I'm going backwards .... what am I doing wrong???

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nancy and payne

nancy and payne

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I have written quite a bit about my cat Payne, how she is very prone to ketones (was frustrated ..)
and it would seem, she is immune to all our best efforts to turn this situation around .....

She was DX on Oct. 11 and it has been a roller coaster ride! She spent 3X in the hospital at Davis
with DKA and with the help of this list, we have been able to treat everything at home since then.
She is currently on 3.5u of ProZinc and 1u of NovolinR b.i.d., plus 5mg. pred, tylosin and pepcid s.i.d.

I am home testing and have my SS available .....I feed her canned, I changed over in the
beginning, and have recently lowered the carbs to 0-5. I feed her no fish and have eliminated gluten,
starches, grains and rice from her foods. I bought a meat grinder to prepare raw foods. I give her
her shots exactly 12 hours apart, her meds. at the same time each day. What am I doing wrong!!
Look at her #'s!!!!

I recently upped her ProZinc .5u but that doesn't seem to have helped. I realize the second insulin
mucks everything up but I am afraid to mess with it because it is the last resort with the
ketones. (which we check all the time!)

I read all these wonderful stories about cats responding quickly to diet, coming off the juice and
I can't even get mine just regulated! I feel like such a failure ..... there is soooo much I don't
understand, like ketones .... why did she start showing ketones when we upped the insulin? Did
lowering the pred play into this ketone thing?

Any ideas? I am???? very sad because I can't seem to get on top of this.
Nancy and Payne
 
I am sorry you are having problems.
I wish I could offer some suggestions but I have not used that insulin.
I do have a couple questions -
I don't understand why you started at that dose 3u and also give R plus why you are not adjusting the dose as needed. From the ss, you were at 3u for some time, then increased to 3.5u and stayed there. If the numbers are high, why don't you increase the insulin?

I don't know what you have considered but you could try a longer lasting insulin. I have been using Levemir and had used Lantus before the Lev, so it's one thing.

For the immediate though, why not post in the PZI group on this board to see if you can get specific help with the insulin you are using now. I am sure the people in that group will be able to help you.
 
Can you refresh our memory as to why you are giving the Pred and tylosin. If you are giving the Pred because of the suspect IBD you might discuss with your vet the use of budesonide instead. The Pred is probably making regulation hard. When are you giving the Ped AM or PM? giving 2.5 mg BID instead of 5 SID might help with regulation. How was the i unit R determined?
 
1 unit of R is quite a lot. Most kitties get quite a large drop from only 0.25u or 0.5u of that stuff. What I think is causing the most regulation issues for you is the prednisolone. That can raise glucose levels quite a bit in and of itself. Until you are able to back down on the dosage, you probably won't see much change in the numbers unless you raise the insulin. Please be aware that when you do start backing down on the pred - you need to test very often because it could dramatically (or not) change your kitty's insulin needs. If you are still seeing the same number pattern after the pred is good and out of the system, then you need to consider getting your kitty tested for acromegaly and/or insulin resistance. The sugar dance can be quite a frustrating thing, and it is especially compounded when your kitty is ketone prone like yours. We are all here for you! cat_pet_icon
 
The pred. was given for suspected IBD. We give her meds. in the PM. We tried going down to 2.5mg.
but that is when her ketones
started showing up again. The suggestion to split the dose is a very good one. My vet is out of town
until the end of the month (an internist) but I was going to take her to my personal vet (Davis) for a
new set of eyes.

The 1u of R was added back when she kept going into DKA and cross my fingers, since it was added,
she has not gotten that sick. The tylosin because of suspected infection. I was hoping that cleaning
up her diet would help the suspected IBD and her #'s but there is so much going on, I'm not sure. I
do know had I not found this list, she would be gone .... and even now we are barely holding on.

As far as the dose goes, she started at 1u ProZinc BID but kept going into DKA. A specialist adjusted
it after the third episode to 3u and added the R. Just recently we upped to 3.5 but there is so much
going on that I don't understand ...... I am afraid to mess too much. I have posted with the pzi
group but because of the R, they are not sure. Thanks everyone!
Nancy and Payne
 
This site says:
"In small animals, tylosin is not used as an antibiotic at all but as an anti-inflammatory. Its chief use is for the treatment of colitis. Here, it is not used as an antibiotic to treat infection but instead as an anti-inflammatory to soothe the large intestine. While few formal studies have been performed to examine this non-antibacterial property of tylosin, it certainly seems to work in this regard."
http://www.marvistavet.com/html/body_tylosin.html

That is why I did not recognize the tylosin as an antibiotic.

I not infrequently use R in conjunction with Lantus for my Bailey. I only usually use 1/2 unit though but have in the past used higer does to more quickly get the BG down from a high (400s) BG.
 
