I need help.

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by lozenge89, Mar 29, 2020.

  1. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Hello everyone, I'm new with a newly diagnosed cat and I feel like I'm going insane. I've searched the internet high and low for help and no one seems to be able to.

    Flynn is almost 8 years old, neutered male. Diagnosed about a month ago, he was put on 1 unit of caninsulin twice a day. He had a glucose curve done, which showed no change, they upped it to 2 units twice a day, rinse repeat. We're now up to 3 units a day, with still no change. His glucose levels have been jumping around 22-25. The vets say there's nothing else they can do and have referred him to an animal hospital, which i am having an online consultation with them tomorrow and can't really afford.

    He is not overweight and never has been, he has also not really lost any weight. We feed him the Royal Canin Diabetic wet food x3 a day. He's drinking a lot and peeing a lot, i have to change his litter tray about 4 times a day. But his hunger is beyond ravenous and most problematic symptom, he's constantly crying for food, even straight after he has been fed. He cries for hours at a time, tries to steal our food, jumps in our refrigerator, he cries until late at night then starts up again at 4am. I'm losing the will, I can't sleep because he keeps me up, I can barely eat because me going to the kitchen sets him off even more.

    He's randomly lethargic but generally he's very alert. I test his urine regularly for ketones, and have tried testing his blood at home, however find this extremely difficult as he will not stay still when we try to prick his ear and when we do, barely any blood comes out and then we get an error on the meter. I've read so many different things on the internet about insulin resistance and I'm at a loss at what to do. I'm devastated and tired. Any advice, experience... anything would help. Please.
     
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  2. Panic

    Panic Well-Known Member

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    Apr 10, 2019
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  3. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    While we wait on replies:

    First off Flynn is gorgeous! It's awesome that you're checking for ketones already. As we chatted about previously, there is a learning curve to pricking the ear that just takes time. I find that "less is more" when it comes to restraining a cat for ear pricks. Most caregivers have a special treat for the cat after every test (failed or successful) to get them excited for testing. Some people sit on the floor and put their cats in their lap, others "burrito" their cats in a blanket, really anything that works for you two. My girl sits on my lap without restraint but that was after teaching her just to sit for a moment and rewarding her for it.

    What size lancets are you using? You'll have an easier time with 26 Gauge if you're not already using it.

    Are you using clumping litter? The constant litter box changes are normal, but if you don't already I recommend using wood pellets instead. It's cheaper and easier to clean up, and you won't have to do it as often.

    We're probably not at the point of insulin resistance yet. If you have any blood sugar tests to share, that would help us greatly! Most of us have a spreadsheet (if you look at my signature where it says Panic's Spreadsheet) where we fill it out and share to other members so they can give assistance based on the dose. A mod can set one up for you or you can do it yourself here.

    Another thing you can do while we wait is set up your signature! It's just a little compilation of Flynn's information: insulin, dosage, any diseases he may have, food type, and diagnosis date. That way if you have questions about Flynn you don't have to repeat yourself. :)

    Deep breaths. You got this!
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi to Flynn's mom or dad. What is your first name?

    Ok, there is a wealth of information here, to help you help your diabetic cat.

    Let's get you some UK specific information first.
    This first link includes some supplies, as well as some food ideas.
    Food, Insulin, and Other Supplies

    This second link is some more recent information about foods that are good for a diabetic cat, and available in the UK. With the lockdowns, it may be difficult to find some of these foods. UK Cat Food List
    That UK food list is maintained by a UK member @Elizabeth and Bertie.

    I've tagged her, in case she knows of where you can get things easier these days with the stay-at-home orders in the UK.

    There is more, but please take a few moments to review those links, bookmark them, save them for later review.
    I'll be doing another response in a few minutes. Takes me time to type things out.

    While I am doing that, if you could get your signature setup, in your User Id profile, that would be greatly appreciated.

    Deep breath, hold, release, deep breath, hold, release.
    We'll help you as much as we can.
     
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  5. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Ok, you say you have a meter for home testing, but you have difficulty getting blood.
    First, because Flynn is not cooperative, second because the blood drop is too small.
    1. Treats. Any kind of pure meat, or cheese or fish, to use as a "bribe" to get Flynn to accept the testing process.

    2. A double poke with the lancet. Two quick pokes, right next to each other can get a bigger blood drop to form.
    Also, heat the ear first. Take some grain like rice, or beans or barley or anything dried. Put it in an old sock. Warm in the microwave. Apply to Flynn's ear to get the blood flowing. Then give him a treat, poke, poke, give him a treat.

    You are training your cat with treats, to come to associate something good, the food treat, with the testing process. Would you try that please?

    Lots more testing tips here. Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos
    My Favorites are the Ear Testing Psychology
    and Marje and Gracie's Testing and Shooting Tips
    which has this wonderful paragraph along with a diagram of where you should be poking.
    Testing
    We all know the basics:
    • Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.
    • Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.
    • Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
    [​IMG]
    But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly. In the photo below, you can see the lancet is angled. Open that document, to see the picture of the angle for the lancet, if you free hand.

    Do you have 26 to 28 gauge lancets? They are labeled on the box "For Alternate Site Testing."
    They will make it easier to get blood. Paw pads can also be used for blood testing.

    p.s. If you could click on the "Like" in the lower right of the posts, that let's us know you have read them. There have been multiple responses. Be sure to read them all.
     
