Kitty showing signs of relapse...

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malibu4590

Member Since 2013
Hi Everyone,

Background: My 9 year old cat, Malcolm, was diagnosed as diabetic on June 10th, 2013. He spent 4 days in the hospital with BG levels registering around 600 when he was admitted. The lowest the vet got his BG during his stay was in the 300s. He also had high levels of ketones in his urine. He was on an IV during his hospitalization of B vitamins and other minerals to help with the ketones. He was released to us Thurs June 14, 2013. Malcolm was prescribed 3cc's of ProZinc every 12 hours, an antibiotic Clavamox to take every 12 hours, and Royal Canin Diabetic dry food (Malcolm will not eat wet food, but vet gave us a can of diabetic wet food just in case we want to try again). My husband and I were very diligant about giving Malcolm his meds on time everyday. His check up is scheduled for this thursday, however my husband and I are going to take him first thing tomorrow morning.

When I gave Malcolm his insulin shot this morning, he seemed his normal self. I usually sit with him for a while before and after I give his injection just to keep him at ease. He has had a great appetite these past 10 days. He eats the recommended amount of food for his weight ( 3/4 of a cup --he weighs 9.5 lbs) but still drinks a lot of water (about a cup and a half) a day.

I asked our vet during the discharge if we should be checking Malcolm's glucose along with administering the injections. He said, "Not yet."

I gave his second injection this evening at the appropriate time. He seemed lethargic, walking as if he was dizzy, and just laid around. He stopped drinking water and eating though he would walk over to his bowl as if he would, but instead just hovered over it, then laid down after a few mins. Malcolm is currently lying on the bathroom rug, seemingly too weak to move much. He purrs when we rub him but he doesn't look good. He reminds me how bad he looked when we rushed him to the vet two weeks ago.

At this point, my husband and I are worried sick. We force fed Malcolm 5 small syringes full of water to get him some hydration. My husband just ran out to CVS to get a glucose meter (Accu Check Aviva Plus) so we can check Malcolm's sugar. I'm worried that he may be hypoglycemic since he's showing some signs that I've read here.

We still have that can of diabetic wet food. Should we try to force feed it to him if the numbers come back low?

Any advice is much appreciated!
 
Re: Kitty showing signs of relapse

Because you don't know if he is going hypo, until your husband gets back with that meter please rub some Karo syrup on his gums, or honey, or see if he'll lick some vanilla ice cream. Better safe than sorry. Please post back for help in testing ASAP. We need to know what his bg is right now. Hope you have Karo or honey, even maple syrup but rub it on his gums and post back.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

While you are waiting for your husband to return, you might read How to Handle A Hypo and gather any of the needed supplies together.

If the Karo/honey/syrup seems to help him, you'll want to start giving him small amounts of high carb wet food or gravy about every 15-20 minutes.

Dry food takes too long to digest and may provoke vomiting.

If necessary, syrup and flour stirred into water will make a high carb gravy that may be syringed in orally, too.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

Thanks Hope for the quick response. We just took his BG. It's 589 so I would believe he is not hypoglycemic.

Any idea on the next course of action? Can we do anything here at home to lower his BG? He's definitely going to see our vet first thing in the morning. His last insulin shot was at 6:30pm eastern.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

BJM said:
While you are waiting for your husband to return, you might read How to Handle A Hypo and gather any of the needed supplies together.

Thanks BJM...it doesn't appear like he's hypo. It took us forever to try and get blood from his ear! DH purchased 2 types of lancets...micro thin and ultra thin and neither seemed to work. All of our poking didn't seem to bother Malcolm but it made us a wreck! I finally gave up and poked his paw and got the 589 reading. Hopefully we did the right thing.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

Smell his breath - does it smell fruity or like nail polish remover? That would be the smell of acetone, a ketone.

Do you happen to have urine ketone test strips?

When there isn't enough insulin, glucose remains in the blood and the body breaks down fat for calories. A by-product of this is ketones. Too many ketones can indicate diabetic ketoacidosis, a potentially fatal, expensive to treat complication of diabetes.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

BJM said:
Smell his breath - does it smell fruity or like nail polish remover? That would be the smell of acetone, a ketone.

