Long story - advice please

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brickyard

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Hello, I posted this to the Lantus forum, but since it's not strictly a Lantus question I'm crossposting it here too...

This is my first time posting and I am hoping for some wisdom from those more experienced. My 10 year old cat was diagnosed with diabetes a year ago and I've never been able to get her blood sugar remotely regulated. I'm really worried about her, and don't feel like the vets I've taken her to take it all seriously enough or can explain why she isn't responding.

She used to be quite overweight, and in retrospect she was always hungry and drank a lot. She was tested last year and her BS levels were around 350. I put her on Hill's MD first, then after a month or so and reading around I decided to switch her to an all meat and lower carb food. She started on ProZinc and at first it seemed to help and I saw numbers down around 70 (I home test). But for every good day with low numbers there three or four where she never went below 300. I can't remember all the details honestly, but after two months or so, I stopped seeing the low numbers and she was usually between 500-250 even as I increased her dose. During this time she also had recurrent bouts of diarrhea with blood in it. In the fall I had a test done for pancreatitis, which was inconclusive, and in January another test that I forget the name of but it was pancreatitis related and checked something with her intestines - it came back fine. Her bloodwork (full panels) have all been ok too other than her glucose. The last test was probably in January. Back then her cholesterol was extremely high (the Instinct wet food I was using was high fat) so she was put on Hill's WD. Her cholesterol has gone back to normal and I'm wondering if she should come off the WD now to something lower carb, but also low fat - but I'm not sure what would be a good option. She seems very sensitive to changes in diet too - she ate some oat grass that I grew for her a couple weeks ago and had intense intestinal upset the next day. Her diarrhea kept being a problem and finally (!) the vet decided to send her sample to a lab for a test that checked DNA for whatever they found and would tell me what she had.

So, in the last month I found out she had clostridium enterotoxin and coronavirus in her intestines. She just finished 3 weeks of metronidazole and I give her FortiFlora daily and once a week B12 shot and sub-q fluids. She still has unhealthy look stool with blood in it, though it's better formed than it had been. In January she was switched to Lantus and is now on 5 units of Lantus twice a day. Generally it seems to move her blood sugar no more than 100 points down from her pre-shot high, and some days it just stays within about 20 points of that number. And on bad days it just goes up and stays up all day. (Sorry - my testing data isn't organized right now - just on note paper all over the house.)

She is very skinny and no matter how much I feed her she doesn't gain weight. Her blood sugar is completely unregulated. No matter how much I give her - 1/2 unit or 5 units her blood sugar is erratic and can be anywhere from 500 to 170 in a day. Increasing the dose honestly doesn't seem to have much effect - she stays in that range with low and high doses!

I don't know what to do. I've gone to three vets and a specialist and no one has been able to help her. The only good thing is that whenever we've tested her she has not had ketones. Other than that she is wasting away and it is so hard and frustrating to keep trying to help her and to keep having nothing get better. I'm not sure what my next steps should be. I feel like I need to find a way to get her to gain weight (She's about 7 pounds down from about 11 last year), but I don't know why the insulin isn't helping more and I don't know if it's her diabetes or intestines that are keeping her from gaining weight. She eats 2+cans of WD a day, and is always hungry. :(

Sorry for so much info, but I really hope someone has had success in dealing with similar issues and can offer advice. I love my kitty so much and want her to live a long and happy life.

thank you,
belle
 
It would really be helpful if you could make a spreadsheet with all the data you have collected. It is hard to give dosing advice when you say you are dosing from .5-5.0 units.

viewtopic.php?f=6&t=18207 - how to create spreadsheet

How are you determining the amount to dose?
How often are you changing the dose?

viewtopic.php?f=9&t=1581 - lantus tight regulation protocol


There could be so many factors coming into play and without a spreadsheet that we can follow and understanding of your dosing plan, it will be difficult to give specific advice.

I can tell you that if you are feeding dry food at all, to stop doing that and feed her canned food only. You also mentioned you are feeding W/D. If you look at the carb content of WD, it is actually higher than you want to feed.

So, save some money and purchase regular cat food that is under 10% in carbs. You can purchase Friskies and Fancy Feast if you need to save money. Or if she will eat some of the higher quality foods that are low carb, such as Wellness, etc. go for that.

