Introductory post, at wits end.

[AZJenks]

Hi everyone. First, thanks for this forum, and thanks in advance for your knowledge and assistance. Please excuse our frustration, but we're desperately in need of guidance. Also, apologies for the extended length of this post, but I figure a history leading up to it is warranted for a first post.

Intro

Jenks is an 8-year old male. Neutered. Exclusively indoor except for the occasional supervised visit to the front yard to eat grass and sun himself. Simply the most easy-going, well-tempered boy I have ever seen.

Pre-diagnosis

Ever since Jenks was a kitten, the vet said he was going to be big. So we didn't think to be concerned that he was 28 pounds, had a large appetite for food and water, or had voluminous litterbox habits. Things started to change in the months leading up to diagnosis. Principally a dry-food free feeder, he started to suddenly shun his Blue Buffalo Wilderness. So I transitioned him to a comparable food, Merrick Purrfect Bistro. That lasted one bag before he quit eating it. Unable to continue "sampling" $30-$40 bags of dry food, I discovered he liked IAMS Healthy Naturals, so we tried that for awhile until he didn't want it anymore. Finally, I just had to give in and give him Purina Naturals, which is what I had been offering him as treats. My other family member prefers to indulge him with Temptations at his whim. And even though I served Friskies wet food for dinner to his siblings, he remained mostly a dry food addict.

One day I picked him up (he doesn't usually like that so it had been awhile since I had done it) and I noticed he felt lighter. After weighing him, we were surprised to see that he had lost 6 pounds. Combined with other concerning signs I had observed -- increased water intake, seemingly insatiable appetite & begging for treats, increased lethargy, large urinations, and hind end weakness -- I knew it was time to take him to the vet.

Diagnosis

At the vet, they did a full blood screen and urinalysis. The results were definitive. His BG was in the 400s. Thankfully everything else was fine. So, the week of Christmas, he was diagnosed as diabetic. The vet sent us home with a prescription for a Lantus pen with the screw on syringe tips and an order to begin giving him 2 units twice a day and to come back eventually for a follow up blood panel. Otherwise, we were to treat him as normal, including feeding. We scheduled his insulin at 9AM & 9PM.

Post-diagnosis

Week 1 - He seemed more alert and generally livelier. We continued his diet as normal. He rapidly developed soft, malodorous stools but otherwise seemed stable.

Week 2 & 3 - Despite continuing as normal, he declined. Stools became even softer. Cravings for food increased. Hind end weakness increased noticeably. He was losing footing on the wood floor. He could no longer hold himself up in the litterbox. As a result, he often got messes all over his backside necessitating regular cleanings.

Week 4 - By now he's worse than he was pre-diagnosis. I discovered this board, tried to digest as much info as I could, and chose one night to check his blood sugar with the Accu-check Aviva meter we had lying around. I managed a blood draw from the ear (the only time since I've been able to achieve that) and his BG was an astounding 465. I felt defeated, like I had let him down the last four weeks. Even worse, I felt like I had wasted all of that expensive insulin.

I curved him on January 23 with the Relion Micro that I purchased at the behest of recommendations on this site. After repeated attempts terrifying him trying to get blood out of his ear, I found a suggestion to use the rear center pads which he tolerated. His numbers looked like this:

5AM(+7) 433
6PM (+9) 327
9PM (+0 pre shot, meal time) 462
1030PM (+1.5) 451
1230A (+3.5) 480
315AM (+6.25) 585

We scheduled him for an immediate follow-up vet visit. The vet didn't seem concerned. He just said to up the dosage to 3 units twice daily. Otherwise, keep doing everything as normal.

We began shooting 3 units 2x day on January 25.

From my admittedly incomplete research, I read that Lantus takes up to a week to take full effect from a dose change, so I didn't test him again until February 1.

His pre-shot number at 9PM (+) meal time) was 495.

At this point, we decided that we had no choice but to remove all dry food. Currently, if he begs for food, we open a can of Friskies wet food and put it in front of him. He eats, albiet not much.

Numbers for February 2, the first full day with only wet food:

3AM (+6) 464
3PM (+6) 59 (no idea how to explain this)
9PM (+0 pre shot meal time) 512/430 (so shocked by 512 that I tested the other foot just to double check)

Finally, numbers so far for February 3. Again, all day with only access to wet food.