  6. Jacque- Tiger & Jazz Man

    Jacque- Tiger & Jazz Man Member

    Joined:
    Apr 13, 2014
    After testing Tiger for almost 2mos now, 10-20 times a day..now I don't even need to warm up his ear anymore. I think someone said something about the capillaries open up the more they are poked
     
  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    How much of the Royal Canin Diatetic wet/canned food do you feed him?
    Unregulated diabetic cats can not process their food properly.
    He may need a lot more food than you are feeding him.
    And more frequent feedings. 3x a day may not be enough.

    That Royal Canin Diatetic food isn't the lowest in carbs that it could be, 14% carbs, but it isn't the worst food you could be feeding. But it is what food you have for now, so please keep using it.

    Switching to a lower carb food would be better for Flynn, but do not do that until you are home testing, as the BG levels can drop dramatically and we do not want Flynn to have a hypoglycemic episode.

    You might ask the new animal hospital if they will prescribe Prozinc.
    The RVC (Royal Veterinary College) did a study a few years ago for diabetic cats, and many cats do better on Prozinc than they do on Caninsulin (called Vetsulin in the US).

    Here is a link to that study, Diagnosis and Treatment Guidelines of the RVC Diabetic Remission Clinic.
    https://www.rvc.ac.uk/Media/Default/small-animal/documents/feline-diabetes-guide.pdf
     
    Last edited: Mar 29, 2020
    Reason for edit: spelling
  8. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    One idiosyncrasy about feline diabetes in the UK -- vets are required to prescribe Caninsulin as a first line insulin. In the US, the American Animal Hospital Assn no longer recommends Caninsulin. It has a short duration which is inappropriate given a cat's metabolism is faster than a dogs (and no doubt you've figured out from the name of the insulin, Caninsulin was developed for dogs). It also can have a fast reaction and drop numbers abruptly. The insulins that have been recommended by the AAHA are either Lantus or Prozinc. The latter is a pet developed insulin whereas Lantus is a human insulin and available at any pharmacy. It is also an insulin that has a good body of research supporting its use in cats.

    I'm glad the @Deb & Wink posted information from RVC. I wasn't sure whether Prozinc would be available in the UK. Bottom line -- you have better choices than Caninsulin for managing your cat's diabetes.

    I'm going to add a question to the one's that Deb has already asked. How often are your testing? If you are not getting some tests prior to 8 to 10 hours into the 12-hour cycle, you may be missing some lower numbers.
     
  10. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Caninsulin used to be the first line choice for insulin in the UK. But I thought the RVC study cleared that up, and vets in the UK can now prescribe Prozinc as the first insulin for a diabetic cat. Unfortunately, many vets in the UK seem to be unaware of that change.

    Found this recent reply to another UK member on medium and high carb foods. From Elizabeth and Bertie

    Hi, as for high carb food in the UK (which may also be available elsewhere in Europe), the Gourmet Gold 'in gravy' foods are good. These are around 25% of calories from carbs (or they were the last time I checked, I will check them again...) For more details see link below.

    Can't immediately think of 'medium carb' foods, but I'm sure there are plenty of those around. I can have a look online for some...

    .http://www.felinediabetes.com/FDMB/threads/uk-high-carb-gravy-food-for-hypo-kit.135997/
     
  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Ok, Flynn's mom or dad.

    That was an awful lot of information we've given you. Sorry to overwhelm you, but I thought you needed a lot of information right now.

    What questions do you have for us?
     
  12. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    Please don't feel obligated to read every link we've sent you all at once. It's a lot to take in and easy to feel overwhelmed. Pick at them as you feel you can handle right now. :)

    And thank you @Deb & Wink and @Sienne and Gabby (GA) for checking in!
     
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  13. lozenge89

    lozenge89 New Member

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    Mar 29, 2020
    Thank you all for the responses! I am overwhelmed but thankful! It is very late here in the UK at the moment so i will be heading to bed now but i will read through everything and answer everything tomorrow.
     
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  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Not anymore...ProZinc was approved a few years ago as a "first" insulin as well. You still have to prove it doesn't work to get approval to try Lantus, Basaglar or Levemir though.
     
  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    My girl started on Caninsulin too. We got up to 5 units before she started seeing some decent numbers. At which point I changed to Lantus, but that’s a different story. Some cats need more insulin that others. It’s not uncommon to need more than three units. My Neko also had two secondary endocrine conditions (acromegaly and insulin auto antibodies), which meant she needed a higher dose. One in four diabetic cats has acromegaly, as discovered by a study at RVC. One of the hallmark symptoms of acromegaly is ravenous hunger. It is caused by a benign pituitary tumour sending out excess growth hormone - think growing teenage boy appetite. I found going to multiple small meals of raw food, and feeding from an automated feeder, helped stop her from bugging us all the time for food.
     
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  16. lozenge89

    lozenge89 New Member

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    Mar 29, 2020
    Thank you again for the replies. I'm wondering myself if Flynn has an underlying condition as he is ravenous, almost savage. He constantly cries, he's like an alarm that won't switch off. I tried to test his blood again this morning, I followed advice here, warmed up his ear, tried to prick the right spot on his ear but still little to no blood. I tried a couple more times however he was getting very distressed so i gave up. I have wondered about acromegaly or cushings, however his appearance is the same, no change in paw or jaw size (from what i've read) no skin tearing. Are these symptoms not always present? What was her treatment for acromegaly and IAA?
    I feel that his symptoms are worse since being on insulin, but i'm unsure whether that is due to the insulin or simply that his diabetes is escalating. I have a video consultation with a specialist vet this morning as they are not seeing new patients in person unless it's an emergency due to the virus/lockdown. Hoping they can help as my regular vets have seemed to have given up without even offering to try anything different.
     