Regarding her digestive problems, keep to one type of flavor, ie. poultry - and with poultry you can feed turkey, chicken, duck, etc. This may help.

You may also find feeding duck and venison may work best for her too as these are the non-traditional foods and may just help her.

Others will be along with more specific advice, but if you could take all your papers and put them into the spreadsheet, that will be a helpful start.
 
Hi - to clarify, I am giving her a consistent dose. Sorry if that was confusing. When I say .5 - 5 units I mean looking at her curves over the past 6 months, starting at .25 in January and gradually increasing to 5 units in June, I haven't seen any substantial difference in her BS response to the insulin. Right now she gets 5 units twice a day exactly 12 hours apart.

She only eats wet food, ever, and I'd like to try a lower carb food again, but I have to stay away from those that are high in fat so that her high cholesterol doesn't come back (something that further reduces her body's ability to use insulin). Fancy Feast gave her terrible intestinal upset - blood, pudding like consistency, etc.

Thanks
 
Hello there Belle! Welcome!

Here are a few lists for finding a good canned food:
Hobo's List:
https://docs.google.com/spreadsheet/ccc ... hYXc#gid=0

inky's List:
http://binkyspage.tripod.com/canfood.html

Hillary is right- the dry food WILL shoot those numbers sky high and keep them there so making the switch to wet will help level your cats BG out to something more consistent. Both lists have the %kcal for carbs and the %kcal for fat listed so you can find something with low fat but also low carbs. We suggest to feed under 10% carbs but most here feed under a 5% carb level as well. I would suggest to pick a level that has the better range for you and feed that level, any cans you want but just that one level- say 3% carb- for two weeks so the BG levels have a really good time to settle. I learned this the hard way- Sneakers is very carb sensitive and when I was jumping from )% to 4% carbs so would her #'s. Once I settled onto just one % and fed that for two weeks I was able to see the leveling of her BG and was finally able to see what was going on.

Do not feed a whole bunch of seafood as some cats become addicted and won't eat anything else. While a nice treat the seafood is low in protein but doesn't have the necessary nutrients/vitamins for long-term health.

Big caution here- HOME TEST when you are transitioning her to wet as her BG will drop once the high carbs start to leave her system. Since you are shooting at 5u BID it might lead to a hypo situation.

I don't use Lantus but the protocol is the same as for Levemir in the dosing- hold the same dose for 5 days or 10 cycles before changing. Don't make huge leaps in the units- 1u change is usually too much unless you have a medical problem like IAA or acro. Most changes are .5u or even .25u. And Lantus Land has a whole bunch of people that can help you with dosing questions.

The first thing you need to do is get a spreadsheet going- Hillary sent you a link to the thread on how to set one up and link it to your signature.

Good luck! With this help hopefully your kitty will get better.

heather
 
You don't have to use Fancy Feast, there are so many other options available. And why the concern about cholesterol? Honestly, a lot of cats have high cholesterol, but this isn't a huge concern for us. What is the big is the BG level.

Have you considered raw food diet? Either buying it like Nature's Variety or making your own? That is one way to control what your cat is/is not eating.
 
I know, I really was adamant about low carb food for the past year. I convinced my sister to put her diabetic cat on it last year (the two cats are related and were diagnosed at same time) and luckily for her the cat has been off insulin for about 12 months and is still normal for BG. But not my poor kitty. The vet had to talk me into the WD (canned - only canned ever!!) in January and I hated to do it, but as he explained it her cholesterol was so high that as he was drawing the blood for the test, he was having trouble getting it to flow properly and it was oily or something in the vial. He said that with it so high (I forget the number) it would affect the efficacy of the insulin. So it's all just one big vicious cycle! When she ate low carb for 6 months things were the same with the BG.

That's why I feel like there's something else going on. I'm diligent about her shots and testing and following all the advice (I've lurked a long time) and used it to help my sister with her cat, but nothing seems to help my cat. I just think something else is affecting her use of insulin. The vet is recommending Tylan powder because the metro didn't seem to take care of the clostridium, and as long as that's going on and her intestines are inflamed he says she won't get regulated. So hopefully that will work and things will get better. I also worry that her gray zone inconclusive pancreatitis test result might mean she does have that going on and it's not being treated.