What were the symptoms that the vet used to diagnose IBD? Have you been on the antibiotic this whole time for the suspected infection? Does the dr. have an idea where the infection might be at? You probably already know this, but once a cat goes into DKA once, they are more prone to ketones from then on. Ketones result from 3 things usually: lack of insulin, lack of food, and infection. The presence of ketones when you lowered the pred dose could be coincidental, or not. I also noticed on your spreadsheet that you were getting larger spikes of ketones more often just before you lowered the pred dose. (the 4th, 5th, 7th; decrease was on the 9th and only time you saw ketones after that was 6 days after the reduction). I am inclined to suspect that the pred decrease isn't the culprit and it is just kitty wonkiness.

With such a ketone prone kitty - I would suggest not waiting as long to up the dose again as you did with the 3u to 3.5u increase. When does your internist plan on upping the dose again? You are on your 8th day of this dose, which I personally believe is more than enough time for the dose to settle. But I do know several vets out there that like for a dose to settle for up to a month.
 
She had no symptoms of IBD that I could tell, but in the beginning of all this she was one sick kitty
and we were concentrating on keeping her alive because of the DKA .... DKA is vicious! She has been on the
tylosin since almost the beginning, a very small amount.

We go to UC Davis and once Payne
was DK we were sent to internal medicine and I have not seen my regular vet since. She is an older
vet, has had her own practice and I think I need to go back to her to start at step 1 .... the internist didn't
up her insulin dosage, we did. I think I am afraid to mess with the dosage too much because of everything
else going on. I think the internist is confused by Payne and is somewhat hesitant to change doses ....
How does one fight kitty wonkiness?? (Payne says don't mess :)
Thank you all, this is so confusing and all I am doing it seems, and still not succeeding!
Nancy and Payne
 
I would not suspect IBD unless kitty is having bouts of vomiting, constipation/diarrhea issues, etc. Typical symptoms include: vomiting, bad breath (halitosis), diarrhea, constipation, increased thirst from dehydration, gas, rumbling and gurgling in the stomach, abdominal pain, anorexia, moderate to severe weight loss, litter box refusal, dark/tarry stools, lethargy and depression, weakness and fatigue, vitamin deficiencies and anemia.

I would strongly urge you to find a second opinion here.

Due to the ketones - I would not advocate decreasing the dose at all. Depending on what your hometown vet says and your comfort level, I would suggest thinking about a dose increase of at least 0.25u here in the next day or so.

Sometimes we can never get rid of kitty wonkiness. My Oscar is the king of it sometimes (I think), and I chock it up to him making sure I am always on my toes. :roll: It is really frustrating when you see some of the kitties on here that respond like *textbook* to diabetes management. I have a siamese rescue kitty that is one of those. 2 months on insulin and he went into remission, now going on 4 months. Oscar, on the other hand, has been on insulin for almost a year now, and it is a constant battle to figure out what is going on with him and to find a protocol that will work for his needs. All I can say is that through all of this, you will learn your cat better than anyone else out there. You will start to learn patterns, and start to learn what works and what doesn't work. I completely know what you mean about Payne confusing the vets - Oscar has consistently done that too. You know your cat like a mom knows their kid. You are his only advocate. You have no loyalty to a vet - if you think they are grasping at straws, then go somewhere else! My hometown vet now knows that when I call in, it means she is going to have to do some reading and research :lol: Don't give up hope!
 
I think I am just over-whelmed .... I remember when I first heard she had diabetes and I thought I
don't know ANYTHING about this! what will I do? but like everyone else, we learn and move forward.
I feel because I am not an expert, somehow I am letting Payne down but then I found you all and
you virtually yelled ..... test, change diet, figure it out! and again I moved forward. I thank you for
that.

Davis is a teaching hospital and I could have my choice of vets and I agree we know our animals, we
make the decisions. I do like my basic vet, the one you go to until something serious is found and I
am taking Payne back to her, she originally Dx the diabetes. We will go back to square one. I don't
think she has IBD, she doesn't have any of the symptoms except the weight loss, which could be the
diabetes.
Thanks
Nancy and Payne
 
Nancy, have you tried one or two cycles without the R? It really should be used as a short-term fix to bring down a higher number. When it does this, it usually starts wearing off as the other insulin starts kicking in, but so far, I can't really see that on the spreadsheet.


Payne is getting a lot of insulin - and sometimes, the answers aren't obvious and you can get varying opinions.

I can't say how the other medication is affecting the glucose levels and maybe this is what you should discuss with your vet.

I would also suggest asking your vet to explore other insulin options, because as of now, not only are you not getting the drop you need into safer numbers, you are also not getting the duration you need Payne to have with the insulin. Ask your vet about switching to either Lantus (glargine), or Levemir. The university vets should know about both of these insulins, but if not, here are a couple of links (sorry if someone has already suggested this).

http://petdiabetes.wikia.com/wiki/Lantus

http://www.felinediabetes.com/glargine.htm

http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

I hope you will find something in all the suggestions you received that will help you manage Payne's diabetes. Just a little fyi - I would urge you to not raise his dose in the evening - do it at a time when you are home and can monitor.

Don't look at what you are doing is wrong - you are doing the best you can with what Payne is giving you. Some of us have very difficult cats and Layla says welcome to the club! It will get better and I suspect it might get better once he is off the other meds, but, do look into the other insulins as well.
Best,
Pam & Layla
 
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