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  17. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Lauren @lozenge89
    Waving to you from Surrey! :bighug:
    How often are you testing your kitty's blood glucose? Are those numbers in the 20's at random times, or just before you give the insulin shot?
    Do you know what Flynn's blood glucose is dropping to at the lowest point of the cycle? Just wondering if the blood glucose is dropping low at times but is being missed...

    BTW, 3 units isn't a huge dose; larger than average for sure, but not huge. So it does seem to me to be a bit soon to test for high dose conditions... (That's just my thoughts though...)

    Eliz
     
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  18. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    If kitty is getting stressed then it is better to just stop and try again later when things have settled a bit.

    Do you know exactly what it is that your kitty is getting stressed about?
    Are you holding or restraining him? Or, does he not like his ears touched? Please be reassured that the ear pricking should not really hurt the kitty, so it is usually something else that causes the distress. If you can identify what that is then there may well be ways to resolve that. :bighug:

    (((Reassuring hug))) to you.
     
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  19. lozenge89

    lozenge89 New Member

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    Mar 29, 2020
    Hi all again, @Elizabeth and Bertie hello! we have been holding and restraining him, however he cannot stay still long enough and he doesn't like his ears touched anyway. We haven't been able to check his blood a lot since his last glucose curve, but we check his urine regularly.

    I had the video consultation with the vet and he was so helpful, he said going off Flynn's symptoms and his 3 blood glucose curve results from the vets he said Flynn's results don't seem to dip, but stay "high and flat" throughout the day. As he has no other symptoms that indicates acromegaly or cushing's it is unlikely that. He said he suspects he may have an underlying condition (maybe pancreatitis or urine infection) as he is not and has never been overweight. I talked with him about insulin's and he agreed ProZinc is generally better for cats, however with the virus and lock down they are under strict policies and are unable to change his insulin prescription from a distance (Since this is also a new hospital). So he has suggested bumping him up to 4 units twice a day for the next two weeks, if there is no improvement to go up to 5, then at the most 6 (while keeping in touch with the vet). If still no improvement he said they will try switching him to ProZinc. If still nothing improves, they will then do a full blood count, chest x-ray and abdominal scan and take it from there.

    We need a miracle :(
     
  20. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Lauren, a few thoughts...

    Blood glucose curves done at the vet are not an ideal way to assess how well the insulin is working, because the stress of the vet visit can affect the blood glucose levels. This is one of the reasons why it's better to test at home, if possible.

    Kitties with acromegaly don't always display the classic symptoms, or, they may not display the symptoms until much later on into the disease. (So, no outward symptoms doesn't rule acromegaly out of the picture.) There may also be some other underlying condition, such as pancreatitis, which is not uncommon with diabetes. Ditto to urinary tract infection.

    However... What really jumped out at me from your post was your saying that the numbers were 'high and flat throughout the day'... This is something that we quite often see in kitties whose blood glucose is 'bouncing' (rebounding). Did your vet also suggest this as a possibility...?
    If the blood glucose drops too low, or too fast, or both, (or just lower than the kitty has become accustomed to), the body can respond to that perceived threat by releasing stored glycogen from the liver to raise the blood glucose level. It can also release hormones that cause temporary insulin resistance. This can last up to a few days, and the blood glucose levels will typically be 'high and flat'... So, when we see that pattern, it is always worth considering 'bouncing' as a possible cause... This can happen when the insulin dose is too high.... I know this sounds odd, but high numbers can be caused by an insulin dose that is too high, as well as by being too low....

    Did the symptoms get worse as the dose was increased...?
     
    Last edited: Mar 30, 2020
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  21. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    I don't think upping the dose is the right call but please wait for one of the more experienced members to comment on that. Often when a cat is being overdosed they drop too much and "bounce", a phenomenon where the body dumps excess glucose in the blood to protect itself from low blood sugar. If you do not see this drop in time and test later, the reading will be very high and look like the insulin is ineffective, when it is in fact the opposite. My vet did not know this either and she bumped my cat up to 5 units rather quickly when she actually needed a reduction. We try to be very careful with dosage; kitties are very small and don't usually need that much.

    As far as the weight issue, while it's more common to see chubby cats getting diabetes it's not always the case, sometimes it's simply genetics or steroid use that causes diabetes. My own cat has always been an 8 lb cat and she still got diabetes.
     
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  22. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    We usually recommend only increasing the dose by 0.25U at a time. Not full 1U increments.

    With both of the vets you have seen for your cat, increasing the dose by full 1U increments, you cat could be overdosed on the insulin.

    The best way to find that out, is to home test.
    Did you look at the links back in post #5?
    The one called Ear Testing Psychology is a gentler approach to testing, being a "cat whisperer" for testing your cat. Using behavior modification techniques to teach your cat to accept the testing process.
     
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  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The majority of cats with acromegaly don't show physical signs on diagnosis. My girl's only signs were her hunger and one teary eye (from soft tissue grown in her tear duct). But I didn't find out that was a possible sign until later. She never did get jaw growth. Cats don't all get the same physical signs. One sign is not losing weight, in spite of being in high numbers. And the RVC study that found ithat 1 in four cats has acromegaly found cats on doses as low as 1 unit. I don't call these "high dose" conditions anymore. My Neko's dose was less than 3 units for most of her time as a diabetic. If it's something you want to explore, blood for testing IGF-1 is sent to the Royal Vet College. They don't test for IAA - but IAA doesn't make then frantically hungry. It's like an allergy responsed to the injected insulin, just makes it harder to regulate.