1AM (+5) 452
3AM (+6) 500

To be sure there wasn't something wrong with the meter, I tested it on human blood versus the Accu-check Aviva in the house. Aviva read 117, Relion Micro 130.

Is the Lantus bad? It's clear in the tube and constantly refrigerated.
Why is it ineffective? Is he resistant to it? Not getting enough?
How can he have numbers so high when he hasn't had dry food for two days?
Where did the 59 come from?
Why all of a sudden did he develop loose stools on Lantus?
What do I use to replace the calories he's missing from the dry food? He can't afford to lose any more weight, and I don't think he is taking in sufficient calories from wet food to make up the difference. And he won't eat any of the freeze dried high protein treats we've purchased.

Can someone please help me figure out what's going on? I don't know where else to turn, and I can't continue this in futility knowing that he's miserable.

 

[Larry and Kitties]

The 59 is very likely an erroneous reading. In the future when you get an unexpected reading then retest.
He could be insulin resistant or maybe just a high-dose cat .
My MurrFee is a high-dose cat. He now gets bout 8 units Levemir (a human insulin very similar to Lantus) with 3 units N )NPH) twice daily. The follow includes some topics on high-does cats,
viewforum.php?f=12
With those high BG I would be testing his urine for ketones using dipsticks that yo can purchase at a human pharmacy.
A lot of cartakers use the disticks that measure both glucose and ketones
https://www.google.com/shopping/product ... CFoQ8wIwAA

 

[ebuckley]

Hi there. Thanks for sharing your story. I am new here too, so can't give you much advice; but if it helps, I totally commiserate. The information on this message board has totally saved the day for Napa and me. It is definitely a bit overwhelming at first, but I took it one step at a time.

These recommendations (from folks here and generally supported by my vet) made a huge difference for us:
1. We started home testing (as you are doing). The ear was very difficult at first for us too, but it's much, much easier now...everyone said it would get easier. It's still a pita, tho.
2. Then we started home testing more systematically and used the spreadsheet template here. I resisted this because I don't like Google docs but am glad the generous folks here encouraged me to do so, because it makes tracking and sharing numbers much easier and it helps when trying to make sense out of the numbers and how to respond. Data to inform? Yes, please! Take a look at a few peoples' spreadsheets and you'll see what I mean.
3. We took away all dry food....even the relatively low carb dry food. Low carb canned food only. (Be sure to do this gradually and carefully as it can upset GI and interact with insulin doses). It took several days to get her to eat it but once her appetite came back, it came back in a big way. I am now feeding her about 1oz/per pound of healthy weight spread across the day as much as schedule allows. For treats, I give her small chunks of pork chops (oddly, pork is the only people food she likes). I boiled up one chop and portioned out a few weeks worth into small zip lock baggies and put them in the freezer. We never had loose stools with Lantus.

Two additional pieces of information might help others reading your post:
1. With your tests, when were Jenk's most recent meals?
2. Where are you injecting the insulin? The "scruff" behind the head doesn't have enough blood supply to absorb the insulin according to my vet (and corroborated here).

 

[Deb & Wink]

Welcome to sugardude Jenks and his caregiver. Would you please introduce yourself?

I'm Deb, and that tuxedo pictured with my post is my sugardude Wink.

Is the Lantus bad? It's clear in the tube and constantly refrigerated.

You Lantus pen is probably still good if still clear and never frozen. Many people here use the pens to the last drop.

Why is it ineffective? Is he resistant to it? Not getting enough?

You may have not found the correct dose yet. You said Jenks was 28 pounds, lost 6 so if he is now 22 pounds, that would mean a starting dose for Lantus of 2.5U. We suggest using regular insulin syringes with the Lantus pens because the pen tips only allow you to change the dose in whold unit increments. We've found that changes are better if done in 0.25U increments. You should get 3/10 cc, 1/2 unit markings on the barrel, 29-31 gauge, needle length is a personal preference but many beginners prefer the longer needles.

How can he have numbers so high when he hasn't had dry food for two days?

Dry food can last in his system for up to a week.

Where did the 59 come from?

Could very well have been a bad test, as Larry said.

Why all of a sudden did he develop loose stools on Lantus?

Don't know.

What do I use to replace the calories he's missing from the dry food? He can't afford to lose any more weight, and I don't think he is taking in sufficient calories from wet food to make up the difference. And he won't eat any of the freeze dried high protein treats we've purchased.