I am switching food though, I just have to aim for low fat and low carb. And the vet wants me to try a hypoallergenic food just in case her intestines are being upset by her food too, so I have to consider that too! :( :( :(
 
Okay- then I would suggest two tests you can get- one is for acromegaly ($49) and the other is for insulin auto-antibodies ($15) just to kick them to the curb- or realize you have a longer road to go with FD. Your vet can draw the blood but he has to send it off as there is only one place that does either test right now.

Here is a thread for both-
http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

Link to have blood sent for IGF-1 testing:

For the USA and Canada – costs vary depending where you live: http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401
UK (free test): http://www.rvc.ac.uk/CIC/Current/Internal.cfm


In the US – a result > 100 is considered + for acromegaly; in Great Britain a result > 1000 is positive.

I recently had the tests done and it confirmed the acro probability for Sneakers. I don't have the money to take it further at this time but it is a reason why she is at 12u right now and climbing. It is sad to know but easier on me to know even if I can't do anything about it.

And the fact that two litter mates (related or litter mates?) were diagnosed at the same time. We had a thread about that early this year about it being hereditary in cats like it could be in humans.
 
Hi there - just thought I'd do a quick jump in. It could be that food allergies are making things worse. You could try using a canned food with a single novel protein/carb source - Royal Canin makes a prescription variety but Natural Balance makes the same food commercially. Try either Duck & Green Pea or Venison & Green Pea. I think Instinct also makes a Rabbit food but I'm not sure its a singe carb source - you'd have to check the ingredient label. One other thing you might think about is finding a internal medicine vet - they have more training in disease management then regular vets. My cat has multiple diseases and I had to switch to an IM vet because there were just too many things going on with her. Jan
 
Oh thank you - I will look into Natural Balance. I used to feed that in dry form years ago and had forgotten it existed.

I've kind of given up on vets, the way I have with people doctors actually... I think I have a good vet, but there just seems to be so much misinformation out there even in veterinary science, that none of them seem to really know anything... I went to an internal medicine specialist that was recommended to me because she supposedly had a special interest in feline diabetes and was researching it... She knew I was using ProZinc and she kept going on about how she was surprised that my vet was able to get it for me since it had been discontinued in the States. I realized she was talking about the discontinued bovine PZI and didn't seem to know the brand ProZinc. How can a vet specialize in feline diabetes and not know what ProZinc is?! But I will look around in some nearby towns for other internists because you're right that's it's a good idea. Thanks. :)
 
First of all, big hugs... this situation sounds INCREDIBLY challenging. :YMHUG: I don't know anything about cholesterol or intestinal problems in cats (although if she is still having the bloody stool, it does sound like your vet is right, and the infection is not gone yet, which could also be affecting her blood sugar). I do remember seeing on Dr. Lisa's site (catinfo.org) that Merrick Cowboy Cookout is one of the more moderate-fat "premium" foods. However, it's beef, and I don't know if that's OK for your cat with her digestive issues. Wellness and Evo are nice foods and fairly pared down in terms of ingredients, but as you know they are pretty high in fat.

When I was struggling with Saima's allergy issues, I remember finding that the Primal frozen raw food nuggets that I could get at my local pet store were low-carb and fairly low-phosphorus, and the great advantage is you can get them in single novel proteins (a potential good one is rabbit, which in theory should also be low fat) if that is something you want to try. I've heard people here say that a raw diet is good for IBS and other intestinal issues, but it sounds like your cat's issues go beyond the norm, and unfortunately these nuggets do contain fruits/vegetables etc. that are not really necessary. So if your cat was allergic to this product, it might be hard to tell what the culprit was.

You couldn't do this long term because it is not nutritionally complete, and I'm sure you have tried it anyway if you thought it would be useful, but have you tried feeding her just plain boiled chicken breast on a short-term basis (maybe organic or locally processed so you can know if it contains flavor-enhancing solutions, etc.)? At least then it would just be one ingredient, very low in fat/cholesterol, and you could feed her maybe one "meal" of this and see how she does.

I also used to use a powder called Feline Instinct that is meant to be used with raw meat (you can get it in a regular or more kidney-friendly formula), but I used it with canned cooked meat because my cat was on duck and I hadn't made the leap to figuring out an affordable source of whole ducks at the time that she passed away. However, she was getting some dry food as well... if she hadn't been, I wouldn't have risked the possible nutritional insufficiency of using a mix with cooked meat that was intended for raw. Anyway, this product might be helpful to use with raw chicken, if you determine that she does OK on chicken. I remember the ingredient list being reasonably simple.