    For both conditions you just need to try to get to a good insulin dose where they spend the majority of time in good numbers. As for treatments, IAA gets better over time. The Royal Vet Colllege also can do treatment for acromegaly. They have done work with both surgical removal of the pituitary, and medications.
    Not entirely true - cats "bounce" when they see numbers they are no longer used to. They can still be on too low a dose. Cats can bounce from numbers that are still way above normal, if they are used to even higher numbers. High and flat is a classic sign of not enough insulin too. Only blood testing is the way to know for sure.
     
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  24. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Lauren, I agree with Deb that the best way to find out what's truly going on is to hometest... So, let's see if we can help you find a way to do that.
    I notice you said that 'we' are testing. Are there two of you doing this? It is actually often much easier if just one person does it. Even people who swear that they'll never be able to test alone are often pleasantly surprised to find that they can do it, and that it's easier that way...

    Please know that the test itself should not really hurt the cat. Honestly. So if a kitty is getting really stressed about it then there is probably something else that is causing that stress. It may be that the kitty doesn't like being restrained (many cats don't). Or it may be that the kitty doesn't like having their ears touched, or doesn't like the sound of the lancing (ear pricking) device. But there are quite often solutions for all of these things.

    Deb posted some links to great info on hometesting. And I'll just add to that by saying what worked for my two diabetics...

    I knew from the outset that I'd have to test on my own. And my first diabetic was 6 kilos of 'attitude', and if he didn't want to do something it wasn't going to happen (!) ...So, I just had to find a way of testing that he was OK with. What I found, thankfully, was that it was not necessary to restrain the kitty at all. You only need a way to keep them relatively still for the minute or so that it takes to do the test. And the only part of the cat's body that you 'have' to touch is the ear that you're testing. 'Distraction' works well for many kitties, including mine.
    My first diabetic, Bertie, was strongly food-motivated, so I found I could crumble some treats for him and then test him while he was hoovering up the crumbs. My current diabetic, Bonbon, is not particularly food-motivated, and she absolutely hates having her ears touched. But she does love to be brushed and stroked. So, I sneak her test into the middle of a little brushing/grooming session, and she barely notices.

    With both my diabetics I spent time getting them used to the sensations and sounds of the test process, and got them to associate those with something positive - treats! So, at various times throughout the day I'd go to wherever they were dozing, stroke them, then hold or massage an ear just for a second or two (not enough to stress them), and then give a treat. Similarly, I'd rattle the test strip vial, or click the lancing device, and then give a treat. By doing this you are introducing a new stimulus and getting the kitty to associate it with a reward.
    I did these kinds of things maybe 6 or 7 times a day for a couple of weeks. It only takes a minute or two each time, but that repetition is key. ...After a while my diabetic boy would come running when he heard me rattle the test strip vial. And my diabetic girl goes to her favourite armchair (our testing spot) when she hears me setting up the test kit. It's just as if I've got the tin opener out to open a can of tuna! It's the same learned response. And they learn fast...

    Many people find it helpful to test in the same place every day, especially at first. Some people test on a desk or worktop. Some test with the cat next to them on the couch. Some sit on the floor with the cat in their lap. You will find what works best for you. But do ensure that you have a good light source nearby.
    At times when you're not testing you can get the kitty to go to that spot and 'just' stroke and give a treat. Make it a nice place to be. ...If you can get the kitty to the testing spot, hold an ear for a second or two, and reward with a treat, then you are most of the way to being able to test...

    If you are finding that the ear is too cold and isn't bleeding well then you can warm it with what we call a 'rice sock'. To make this you put some rice (or other grain) into the toe of a thin sock. Then tie with thread or string, and cut off some of the excess fabric (leave some to hold onto). Some people make these firm like golf balls, and these can be held against the underside of the cat's ear while the ear is being pricked. I made mine soft and squishy like a miniature bean bag, and so that it fits comfortably in the palm of my hand. The rice sock is warmed in the microwave until nicely warm but not too hot, and then it's used to warm the cat's ear. ....I stroke my cat's head with my squishy rice sock (she likes the warmth) and I stroke it down over one of her ears to warm it up (a few strokes over her head, a few over the ear...). And it's often helpful to talk softly to the kitty, or even sing to them, haha! This can be calming for both kitty and human... :smuggrin:

    Do be patient and kind with yourself. It can take a little while for kitty and human to get used to testing. But, with practice and patience, you will get there. :cat:

    BTW, my Bertie was diagnosed at age 8. His numbers were awful for a time, and I got very depressed about it and thought we were a totally hopeless case. ...But...his numbers got better over time, and he lived to be 20 years old, eventually going into remission.

    Eliz
     
  25. lozenge89

    lozenge89 New Member

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    Mar 29, 2020
    Hi, thank you for the replies. I am going to call the vet again and speak with him about some issues that were raised here as i do agree. Please bare with me though, I'm still learning and finding this very difficult to take in, I'm also a med student and finding juggling these two are really having an affect on each other.

    We upped his dose last night to 4 units, and for the rest of the evening he wasn't as bad as he has been. Not crying as much and seemed calmer. This morning before his breakfast i tried to test his blood but as i soon as i touched his ear he was pulling his head away, he just really doesn't like to manhandled at all, I even tried putting a little bit of food down but he wolfs it down so fast he's gone time by i try to prick his ear, trial and error. Two hours after his food/insulin i tried again as his behaviour was worrying. I finally succeeded and the meter said "HI" :( I will keep trying throughout the day to get more results, I know i didn't get a result before food but hopefully if i do it enough times today he will start to get used it.

