Introducing Pekoa

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pekoa's mama

pekoa's mama

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Hi all and happy holidays. Let me start by thanking all the active users. I've been reading through the posts for about a month, digesting all the info.
Pekoa (pronounced "pico" as in pico de gato :), or as in the tea orange pekoe.)
Birth date: 11/7/1997

I had noticed that he was drinking more water, and urinating more, than usual. On Friday I made an appointment with his vet for the next Tuesday. However, Saturday 10am he seemed dehydrated, so I took him to the 24 vet for some subQ's. That's when I found out about diabetes.
Diagnosed: 11/20/2010
Readings at diagnosis:
-------------------------------------------------------
Weight: 4.636 kg, 10.20 lb, 0.28 m2
Glu(60-115): 530 mg/dL
BUN(10-26): 38 mg/dL
Na(142-150): 144 mmol/L
K(3.4-4.9): 3.5 mmol/L
Cl(106-127): 119 mmol/L
TCO2(17-25): 15 mmol/L
Anion Gap(8-25): 15 mmol/L
Hct(35-50): 32%
Hb(12-17): 10.9 g/dL
pH(7.39-7.41): 7.195
pCO2(35-38): 36.2 mmHg
HCO3(15-23): 14.0 mmol/L
BEecf([0]-[+6]): -14 mmol/L
URINALYSIS -----------------------
Appearance- Clear
Glucose- 2000+
Bilirubin- neg
Ketones- neg
Sp. Gravity- 1.015, Refract. 1.030
Blood- Small
pH- 6.0
Protein- trace
Urobilinogen- 0.2
Nitrite- neg
Leukocytes- small
Sediment: few white blood cells
-----------------------------------------------------------
They put him on IV fluids, antibiotics, and started him on fast acting humulin r - testing bg every hour. After about 6 hours, the shift vet gave 1u of vetsulin, and his bg dropped from 220 to 80 in 3 hours. They started him on burette with 5% dextrose, and got him back to 311 before they stopped the dextrose. They kept him overnight on the fast acting humulin r, fluids, and antibiotics. They continued to do bg tests every 2 hour - his numbers where all over the place. Kept him at ER on Sunday.
On Monday morning, my vet couldn't work him in (she's a small (1 vet, 2 techs) holistic vet) , and felt he was too unstable to go home, so I kept him at the ER until Monday night 10pm. Took him in Tuesday morning 8am, with about 50 units of vetsulin (ER vet no charge :). She curved him (8am - too hi to register on meter), sent home on 0.5u vetsulin once a day to start. I began testing at home. Switched to 0.5u 2x/day after 7 days. Then switched to 1u 2x/day 7 day later. Also changed from Natural Balance to EVO low-carb.
Now after 12 days, I'm switching to Lantus. Starting tomorrow with 1u 2x/day. I'll be using the modified tight regulation as described here, home testing and calling vet about dosage changes. Hopefully we can start seeing some better numbers!

Again, I wish you all happy holidays, and thank you for posting about your experiences - it helps alot!
 
Welcome from a newer newbie! :) Hope you have better success on the Lantus. My Willie has taken too it quite well. Looks like you're off to a great start!

Happy Holidays!
 
Good morning and welcome to the site!

OK first thing that jumped out at me was the insulins you mentioned.
Vetsulin has warnings; I would not use it.
Lawsuit against Vetsulin Manufacturer
Vetsulin FDAs Warning December 15, 2009
If you can, please print out the warning info to give to your vet so that your vet is made aware and switch to a better longer lasting insulin, like Lantus, was a great choice. I am sure you will love it and start to see great results in Pekoa.

If you were to start posting in the Lantus group on this board, you will be able to have other Lantus users to help you along. It will be helpful for you to have experienced Lantus users watching your posts. They will be asking for numbers from your home testing, so setting up a spreadsheet will be an excellent idea.
I have this link but not sure if it's the most current
Spreadsheet setup instructions
 