Maybe try some of these ideas to tempt him to eat the wet food.
sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo Liv-a-little chicken treats -- crumble into dust over food
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.

Heat the food until it is stinky. The smell could be enticing.
Add water to the food, until applesauce consistency. Many cats like the texture better.

These transitioning tips for dry food addicts helped me to get my Wink to recognize wet food as edible. It took patience, persistence and trying many of these tips, but it was possible. Took about 6 weeks.

ETA: Fixed link

 

[BJM]

Some cats develop stinky stools when changing from dry to canned. It may help to give him some probiotic such as Intelliflora, Forti Flora, or a teaspoon or two of plain yogurt with active cultures.

Voluminous, malodorous stools could be a sign of exocrine pancreatic insufficiency. This is something to discuss with your vet.The treatment is pancreatic enzyme replacement and some of these are over the counter.

My signature link Secondary Monitoring Tools has a number of other assessments that can be helpful in monitoring your cat's health.

 

[Tara & Buster]

Welcome! You have gotten some great information. I just wanted to fix Deb's link to help transition Jenks to canned food: Transitioning to canned food

Also, here's a link on how to set up a spreadsheet to track Jenks' numbers: Spreadsheet setup It is very helpful for dose experts to be able to see trends and offer advice. Try to take a test before each insulin injection and at least one other time in the cycle. We test, feed then shoot.

We also ask that you put up a profile so we have a quick reference on your situation. Profile info

I hope that isn't overwhelming. We have all been in your shoes and we can help! Hang in there and keep asking questions. You really are in the best place you can be to help Jenks get back on the right track.

 

[AZJenks]

Wow! Many thanks for such a great set of initial replies. I'm not sure if it's appropriate to reply to each one individually, so I'll try to address each in turn.

First things first. Today has been a better day. After about two days with no dry food, he's becoming more used to an all wet food diet.

With the diet change, I think we've resolved one variable to this equation. His bowel movement today was small, firm, and dark! For the first time in weeks it hasn't been runny and the greenish color of the Purina Naturals dry food. Never once did I ever see myself getting so excited about poop! Clearly, the dry food was the culprit.

But his numbers were still high all day.

1AM (+4) 452
3AM (+6) 500
3PM (+6) 391
9PM (+0 PMPS) 512

After reviewing the numbers, the vet told us to give him 4U at the 9PM feeding. I did that and observed him all night, as usual. I tested him at 3AM (+6) and he was a 215. I can't tell you how thrilled I am to see a number that's not 400 or 500.

Ok, question & comment answering time:

A lot of cartakers use the disticks that measure both glucose and ketones

Thank you for the advice on the testing sticks. I assumed that the vet would've detected ketone bodies in the initial urinalysis, but if this is something that requires ongoing monitoring, I'll try to find some to add to my regimen. I remember seeing Ketone Test strips when I was at Walmart. Are those useful here or does it have to be a particular brand?

Two additional pieces of information might help others reading your post:
1. With your tests, when were Jenk's most recent meals?
2. Where are you injecting the insulin? The "scruff" behind the head doesn't have enough blood supply to absorb the insulin according to my vet (and corroborated here).

Thank you so much for your words of support and recommendations.

I'm not up in the mornings, so I handle his tests in the afternoon and overnights. His other human is uncomfortable with the procedure, so they just give him the insulin and feed him. He gets insulin at 9AM and 9PM, and gets fed immediately afterward. Aside from a few treats that I need to get better at monitoring, he usually goes for about 6 hours until his BG test without food. At that time, I'll give him another meal. He may get additional wet food at other times as we haven't yet determined what a proper feeding schedule is. Right now we're mostly concerned with getting as many calories in him as possible to maintain weight.

As for the scruff, that's what our vet instructed us to use. His other human is only comfortable giving it to him there, but to avoid pricking him too many times in the same place, I try my best to work along either side of his backbone. But without much fat, he's started protesting the shots there. For instance, tonight he growled at me and tried rolling over mid-shot. So he feels them, compared to the scruff which he simply ignores. I'd appreciate any recommendations.

Maybe try some of these ideas to tempt him to eat the wet food.
sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo Liv-a-little chicken treats -- crumble into dust over food
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
-powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.

Heat the food until it is stinky. The smell could be enticing. Add water to the food, until applesauce consistency. Many cats like the texture better.