    As the days go on, i am more and more convinced something else is going on, I just have this gut feeling. He has vomited clear liquid about 5 times since he was diagnosed, has a "pot belly" and his breathing is off, he's taking huge breaths and I've noticed he will breathe out of his mouth when this happens. I'd rather they just do the clinical examinations on him sooner rather than later, I feel like we are just prolonging the inevitable and Flynn's suffering.

    I will see how today goes and update later.
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Hi Lauren,

    It takes time to gain cooperation from your cat when you are learning to test the blood glucose. Give yourself some time. It becomes easier.

    How fast is his respiration rate? <30 per minute, or >30 per minute?

    It's possible that Flynn has a high dose condition IAA or acromegaly.
    "Pot belly" is one of the signs of acromegaly.

    p.s. Med school takes a lot of your time. Hope you are able to better learn to balance the high demands of med school with taking care of Flynn and his diabetes. Juggling life responsibilities is not easy.
     
  27. lozenge89

    lozenge89 New Member

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    Mar 29, 2020
    Hi sorry for late reply. Last couple weeks haven't been good. We've tested his blood as often as possible and it was always high around 28-30 even after food/insulin. His symptoms are not improving, the vet seems to think there's something underlying to be making him insulin resistant. He hasn't lost any weight, he still has a pot belly and he's not pooping very often, despite ploughing through bowls of water. His respiration was >30 per min however his breathing seems to have improved slightly lately.They want to do a CT scan on him, full blood test, urine samples to get to the bottom of this. I've been told this is going to cost £4,000 (almost $5,000 for those in America) , i'm devastated to say the least. Our insurance is only £4000 per year and we've already used a chunk of that on his first diagnosis of diabetes. This £4,000 is just to see if there is anything else wrong. If something comes up and he requires further treatment or surgery, we are buggered and I will have to have him put to sleep, as we simply cannot afford anything else.

    I'm not sleeping or eating and have cried every single day since, I am exhausted. I really want him to get better but i don't know what to do or how to handle this anymore. Sorry for whining, I guess i just needed to let it out.
     
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  28. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Vent, cry, yell, scream all you need to here. We understand. We've all been through tough times. And these times are even tougher right now. I know this is a lot to ask, but would you, could you answer a few questions again.

    What dose of Caninsulin?
    What are the history of the dose increases?
    When do you home test?
    Do you home test at pre-shot? mid-cycle? in both the AM and PM dosing cycle? towards the end of the cycle, to see the duration of the insulin?
    Or has the blood glucose testing all been done at the vet, when your cat is stressed out?

    You do not have a spreadsheet setup and linked to your signature, so there is no way for us to see what the BG levels are.
    If you set that up, we may be able to see something that your vet(s) have not. I realize it's a lot to ask, but it will help us help you better. I know you are exhausted, and this may be 15 minutes you don't feel you have to spare. But let us help you, by letting us see the BG tests you have done. Please. Template for you to copy, you want to use the "World" version and enter your test data on only that tab on the spreadsheet (SS).

    FDMB Spreadsheet Instructions

    Understanding the Spreadsheet/Grid

    Enter 2 weeks worth of data. Do you think you could do that?

    I suggest that you prioritize the testing at the vet. I know that I'd be asking the vets a ton of questions. Ask them what would be essential, and what extra blood tests is your vet talking about? Are they going to draw blood to test for IAA and Acromegaly and send that off to the RVC? Or simply repeating blood work that has already been done? Or something else?

    What are they hoping to find out from the urine samples? What special tests on the urine do the vets plan on doing?

    Why did they recommend a CT scan? To find/rule out what conditions?
    Is there something else that can be done instead?
    Did the vet clinic do a cost breakdown, a proposal for you to review?

    When I took my cat to a specialty vet clinic, they did a detailed cost breakdown, explaining the testing options for her suspected kidney disease. With prioritization of the testing and why it was recommended.

    Hang in there Lauren. We're rooting for you and Flynn.
     
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  29. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Hang in there Lauren. Get that spreadsheet set up and we'll look at it and help you. Let us take some of that burden off your shoulders. You've got decades of experience at your disposal here; don't let those vet visits scare you. There's probably nothing you can throw at the members that hasn't been experienced here already.

    Remind yourself: Flynn is on Caninsulin. You will 99.9% have better results on a better insulin. Your vet is not nearly as experienced as the people here. Don't let them scare you into a bunch of tests just yet until you understand why. Let us know what and why they want to do a CT scan. Help us help you.

    I would get him checked for IAA and Acromegaly just to either get that out of the way or determine if he needs to go onto Levemir.
     
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  30. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Sorry i haven't been able to get one done, Flynn has been at the animal hospital having some further tests. Just gotten off the phone with them and the vet said he had a quick look over his CT scan and said they noticed what looks like a small mass on his pituitary gland, which is probably suggesting acromegaly. He's sent off a blood test and is getting his image reported on, so we will have a confirmation within two weeks. The vet said to take it with a pinch of salt as he's not trained in reporting on imagery, but i know in my heart that will be what it is. We cannot afford radiation therapy for him. I'm crushed. I'm reading up on acromegaly and prognosis doesn't seem good. I can't bare the thought of saying goodbye to him.
     
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  31. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Lauren, have you heard the expression "Don't count your chickens before they are hatched?" Well, that is what you seem to be doing here, bringing unnecessary worry and fear to your mind.

    There are several members here now with cats that have acromegaly. It is no more of a death sentence for your cat, then being diagnosed as diabetic.

    There are ways to treat acromegaly besides the SRT treatment.