Do you happen to have urine ketone test strips?

DH and I just smelled Malcolm's breath...it doesn't smell unusual or like the smells listed above.

DH DID buy ketone test strips in the store! Malcolm hasn't pee'd since about 8pm. He seems too week to want to go. Should I stick a strip in his litter box and see if I can get a reading?
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

Ketones are nothing to mess with and can escalate quickly into DKA. Any chance of an ER visit tonight? They can at least check to see if he has ketones or if he is running a high temp for some reason. Glad it's not a hypo but worried now he might be throwing ketones. Can you take his temp?
 
A fresh urine specimen is required.

If you pull up the scruff of his neck and release it, does it stay pulled up?
If yes, that is called "tenting", a sign of moderate to severe dehydration.

With the behavior you've described, if he is also tenting, please go to the vet.
 
Re: Kitty showing signs of relapse...3 units Prozinc,,maybe

Hope + (((Baby)))GA said:
Ketones are nothing to mess with and can escalate quickly into DKA. Any chance of an ER visit tonight? They can at least check to see if he has ketones or if he is running a high temp for some reason. Glad it's not a hypo but worried now he might be throwing ketones. Can you take his temp?

I know, he was treated for ketones during his hospitalization. We can't take his temp. He barely lets the vet do it. We cannot afford an ER visit. The 4 days he spent with the vet two weeks ago cost us $2000. DH and I figure he may be in for another $1000 when we take him tomorrow.
 
BJM said:
A fresh urine specimen is required.

If you pull up the scruff of his neck and release it, does it stay pulled up?
If yes, that is called "tenting", a sign of moderate to severe dehydration.

With the behavior you've described, if he is also tenting, please go to the vet.

Yes he is tenting but not as severe as he was two weeks ago when we realized something was seriously wrong.
 
Quick update...Malcolm has been walking around a little. He left the master bathroom on his own and walked out to the kitchen...all on one floor...and headed for his water bowl. He took one lick and then laid down. DH brought Malcolm back into our bedroom and laid him on the bed where he is now resting.

ETA...Thank you all for your help tonight. It's nice to know there is a community like this available that is so ready and willing to help!
 
Either a) he isn't getting a high enough insulin dose or b) he dropped fast, possibly lower than he is used to and bounced due to hormones releasing stored glucose.

It is off schedule, but if he is going into DKA, I think you could safely give him 1 unit of ProZinc now to help bring him down some until the vet visit in the morning.

you want to push fluids, using an oral syringe if necessary, to help flush any ketones.
 
BJM said:
Either a) he isn't getting a high enough insulin dose or b) he dropped fast, possibly lower than he is used to and bounced due to hormones releasing stored glucose.

It is off schedule, but if he is going into DKA, I think you could safely give him 1 unit of ProZinc now to help bring him down some until the vet visit in the morning.

you want to push fluids, using an oral syringe if necessary, to help flush any ketones.

Ok that sounds reasonable. We're going to give him some more water with the oral syringe and take turns getting some sleep tonight.

I will check back in tomorrow and update this thread once we hear what the vet has to say.

Thanks again!
 
Can you get another bg test before giving him more insulin? Just to be safe. That was a high starting dose too and like BJM said, he may have gone too low and shot back up. Also, will he drink tuna water? Do you have any tuna fish? If it is in oil, rinsed it and run it through water and squeeze the water out and see if he'll drink that down. Hope he'll be okay but please let us know how he is tomorrow.
 
malibu4590 said:
...Royal Canin Diabetic dry food (Malcolm will not eat wet food, but vet gave us a can of diabetic wet food just in case we want to try again).
... He eats the recommended amount of food for his weight ( 3/4 of a cup --he weighs 9.5 lbs)...

The Royal Canin DD is:
29% calories from protein
33 calories from fat
38 calories from carbohydrate
per this food chart at Cat Info

The percent calories from carbohydrates is way too high for a diabetic, according to contemporary feline diabetes treatment.

