (and likely a bounce off the earlier low).

66 @ +3 <<< This is worrying and shows the dose is too high.


Mogs
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The only weird word is on 12/22 after the urinalysis was moderate amount of leukocyte. Before Woody's surgery they ran a feline profile, everything was within normal limits. Less than 7 days later he had a UTI and the glucose test was 456. LEU: ++ UTI GLU: 2000 Diabetic
 
Leukocytes are white blood cells and they can be elevated as a result of inflammation, infection, trauma etc. so chances are this was a sign of the UTI starting.
 
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