    I'm tagging two members that have some experience with acro cats, for you.
    @Judy and Freckles
    @Wendy&Neko

    Would you please help Lauren who is agonizing over a possible pituitary tumor and acromegaly? Blood tests are not back yet to diagnosis acromegaly. She's letting her fears get to her.
     
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  32. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Hi Lauren,

    The feelings that you are going through are completely normal and will not last forever. With being a med student, you may already or not yet be familiar with the stages of grief (any kind of grief from experiencing divorce or a health issue): denial, anger, bargaining, depression and acceptance (not necessarily in that order and sometimes a person bounces around the stages).

    Freckles has been recently diagnosed with acromegaly and IAA (February 2020). First off, Freckles doesn't know she has any kind of condition and neither does Flynn. Give him scratches, attention, brushes or whatever he likes, just like normal. Second, radiation therapy or surgery are not options for me (too costly, Covid-19 crisis etc)., so we are just following the protocol for insulin increases/decreases as her numbers show. There are some caregivers with acro cats that are using a medication called cabergoline and are seeing positive results.

    Just like Flynn, Freckles has a ravenous appetite. The appetite has decrease somewhat since we are getting close to a good dosage for Freckles. We've got baby latches on EVERYTHING. She has quit begging and asking for food because we did not reinforce that behaviour. I bought an automatic pet feeder so her meals are timed and split up to 4 times during the day and 4 times after her pm shot. I also add a bit of water to every meal/snack and than helps her fill a bit more full I think. Now Freckles associates the feeder with the 'thing' that feeds her so she spends time hanging out by the feeder rather than pestering me.

    I've used her appetite in my favour to check her blood and give her insulin shots. I use freeze dried chicken and crumble it up into little pieces into a large dish so it takes her more time to find the crumbles. While she is gobbling that up, I prick her ear, scoop up the blood droplet on my fingernail why she is still eating. Then I can test the blood droplet and not worry if she squirms. I also put a bit of vaseline on her ear so the blood makes a nice droplet. Getting a blood droplet from the ear gets easier as more little capillaries are formed with frequent testing.

    Take comfort that you are not alone in this journey. Experienced acro cat owners on this forum have been very willing to share their experience and give guidance on this trip. Ask questions, read the information, and then read it again. There is A LOT of information on this forum which can be overwhelming (which again is perfectly normal).
     
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  33. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Thank you for your reply, I've sobbed and sobbed since i got the phone call from the vet this afternoon, that my eyes are almost swollen shut. It isn't even confirmed yet, but i know in my heart that's what it is. His symptoms seem to fit the diagnosis. I've read and read through mounds of information and i'm still confused and devastated. I live with my mum, we struggle with money as is, especially now i am back as a student. We simply will not be able to afford SRT or surgery for him. Our last of the insurance has gone on these diagnosis tests. I struggle very hard testing his blood at home, i prick his ear in the right spot but literally no blood comes out. One time i ended up pricking his ear about 6-7 times and nothing came out, at one point the lancet went through his ear and stabbed my finger. Only me who was bleeding in the end.

    I'm worried without me being able to afford proper treatment that he will be suffering, I can't bare the thought of putting him to sleep but when do you know that is the right choice? My mum works full time (she works for the NHS) and the only reason i can focus on Flynn right now is cause my university has pulled all classes/placement. I'm not sure how i will give him the care he needs when lockdown is no more and life returns to normal.

    How fast to acrocats deteriorate without treatment? How has managing Freckles acro on increasing/managing insulin been? I have so many questions but never know how to ask them.
     
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  34. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Are you pricking from the outside of his ear (hairy side) or folding the ear over and pricking the inside (hairless side)? At first I got very little blood as well and then hubby tried and ended up hitting the vein and got blood... too much blood! lol. The bathroom looked like a scene from CSI! Freckles didn't care though.

    I've done this lots too. It doesn't hurt the cat. I have since switched to using the lancet device on Freckles' ear. Hubby still freehands the lancet though.

    These are expensive options and not ones that everyone can afford. Cabergoline is much less expensive and just increasing insulin to a good dose for Flynn is likely more affordable as well.

    I haven't found that Freckles needs any more care than before lockdowns. It doesn't take any more time to draw up more insulin if she needs it. You do the best that you can ... that's all anyone can ask.

    . From what I've read, learned from others and experienced myself, acromegaly is usually a slow progression. It's likely Freckles has had acromegaly for quite some time prior to the diagnosis without me even knowing. Tumors can stall or be active. There are some cats with acromegaly that have even gone into 'diabetic remission' without any special treatment.

    This is a tough one - personally I look at quality of life vs. quantity of life. As long as Freckles is having a good quality of life, I don't even think about it. Here is some information that my help: http://www.felinediabetes.com/FDMB/threads/making-the-decision-help-to-know-when-and-how.131915/

    Again... perfectly normal. We love our kitties! :bighug:
     
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  35. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Lauren, are you using a rice sock or anything to hold Flynn's ear against when testing? It will act as a barrier between you and the lancet in case it goes all the way through the ear. The only time I've been poked is when I was changing them out and fingers slipped (ouch!).

    Have you gotten any BG tests to share? :)
     
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  36. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Hi again, sorry for late reply. Flynn has come home today, I was so happy to have him back again. I have tried the rice sock, I've tried all sorts. Sometimes i will get a speck of blood but not enough to get a reading and he hates his ears being touched so as soon as i touched them he starts pulling his head away, even if there is food there. I will keep trying though.