Is there such a thing as a cholesterol-lowering drug for cats? I know cholesterol is very different for cats than it is for us, but if a human's cholesterol were that sky-high, I would question whether dietary changes would be enough to get it down. Of course it sounds like diabetes, thyroid problems, and adrenal problems can all contribute to this, and you said your cat's blood work was OK, so who's to say what the cause might be.

Sorry... I feel like I am asking more questions than providing answers, and in any case my "expertise" (of which I really have none... maybe "experience" is a better word) is limited to allergies, but mainly I just wanted to let you know that I care and that I am so sorry for what sounds like an incredibly tough situation.
 
So, in the last month I found out she had clostridium enterotoxin and coronavirus in her intestines.
Click to expand...
The fact that your cat has other serious medical conditions may effect your ability to regulate glucose levels. And from what I just read on PetMD about FIP and clostridium, they may be the cause of your cat's weight loss. You may never be able to totally regulate your cat as long as these other diseases are present.

You see, stress and illness can cause blood sugar to spike. For an example, my Maggie was diet controlled until her heart disease got bad. Then her glucose readings went up and down, presumably according to how well she felt. This is true of human diabetics, too. My husband is pre-diabetic and monitors his glucose. He recently had a sinus infection that took him from 120 to 500! Once he got put on an antibiotic, his numbers returned to 120.
 
Wow, thank you, I'm feeling a little better already for some reason. Probably just because I know you all know how frustrating this can be. I'll look into all the food advice this week. The idea of making my own food is not a fun one... I've been vegan for over 20 years and I don't even know how to handle or cook meat safely! I don't think I ever cooked more than a hot dog in my life! If it ends up seeming like it would help her though I'd have to learn. I'm emailing Natural Balance, Merrick, etc. for as-fed info, and I think I will start mixing it into her WD to see how she tolerates it. She's starting the Tylan antibiotic today so hopefully that will help a lot. I would like to get her on lower carb food and get those intestines feeling better!

I think I might cut her dose back some. Since the higher dose hasn't helped yet and there is still hope that she is not truly resistant but just under stress from other illnesses, I'm thinking maybe 5 is too much really. Last summer when things were briefly ok with her BG she was at about 2.5 units, so I'll drop back, change her food, continue probiotics, and try the new antibiotic. And cross my fingers.

Any thoughts from anyone about pancreatic enzyme? Would it help with weight gain or digestive issues?

Thank you!!
 
Maggies Mom Debby said:
So, in the last month I found out she had clostridium enterotoxin and coronavirus in her intestines.
Click to expand...
The fact that your cat has other serious medical conditions may effect your ability to regulate glucose levels. And from what I just read on PetMD about FIP and clostridium, they may be the cause of your cat's weight loss. You may never be able to totally regulate your cat as long as these other diseases are present.

You see, stress and illness can cause blood sugar to spike. For an example, my Maggie was diet controlled until her heart disease got bad. Then her glucose readings went up and down, presumably according to how well she felt. This is true of human diabetics, too. My husband is pre-diabetic and monitors his glucose. He recently had a sinus infection that took him from 120 to 500! Once he got put on an antibiotic, his numbers returned to 120.
Click to expand...

I think this is definitely true. I know stress affects it, and I'm sure feeling poorly from infections is pretty stressful. I'm going to attribute her high numbers to infection stress for now and lower her dose and focus on fixing her other issues. Thank you.
 
W/D canned or dry was used years ago because vets thought diabetic cats needed to be on it. What W/D was also mainly used for, along with R/D, was weight reduction in fat cats. That could be by she isn't gaining weight also.
 
Hope + (((Baby)))GA said:
W/D canned or dry was used years ago because vets thought diabetic cats needed to be on it. What W/D was also mainly used for, along with R/D, was weight reduction in fat cats. That could be by she isn't gaining weight also.
Click to expand...

Hmm! Good point. I'm trying the Merrick Cowboy Cookout mixed with WD today to see how she tolerates it. Fingers crossed!
 
