Jackie Newbie - Here's your post

[Sue and Oliver (GA)]

Hi - I'm new and still haven't read all the rules, so I think I lost my first attempt at a reply. I apologize if this is a re-post.

Anyway, I wanted to comment on the inappropriate elimination question because I've recently had that issue with my diabetic cat, Argyle. She has been hard to regulate, so I've been doing a lot of searching into the questions of how you tell the difference between a cat who is hyperglycemic because they are getting too much insulin (rebound hyperglycemia) and one who is hyperglycemic because they aren't getting enough insulin. I ran across something that mentioned that inappropriate elimination could be a symptom of hypoglycemia. If this problem has just started since Luke's insulin dose was increased, it might be worth looking into that possibility.

In Argyle's case, her number were always "HI" on the meter, so her insulin dose kept going up. When we got to 3.5U twice a day of Lantus, she had a really scary hypoglycemic incident. Every cat is different, but that's why 7U twice a day of Lantus struck me a being a pretty high dose. She has had a tough time recently - in and out of the hospital. She is now on much lower doses of insulin, but since then she's had instances of inappropriate elimination, as well as other symptoms of hypoglycemia like vomiting and shaking. It's confusing, because her BG numbers are still "HI". The issue with Luke might be something completely different, but I thought I'd mention the possibility of hypoglycemia because of the similarity to Argyle's experience.

Good luck!

 

[Sue and Oliver (GA)]

Jackie,

You mention her numbers are HI. Are you testing her at home? Have you tested the meter on yourself to be sure it is working right?


It is hard to tell from symptoms whether she is getting too much or too little insulin but both are very dangerous. Tell us more about your kitty. Was she in the hospital for DKA or something else?

 

[jackie]

Hi -

Thanks for responding - I'm so happy to have input

I have been testing Argyle at home with the AlphaTrak. I don't have the control solution, but when I tested myself, and it came out about 30% higher than normal, which seemed right for that system.

Argyle is 18 years old, calico, a total sweetheart. She's been diabetic for two years, but really only got hard-to-control toward the end of last year, when her dose crept up. I took her to the vet in January because I smelled ketones on her breath and it turned out that she had a UTI. After that was cleared up, I picked up where we'd left off with her insulin and that was when she had the first hypoglycemic episode. (Seems obvious, in retrospect). I cut her dose way down, but she had another hypogycemic episode a week later, and when I took her to the vet a couple of days after that, she ended up in the hospital with DKA. They did x-rays and an ultrasound, and some bloodwork, but didn't find anything that wasn't consistent with diabetes. She came home after two days on a really low dose (0.5U twice a day), but slid right back into DKA and landed back in the hospital for five days. This time, she came home on 1.5 U twice a day. This was about a month and a half ago. Since then her dose crept up to 2U twice a day and then 3U twice a day because her numbers were still high. During that time, she was having the inappropriate elimination (i.e., pooping on the bath mat) and vomiting and other side effects, but the ketones were coming and going as well. The vet switched her to ProZinc. and she was on that at 1U twice a day for three or four days, but the ketones came back, and I panicked and took her back to the hospital. They sent me home with Humulin insulin, because I couldn't afford to check her into the hospital again. She started out on 1U every 6 hours, but that dose crept up to 2U, and she still had the high BGs and other symptoms. I'm also giving her fluids.

I've had long discussions with the hospital vet about whether she is getting too much or too little insulin. The vet says there is no way to tell, so we should just give her more! (I admit that is a totally unfair paraphrase - it's just the frustration talking.). On my own, I've cut back on her Humulin dose to see what happens. This got rid of the vomiting and inappropriate elimination, but she still has hypoglycemic symptoms like shakiness, weakness, and being really starving at times. At the same time, her numbers are high (literally, mostly "HI") and the ketones come back. When they get to "Trace", I end up giving her some insulin to get rid of them.

I feel so bad for her, because she's just been on this roller coaster for the last few months. She is possibly the most patient cat in the world. She has been a really good sport about it, but I know she's sick of not feeling well.

So, I apologize for the long message back. It's such a relief to talk to another owner(s) - I'd really appreciate any thoughts on this

Thanks

 

[nancy and payne]

I'm not sure where to start but I'll try .... how are you checking her ketones? sounds like with strips. With a cat that can DKA and hypo .... that is not a good combo, sorry. When a cat throws off ketones it means something is wrong, USUALLY that they don't have enough insulin, or they have an infection OR?

The vet is right about there is no way to tell if its too much or too little insulin now but I can tell you that Humulin is not a good insulin and if you still have ProZinc, I would go back. The pzi is gentler and lasts longer. Because of her having the hypo experience, I would give her a shot every 8 hrs. and test, test, test. Have a hypo kit on hand and print out the hypo directions off this site.

Are you sure the infection is cleared up? an infection can lead to ketones in a ketone prone cat. Is she your only cat? What are you feeding her, is she eating well? The humulin is a harsh insulin and lasts a short time in the system. I would also give her 1/4 of a 10 mg. pepcid before she eats 2x a day.

You want to be like a boat on a river ..... steady, steady, steady. Go back to pzi, give t.i.d. feed baby food all meat, boiled chicken, wet food, pepcid to calm her down. You need to set up a spreadsheet and track her #'s because that is the only way you will know if it's too much or too little insulin .... the cat and the numbers will tell you.

And yes .... you want to breathe. Go back to step one, you can do that, then build on that. She sounds like a fighter, you can figure this out, we are here to help.
Nancy and Payne