    Some of the tests he's had are showing that he has mild feline asthma and flea allergy dermatitis (even though he has been treated and hasn't had fleas the vet said it can be environmental and could only take one bite to cause it) They said they would usually treat these with steroids however they will interfere with his insulin so we have been given some painkillers and a medication that helps with skin allergic reactions to reduce inflammation. We are still waiting for his acromegaly test results and his CT image report. (But at this point i am convinced it is definitely acro) They managed to do a couple of glucose curves on him over the days and his test results were consistently around 22, which they said is showing he is insulin resistant. They have increased his insulin to 5 units twice a day.

    I am still devastated, he is not the same cat anymore and it breaks my heart to see him so unwell and unhappy. I hope with his medication and insulin increase there might be an improvement and if not, if he tests positive for acro at least we will have a diagnosis and be able to go from there.
     
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  37. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Hi Lauren,

    So happy to hear you have Mr. Flynn back home with you. Having high glucose numbers while at the vet is actually quite normal as for many kitties, the stress of being at the vet and away from home tend to skyrocket their numbers. If you can set up a spreadsheet, the members on this forum will help you help Flynn. Inputting Flynn's glucose numbers on the spreadsheet is a really, really good strategy to getting a treatment plan up and running.

    . I'm going to step out on a limb here and say Flynn likely scratches his own ears, and probably rubs his ears against other things, so it's not that he hates his ears being touched. Animals that don't like a body part being touched by a human can get conditioned to accept it. Think of it as an approach and retreat model. Instead of having the end goal in mind (holding the ear and pricking it to get a blood sample), have some short term goals in mind first. Maybe the first goal is just to touch his head. Do this just briefly and then retreat (pull your hand back) before Flynn objects. Then hold your hand on his head longer and then pull back. Then gradually move to just quickly stroking his head and quickly running your hand over Flynn's ear and then retreat and eventually leaving your hand a bit longer on Flynn's ears. You can also condition him with treats/food by rewarding him when your hand is on his head/ear. You've heard of Pavlov's dogs? Same concept here... classical conditioning. Humans do it all the time - go to work to get a paycheque.


    What kind of blood glucose monitor are you using? Some monitors require a much larger blood droplet than others.

    Elizabeth has a good point here. Most cats with higher doses are on a longer duration insulin like Lantus or Levemir.

    Deb also included some very important questions and suggestions in her post. The people on this forum are very data driven and recommendations/suggestions are definitely not done willy nilly - but in order to help you, we need to see the numbers so we can get a better idea on what's going on with Flynn.
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Welcome back home Flynn. Bet you can't wait to get that "vetty smell" off you.

    Does Flynn let you touch and hold his paws? That is another place a cat can be tested. Although, the paw pads do tend to toughen up over time, so it may be harder to poke and get that blood drop.

    We'd love to see a spreadsheet, so we can see what is going on with Flynn's BG (blood glucose) levels with this most recent dose increase.

    Stay safe everyone.
     
  39. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Hi, I'm trying to set up a spreadsheet, however don't have enough info to put into it atm and am still a little confused how it works (I've read the instructions however I'm still a little lost, I use mmol/L ). I managed to test his blood tonight at 6pm just before his food/insulin and it was 21.4, I then tested his blood an hour and half after food/insulin and it was 19.4. I use the GlucoNavii meter, it's a human one, I am in the UK so don't have access to some of the BG meters/food etc that American members do. So it takes me a while to figure out what people are talking about sometimes.I've tried asking my vet about a different insulin, however they are reluctant to change it until they have his acro test results back, which will be in 1-2 weeks. Here are some pics, 7 weeks to almost 8 years.
    thumbnail_IMG_2162.jpg flynnbob.png
     
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  40. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    I am convinced he has acromegaly, insulin doesn't seem to be doing much at all, he is not losing weight and has a "pot belly" appearance. The vet took a glance at his CT scan (the image goes to a reporting radiographer/radiologist to get a full accurate report) but the vet said from what he can see on the image is that some of his organs looked slightly larger, and there appears to be a very small mass on his pituitary gland. I've also noticed (and i don't know whether it is true or that i have convinced myself of it) but i'm almost certain his front paws look larger, nothing in his jaw area yet. We can't afford radiotherapy or surgery, and i'm worried if we can't get his diabetes under control he will continue to get sicker and sicker. He is already absolutely miserable, he is not the same cat. He cries for food constantly and has an insatiable appetite, the only time he purrs is when he is eating. He doesn't play anymore or look alert, he lays flat in weird places around the house looking so unhappy for the majority of the day. This is all new to me, my last cat i had for 18 years. She was slightly overweight and we never had any problems with her, she never needed to see a vet other than when she was spayed. Flynn has been my most unlucky cat, he has had urine infections, an abscess on his spine (through a fight), sprained foot, he cut his paw open a separate time and required a minor surgery, the list is endless. He breaks my heart, he takes after me in the health department lol :(
     
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  41. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Awwww - what cute baby pictures!

    Acro cats sometime need to go to very high volumes of insulin before it reflects in their numbers. Cabergoline is a medication that has been used by some members who saw very positive results to treat acro. Hang in there.

    I'll tag a couple of members to see if they can help you with your spreadsheet. Does your spreadsheet just have the US numbers? I'm in Canada and you can look at my spreadsheet since we use the World numbers.

    @Chris & China (GA)
    or
    @Marje and Gracie
    Can yo help Lauren out with her spreadsheet?
     
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  42. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Lauren

    I can do the SS for you but I’ll need some info. I’ll send you a private message (PM) so click on your Inbox in the upper right corner. Once I get the info, I can do the SS.
     