The only low carb dry foods that have about 11% or fewer calories from carbohydrates are
Evo Cat and Kitten
Wellness Core Original in gold and tan bag
Young Again 0 Carb (internet only)
Stella and Chewy's (actually freeze-dried and supposed to be rehydrated, plus you have to make sure enough water is consumed or constipation may occur)
 
Hope + (((Baby)))GA said:
Can you get another bg test before giving him more insulin? Just to be safe. That was a high starting dose too and like BJM said, he may have gone too low and shot back up. Also, will he drink tuna water? Do you have any tuna fish? If it is in oil, rinsed it and run it through water and squeeze the water out and see if he'll drink that down. Hope he'll be okay but please let us know how he is tomorrow.

The tuna water idea sounds good too. He used to love tuna until we had to put him on the prescription food to prevent struvite crytals and couldn't give it to him anymore. Thanks again Hope!
 
A low carb canned or raw diet may drop his glucose levels by 100 points in a day, so you have to be testing to change the diet safely.

If he likes tuna, you may be able to use that to transition him to low carb canned food, by slowly mixing in a different flavor, such as turkey and giblets (ex Special Diet Friskies Turkey and Giblets), a teaspoon or two at a time.
 
BJM said:
malibu4590 said:
...Royal Canin Diabetic dry food (Malcolm will not eat wet food, but vet gave us a can of diabetic wet food just in case we want to try again).
... He eats the recommended amount of food for his weight ( 3/4 of a cup --he weighs 9.5 lbs)...

The Royal Canin DD is:
29% calories from protein
33 calories from fat
38 calories from carbohydrate
per this food chart at Cat Info

The percent calories from carbohydrates is way too high for a diabetic, according to contemporary feline diabetes treatment.

The only low carb dry foods that have about 11% or fewer calories from carbohydrates are
Evo Cat and Kitten
Wellness Core Original in gold and tan bag
Young Again 0 Carb (internet only)
Stella and Chewy's (actually freeze-dried and supposed to be rehydrated, plus you have to make sure enough water is consumed or constipation may occur)

Thanks for the recommendations.

Hmm, the vet told us the Royal Canin would help with Malcolm's diabetes as well as help prevent the reformation of the struvite crystals he suffered from last year. We went through three different bags of prescription St/Ox foods before finding one that Malcolm liked and didn't give him bloody diarrhia for the struvites. Now we're on this new food, that he seems to enjoy and his bowels are good, yet it appears like it probably is helping him relapse.

It's so overwhelming to know what to do when you have a professional telling you the cat can heal over time through special diet and medication, if neeeded. And this vet, btw, is the owner of a a Cats Only Vet Hospital.
 
Many vets nutrition education was provided by the pet food manufacturers and was maybe a lecture or two at best. These companies have a vested interest in selling their products.

Here are the American Animal Hospital Association Diabetes guidelines, published in 2010.

You might also print out the food chart from Cat Info, or even pages from the site itself.

And to be fair, vets may have a difficult time staying up to date on every condition for every species they treat.
 
Hi Everyone!

I wanted to check back in to give an update on Malcolm.

Early this morning, from 1am to 2am, DH and I force fed him the gravy in the Royal Canin canned food and gave about 3 ounces of water in an oral syringe. We were able to get some fresh urine when I took him to his litter box and checked the ketones. There was just a trace.

We took him to the vet when they opened at 8am. He was admitted for the day so they could perform a BG Curve. They took his first glucose reading of the day and it was 508 on their glucometer and was 472 on our glucometer. We showed them the test strip that stated he only had trace levels of ketones in his urine and were told they use a different test. Well when we picked Malcolm up at 6pm tonight, he still had the same trace levels on their test and said we could continue to check for them with the test we already had. While he was hospitalized they gave him subcutaneous hydration since he was clearly dehydrated and took 5 bg readings throughout the day.

At 8am his BG was 508, by 11am it was 308, and at 2pm it was 250. It's currently hovering in the mid 300s. He has much more energy and a big appetite now. The vet increased his ProZinc insulin dosage to 4 units every 12 hours instead of the previous 3 units. Hopefully this will help stabilize Malcolm and keep him acting like his old self.

Since Malcolm seems to have taken a liking to the Royal Canin diabetes canned food, is it a suitable option going forward to help control his diabetes? I didn't see that actual canned food on the Cat Info food chart to see if the carb load is still too high. Malcolm suffered a blockage from struvite crystals in May of last year and I was hoping this new food could help prevent the crystals as well as keep his diabetes in check.