Thanks for the recommendations on making wet food more enticing. He seems to be coming around more with each day. On your suggestion, I also discovered that he liked parmesan cheese, who knew? I'll also experiment with the others and warming the food. Whatever it takes!

His other human isn't comfortable with the syringe idea, so that may be a tough sell. But if it becomes necessary, we'll do what we have to. And just for clarification, right now he's about 20lbs, and his numbers were at 3U 2x. We're going to try 4 for a few days to see how it goes.

Some cats develop stinky stools when changing from dry to canned. It may help to give him some probiotic such as Intelliflora, Forti Flora, or a teaspoon or two of plain yogurt with active cultures.

Thank you for your insight on the stools. As mentioned earlier, after a couple days on the all wet diet, we had the first proper colored, firm stool that we've seen since starting this process. I think there's little question that the dry food was the culprit.

A second recommendation for FortiFlora. I'm going to have to track some down.

I hope that isn't overwhelming. We have all been in your shoes and we can help! Hang in there and keep asking questions. You really are in the best place you can be to help Jenks get back on the right track.

Thank you for the kind welcome and the links. This whole process is overwhelming, but if setting up a spreadsheet and profile can play a role in getting him better, then it's little trouble. I'll work on it presently.

 

[ebuckley]

As for the scruff, that's what our vet instructed us to use. His other human is only comfortable giving it to him there, but to avoid pricking him too many times in the same place, I try my best to work along either side of his backbone. But without much fat, he's started protesting the shots there. For instance, tonight he growled at me and tried rolling over mid-shot. So he feels them, compared to the scruff which he simply ignores. I'd appreciate any recommendations.

My go-to spot is on Napa's side/flank. The is some loose skin above and behind her "elbow," almost like an armpit. Tons of real estate (plus 2 sides) to avoid hitting the exact same spot multiple times. I am sure others here have good spots, too.

Here is an older thread that discusses injection sites.

ut if setting up a spreadsheet and profile can play a role in getting him better, then it's little trouble. I'll work on it presently.

I think you'll be glad you did! Cheers!

 

[BJM]

Dosing for Lantus is based upon the nadir, the lowest glucose level between shots

The only dose adjustment made on pre-shots is to determine if it is safe to give insulin or not.
For new users, do not give insulin if the pre-shot is less than 200 mg/dL.
- Stall - wait 30 minutes and re-test. If rising and above 200, shoot.

Once you have good test data showing how low he goes, you may gradually lower your no shot level to 150 mg/dL.

You'll want to test in the +5 to +7 hour range after giving a shot to see how low he is going. Dose adjustments are based on numbers around the nadir.

Any test below 50 mg/dL on a human glucometer = reduction in dose by 0.25 units (eyeballed as syringes don't measure quarter units)

 

[Deb & Wink]

Never once did I ever see myself getting so excited about poop! Clearly, the dry food was the culprit.

Yeah for normal colored and more solid formed poop! :RAHCAT As you probably guessed, we're not afraid to talk about anything here, especially if it gets our kitties feeling better.

I remember seeing Ketone Test strips when I was at Walmart. Are those useful here or does it have to be a particular brand?

Any brand of the ketone test strips are good. While negative ketones at the initial vet visit is a good sign, ketones can develop in cases when the cat is not eating enough, not getting enough insulin and has some sort of inflammation or infection going on. These 3 factors can lead to ketones and diabetic ketoacidosis, which is why we recommend testing for ketones regularly. Some cats never have them. Others seem to be more prone to develop them. Better safe than sorry.

Urine catching and testing tips for you to try.

 

[Olive & Paula]

Hello and welcome. You have received good information already. The only thing I can add is to keep ready all the posted stickies. Keep asking questions. All of us here have or is still doing the dance as it's called. I like to call it the rollercoaster ride. Up and down with many twists and turns.

One thing I want to mention though, is that you will see high numbers and low numbers, but as you home test you will begin to see patterns emerge. Eventually the high number will be occasional but it takes time. It does not happen over night.

Your boy is certainly a big guy. My Smokey was 25 lbs at his top weight. Barely 12 lbs when I got him and now maintaining 16-17 lbs. That's him the grey one in my avatar. The black and white is my kitten (even if he's 3). He is compact and still behaves as if he is 1. They are best buds. Keep us posted.

Paula

 

[AZJenks]

Thank you for the warm welcome @Woodsywife! Although I have to point out that Jenks has been here for two years now hehe Better late than never, though, right? All our best to you and Smokey!