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  43. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    Hi everyone, just giving an update. Flynn has declined pretty rapidly over the last two weeks. I called the vet however the one that has been dealing with Flynn was off that day so I briefly spoke to another vet. He checked his results and he does have acromegaly, I knew deep down he had it so it wasn't much of a shock. Still reduced me to tears after though. He's been extremely depressed, a lot more lethargic. He lies down most of the day. Last night he wasn't interested in his food, which is a big change, but one that I don't feel is good. I thought maybe it was an one off thing but I have gotten up to feed him this morning and he's still not interested and went to lie down. I'm in turmoil, I love him so much but his quality of life is zero and I feel guilty everytime I look at him. I dont want to lose him but I feel like I am prolonging the inevitable. His regular vet is due to call me today. I'm not sure what will happen as I think losing appetite is an emergency. Will update again later. Hope you and your kitties are keeping well.
     
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  44. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    Hi Lauren,

    Sorry for the diagnosis of acromegaly - I know how that feels unfortunately. This is the best forum to belong to as there are many caregivers on here who have a wealth of experience with kitties that have medical conditions.

    With Flynn not eating, he may feel a bit nauseous. I'm going to tag @Wendy&Neko to see if she can offer some guidance to you. Her little Neko had a few things going on a the same time as the acromegaly and diabetes. You will want to start another post for today and you may want to title it: "05/02 Lauren and Flynn Vet diagnosis" . Put the question mark icon in the title. Some members may be able offer you questions to ask your vet. Then in your first line, make a link to this thread so people can come back and reference it if needed.

    The last icon is to make the link.
    upload_2020-5-2_10-57-48.png

    Copy this thread's url and paste it in the box.

    Give Flynn some scratches. We are sending healing thoughts to him.
     
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  45. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Sorry about the diagnosis of acromegaly. Unfortunately it's not a very exclusive club. For some reason I haven't been seeing the tags over here.

    For treating acromegalic cats, the number one thing is giving them as much insulin as they need. That also means getting off of Vetsulin and onto a more appropriate insulin. If you can convince your vet, Levemir is the best for higher dose cats. It often has longer duration which means flatter numbers throughout the cycle and getting rid of the wide range of numbers. I did manage to get Neko into treatment with SRT, but it costs about 2.5 times now what it used to. I'd have to think twice about it now. For reasons of cost or travel, most people just treat with the insulin they need. Judy is right that this is a slow moving disease. We've seen a couple cats without treatment live as long as five years, though that's not common. Getting the cat to an insulin dose where they can spend most of their time under renal threshold will help. We have had some success with cabergoline, which is a daily medication that is fairly affordable. It has slowed the growth hormone output, reversed some of the symptoms, and lowered the dose in a number of cats here.

    How is the home blood testing going? Are you also testing him for ketones? This can be done with dipsticks in the urine, and is a good thing to do with a kitty in high numbers. I worry if you are seeing high numbers and lethargy and inappetance om a acromegalic cat that is normally ravenous.
     
  46. lozenge89

    lozenge89 New Member

    Joined:
    Mar 29, 2020
    I have asked numerous times about a different insulin but my vet seems hesitant to switch. I will ask again next time i speak to him. Do you think increasing insulin can have a bad affect on some cats? I only ask as on this past Saturday, Flynn was really ill. He was so lethargic that i actually thought he was dying. His BG was 23.4 at the time and on 6 units of insulin. He had stopped eating for a day and just generally uninterested in food, after i spoke to my vet, he suggested bringing his insulin down to 3 units just on the days he wasn't eating. We did this over the course of 2-3 days and i noticed a big improvement in himself, he was much brighter, purring, venturing outside, curling up on the couch rather than spread across the floor uncomfortably. He was still lethargic at some points in the day but overall he seemed a bit more himself. His appetite has returned but not as bad as it was, so i increased his insulin back up to 6 units last night and have woken up to him being back to lethargic and looking awful again. Maybe there is no connection and it's just a coincidence, but i'm starting to wonder.

    He has been prescribed Cabergoline, we are just waiting for it to arrive. Home testing has gotten better but his numbers just seem to be the same throughout the day. Always within the same number frame. I can't test atm as we have run out of testing strips, I ordered some a while ago however they are taking longer to arrive, also with lock down there is nowhere i can freely go to get them for this meter. I have regularly been checking his urine and no sign of ketones.
     
  47. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Any chance you could update the spreadsheet with your more recent data? We are data driven here and like to see the numbers in the spreadsheet. If you are running out of test, can you get a second meter for a backup that you can get with strips at a local pharmacy? Most places the pharmacies are open.

    As for Flynn's behaviour, cats get used to being in high numbers. For them, getting to lower, but more normal numbers may feel awful. One of members likened blood to caffeine. You feel miserable when you lower the number of cups of coffee a day. Over time you get used to it.

    Good to hear you are getting the cabergoline. You will definitely need a reliable test strip supply once you start giving it. It's not the same for all cats, but some show a dramatic response to the amount of insulin needed.
     
  48. Kimberly J

    Kimberly J New Member

    Joined:
    Apr 29, 2020
    Elizabeth, are you a trained animal behaviorist? I ask because I'm a board certified behavior analyst, for people, and everything you are describing is consistent with behavioral desensitization. If you aren't already an animal behaviorist, you should be! Even with my training (again with people, but same principles), I feel so intimidated to do it with my own very defensive cat. Your post is a reminder that I'm rushing the process, and I need to do the set-up steps first to get him used to the signals. This was a great post, thank you!
     

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