Thanks again everyone!
 
So glad to see this post and know Malcolm is doing okay and back to eating. Main thing is to become really good at testing him before shooting insulin and also keep testing his urine and keep and eye out for signs of dehydration again by tenting. BJM and others will kick in on the RC food. Did the vet suggest the possibility of giving fluids at home just in case trace/dehydration shows up again? I'm so happy he is back home and eating.
 
Since Malcolm seems to have taken a liking to the Royal Canin diabetes canned food, is it a suitable option going forward to help control his diabetes?

I see some Royal Canin canned in two different places on Dr. Lisa's chart... if you scroll down to pages 29-30, is it listed there?

It sounds like Malcolm is doing much better today than yesterday! Great news.

I was wondering with the increased dose (which looks like it worked really well today all things considered), did your vet mention circumstances where you would give a lower dose? Like if you saw a preshot number in the mid-300's for instance? Your story sort of reminds me of my cat's story at the beginning. He was diagnosed diabetic, and three days later he was in the ER with DKA. Severely dehydrated, wouldn't eat, he was nearly dead actually. After three days of touch and go, he came home on a dose of 1u twice a day. About three weeks later, he was up to 4u twice a day. And his numbers at shot time were in the 400s or so. Right about then is when he really started to get better, and a few weeks later he was on 1u or less twice a day.
The guidelines my vet gave me were to adjust his shots based on his preshot numbers. Very basic instructions really.
400 or higher = 4u
300-399 = 3u
200-299 = 2u
100=199 = 1u
Under 100 "call me".

I'm not saying that scale would work for Malcolm. I'm just wondering if your vet suggested adjusting his dose based on his numbers at shot time. 4u today dropped him 250+ points, and that was on numbers off the vet meter in the vet clinic environment (which can be stressful to cats and cause higher BG numbers).

My suggestion regarding ketones is that if you continue to see "trace", call the vet and let them know. If you see anything higher than trace, I'd bring him back for more fluids and monitoring. Ketones can go from trace to worse quickly.
 
If you pop over to Cat Info, this is a section on urinary tract health which talks about crystals. One of the most important things you can do for a cat with urinary tract issues is to feed a wet diet - no dry food, ever. Cats don't drink as much water on a dry food diet and that will contribute to more concentrated urine, which is more prone to form crystals or stones.

The Friskies Special Diet pates are both low carb and formulated for cats prone to urinary tract issues, plus they are a lot less expensive than prescription foods. They may work just fine for him, if he'll eat them.
 
Hello and welcome to the board, I am glad to hear Malcom is doing better.

If you want to test his ears instead of the paws, you will have better luck using a bigger lancet like a 28 or 29g. Make sure too you use neosporin with pain relief after the test.

Also it would be a good idea for you (and us) i you set up a spreadsheet to track results and trends. makes it easier to see whats going on and for us to recommend any dose changes. Heres how : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Wendy
 
Hope + (((Baby)))GA said:
So glad to see this post and know Malcolm is doing okay and back to eating. Main thing is to become really good at testing him before shooting insulin and also keep testing his urine and keep and eye out for signs of dehydration again by tenting. BJM and others will kick in on the RC food. Did the vet suggest the possibility of giving fluids at home just in case trace/dehydration shows up again? I'm so happy he is back home and eating.

The vet did not suggest us giving him the sub-cutaneous fluids at home though DH and I were already aware of the possibility. He wants us to call him if anything out of the ordinary changes. We tested him our meter again this evening before giving his insulin and the meter just said "Hi". I'm not sure if it's not calibrated properly or what because it worked just fine yesterday.
 
Carl & Bob said:
Since Malcolm seems to have taken a liking to the Royal Canin diabetes canned food, is it a suitable option going forward to help control his diabetes?

I see some Royal Canin canned in two different places on Dr. Lisa's chart... if you scroll down to pages 29-30, is it listed there?

It sounds like Malcolm is doing much better today than yesterday! Great news.