Thanks for the welcomes.
My vet and I discussed a variety of options - stay with Vetsulin, or move to Lantus or Prozinc. She is aware of the warnings with Vetsulin, and informed me that I would have to enroll in a hardship program in order to get it. She was actually surprised that the ER had some. The ER vet gave nearly 50 units of Vetsulin to us. We decided to test it out, as I was still uncertain of how to proceed. She has seen good results in the past and she has a few clients still on Vetsulin as they were not well regulated on other insulin.
Granted, my vet is only human, but she is very good at her job. She doesn't rush to surgery, euthanasia, etc., and is very supportive of my at-home care. She's said that as long as I am testing regularly at home, she will review the chart and make suggestions on how to proceed. She also suggested EVO low-carb wet, or a raw meat diet over most of the prescription food (though she did write a script just in case). She and her staff helped me learn how to prick the ear and the paw pad (we practiced on blueberries in the office), and give a shot.
As an aside - She's been my primary vet for near a decade. The first cat I took to her had paralysis in a front leg. The original regular vet I had taken him to wanted to amputate after the swelling went down (that's not the first "rash" decision he had made, just the first one I decided not to listen to!). She worked with him for about a month - acupuncture, herbs, chiropractic adjustment - as well as some exercises and hot/cold compresses for me to do at home. He gradually regained complete use of that leg. She's patient, and willing to give a cat some time to heal.
I actually suggested Lantus to her, and she agreed that that would be a good insulin to use. My suggestion was partly due to all the support and information from the Lantus user group here, and the remission rates in newly diagnosed cats, such as those written about in the article Glargine Insulin & Dietary Changes. I thinks she knows me too well - she knows I'm going to do the research, and run the ideas by her. I have to be on board 100% or it won't work as well as it could.
Well, I got to go get blood from my cat :-D
 
Wow, you have a very lucky kitty. Not much I can add, but I did want to ask if bloodwork has been redone since November?

Tucker suffers from low potassium and we strive to keep him above 4.0 and can't do that all the time, I see Pekoa's potassium was on the low end of normal. K(3.4-4.9): 3.5 mmol/L

I'd encourage you to keep an eye on that. Lethargy and weight loss are some symptoms Tucker had and the the lethargy can easily be confused with a hypoglycemic episode. By giving insulin the potassium level can actually go down because insulin helps move the potassium from cells to muscles, I'm not really up on the technical terms, but what Tucker has is called hypokalemia.
 
It sure sounds like you have a nice vet who is willing to work with you. I have a vet that I adore and my cats like who is amazing at everything but the FD part of things... oh well, I have more than enough support and experience here so all the other stuff like tests and dental are good enough for us. It's such a relief when you have a vet that is reliable and good in many areas.

I had started with Caninsulin (Vetsulin) with Shadoe but she did quite poorly and the move to Lantus made a huge difference. I am glad your vet is aware of the warnings, I wanted to be sure though.
 
Thanks for the info Tucker's Mom. Pekoa has lost weight, but his tone is good. The ER vet ran another panel the day after he was first diagnosed, after he had been on fluids for a day.
ISTAT EC8+ 11/21/2010 05:19 PM
Glu(60-130): 204mg/dL
BUN(15-34): 44mg/dL
Na(147-162): 152mmol/L
K(2.9-4.2): 3.7mmol/L
Cl(112-129): 123mmol/L
TCO2(16-25): 23mmol/L
Anion Gap(10-27): 11mmol/L
Hct(24-40): 25%
Hb(8-13): 8.5g/dL
pH(7.21-7.39): 7.318
pCO2(33-51): 42.3mmHg
HCO3(13-25): 21.7mmol/L
BEecf([-5]-[+2]): -4mmol/L
MANUAL PCV/TS
PCV- 27 %
TS- 8.6 g/dL
Serum: clear

I put in a call to the regular vet regarding any more recent blood work. I really don't remember if we did or not - and she doesn't email the info like the ER did. Guess I should be asking for copies.

??? Do you do anything particular to keep Tucker's K up? Vitamins? Bananas (just kiddin). ???

Gayle and Shadoe - My vet admitted that she was not totally up to date with advances in DM. She did some research, and contacted the local cat vet specialist here (Dr. Gary D. Norsworthy - which is the vet practice I use to use - very expensive - quick to do surgery) found out more about Prozinc and Lantus. I also concur about Vetsulin - Pekoa didn't make much progress - along with the difficulty of getting the stuff - and the warning. We started the Lantus today - I was excited but Pekoa was in a mood - think it may have been a fur shot.

Thanks for the responses! Cheers!
 
Pekoa's potassium went up without any supplements so you're probably fine, it could have been the dehydration, I'm just sensitive to it since I deal with it all the time. Tucker has to take 4 pills per day, Tumil-K, it's a potassium supplement.

I think you're going to like the lantus, it's a nice gentle insulin.
 
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