I was wondering with the increased dose (which looks like it worked really well today all things considered), did your vet mention circumstances where you would give a lower dose? Like if you saw a preshot number in the mid-300's for instance? Your story sort of reminds me of my cat's story at the beginning. He was diagnosed diabetic, and three days later he was in the ER with DKA. Severely dehydrated, wouldn't eat, he was nearly dead actually. After three days of touch and go, he came home on a dose of 1u twice a day. About three weeks later, he was up to 4u twice a day. And his numbers at shot time were in the 400s or so. Right about then is when he really started to get better, and a few weeks later he was on 1u or less twice a day.
The guidelines my vet gave me were to adjust his shots based on his preshot numbers. Very basic instructions really.
400 or higher = 4u
300-399 = 3u
200-299 = 2u
100=199 = 1u
Under 100 "call me".

I'm not saying that scale would work for Malcolm. I'm just wondering if your vet suggested adjusting his dose based on his numbers at shot time. 4u today dropped him 250+ points, and that was on numbers off the vet meter in the vet clinic environment (which can be stressful to cats and cause higher BG numbers).

My suggestion regarding ketones is that if you continue to see "trace", call the vet and let them know. If you see anything higher than trace, I'd bring him back for more fluids and monitoring. Ketones can go from trace to worse quickly.

Lots of wonderful information here, thanks!

I see his dry food listed on the Cat Info food list but not the diabetic wet food. I'll work on figuring out the calculations later. I know it's way better than the dry he had been eating.

The vet did not suggest adjusting his dosage based on the numbers. I think mainly because he doesn't want us to take the BG numbers and play vet tech. He'd rather us bring Malcolm in. I think your scale sounds good and definitely worth taking into consideration as we get him more stabilized.

Thank you for the advice on the ketones. We are keeping a journal of all his behavior, diet, BG levels, etc.
 
Wendy&Tiggy said:
Hello and welcome to the board, I am glad to hear Malcom is doing better.

If you want to test his ears instead of the paws, you will have better luck using a bigger lancet like a 28 or 29g. Make sure too you use neosporin with pain relief after the test.

Also it would be a good idea for you (and us) i you set up a spreadsheet to track results and trends. makes it easier to see whats going on and for us to recommend any dose changes. Heres how : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Wendy

Hi Wendy,

Thanks for the welcome, tips, and link! Much appreciated!
 
the meter just said "Hi". I'm not sure if it's not calibrated properly or what because it worked just fine yesterday
Doesn't matter what number you got yesterday, tonight he is "Hi" which means, depending on the brand of meter, he is either over 500 or over 600. Meters usually go up only to a certain reading and then they just read "Hi" or " Lo".
 
malibu4590 said:
...The vet did not suggest adjusting his dosage based on the numbers. I think mainly because he doesn't want us to take the BG numbers and play vet tech. He'd rather us bring Malcolm in.

Um ... he gets paid when you do that. And for much less cost, you can 1) make sure it is safe to shoot, 2) identify the nadir to make sure it isn't too low, 3) run a curve, and 4) as needed, adjust the insulin doseage ... Just like a human diabetic can do.
 
Hope + (((Baby)))GA said:
the meter just said "Hi". I'm not sure if it's not calibrated properly or what because it worked just fine yesterday
Doesn't matter what number you got yesterday, tonight he is "Hi" which means, depending on the brand of meter, he is either over 500 or over 600. Meters usually go up only to a certain reading and then they just read "Hi" or " Lo".

I figured that. I took a reading before giving him another can of wet tonight and it read 511. He dropped as low as 250 at +6 hours when checked at the vet so I hope to do another BG in a few hours and see if he drops.
 
BJM said:
malibu4590 said:
...The vet did not suggest adjusting his dosage based on the numbers. I think mainly because he doesn't want us to take the BG numbers and play vet tech. He'd rather us bring Malcolm in.

Um ... he gets paid when you do that. And for much less cost, you can 1) make sure it is safe to shoot, 2) identify the nadir to make sure it isn't too low, 3) run a curve, and 4) as needed, adjust the insulin doseage ... Just like a human diabetic can do.

Oh I know that for sure.

I'm trying to process all of this great information so that DH and I can take control helping Malcolm but obviously don't want to get ahead of ourselves too soon.
 
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