Jennifer & Saima (GA) said:
When I was struggling with Saima's allergy issues, I remember finding that the Primal frozen raw food nuggets that I could get at my local pet store were low-carb and fairly low-phosphorus, and the great advantage is you can get them in single novel proteins (a potential good one is rabbit, which in theory should also be low fat) if that is something you want to try. I've heard people here say that a raw diet is good for IBS and other intestinal issues, but it sounds like your cat's issues go beyond the norm, and unfortunately these nuggets do contain fruits/vegetables etc. that are not really necessary. So if your cat was allergic to this product, it might be hard to tell what the culprit was.

You couldn't do this long term because it is not nutritionally complete,
Click to expand...

Primal Pet? The raw frozen and new freeze dried formulas are nutritionally complete. The mixes and grinds are meant as addiitons if you make your own raw food.

Commercial raw pet foods do contain veggies and fruits so it would be a little hard to figure out what your cat might be allergic to. Homemade raw food would be more ideal to try because you control what ingredients go into the food. Most of the raw food people here use the recipie at Catinfo.org


I also used to use a powder called Feline Instinct that is meant to be used with raw meat (you can get it in a regular or more kidney-friendly formula), but I used it with canned cooked meat because my cat was on duck and I hadn't made the leap to figuring out an affordable source of whole ducks at the time that she passed away. However, she was getting some dry food as well... if she hadn't been, I wouldn't have risked the possible nutritional insufficiency of using a mix with cooked meat that was intended for raw. Anyway, this product might be helpful to use with raw chicken, if you determine that she does OK on chicken. I remember the ingredient list being reasonably simple.
Click to expand...

It's called TC Feline now.

Freeze-dried Bovine Bone (New Zealand), Egg Yolk, Gelatin, Freeze-dried Krill, Taurine, Cellulose Gum (as natural thickener), Kelp, Vitamin E, Vitamin D3, Vitamin A (Retinol). The TCfeline “PLUS” varieties also have either dry beef liver or dry chicken liver included.
 
Yes, sorry, I meant the plain boiled chicken wouldn't be nutritionally complete, not the Primal. I didn't word that very well. I agree too that homemade raw would probably be the easiest option in terms of pinpointing the source of any allergies or digestive issues.

I have to admit I did really like the idea of the Primal because although I eat meat, I don't love handling it raw, and it was going to be a pain in the neck to source the novel proteins that the vet felt Saima needed (we were using duck and would probably have tried rabbit next; unfortunately we had to put her to sleep because she became very ill with heart disease before we ever got this problem figured out). It was really easy to just pop a nugget or two out of the freezer and feed them to her, and in the week before she died, this was actually one of the only things she would eat. If I weren't pregnant/about to have an infant in the house, I would probably be feeding my cats Primal now.

But I agree, if the cat can eat chicken, it would potentially be reasonably easy (and certainly more affordable and customizable) to just make your own.
 
I do the raw diet for Sneakers.

I took Dr. Lisa's LONG recipe and condensed it to a one page sheet you can print off. The meat... well, you don't really have to cook it for long if you feed it to her mostly raw :lol: but it can be a stomach turner if you are queasy that day anyway.

I buy the chicken thighs on sale and put them in the freezer. The night before I cook I take and place them in the fridge and 12 hours later they are just barely thawed enough for me to slice and dice into pieces small enough for the grinder. I do 9lbs at a time, so it takes about an hour since i have to cut it off the bone and cube it. All that goes into a 9x12 pan. As the oven pre-heats I scramble the eggs and cook the liver then put the chicken in the oven for about 15 minutes only- stirring half way through. This kills any bacteria that might be on the surface of the chicken. Then grind and mix according to the recipe with the supplements and freeze in ice cube trays. I have 20 ice cube trays (all blue) that I use strictly for Sneakers food- I wash and clean them after using but I wouldn't want to use ice cubes in my water (all white) that came from them :shock: .

It takes 3 to 4 hours- almost 5 the first time- from start up to clean up. I'd have a stool handy to sit on when cutting the chicken- that take s the longest. Second longest is grinding- and I grind all of it but the bones (I use the bone marrow powder instead). Third longest is the scooping into the ice cube trays. If you clean pots/pans as you are finished with them it does cut down on time.

She gets 4-6 oz of the chicken and then about 3 cans of FF a day- acro so she still growing, hungry, needs LOADS of insulin :lol: . Her poop was better when she was on the raw 100% but she objected to the plain and unvaried fare of food so I had to start buying cans again to spice up her life.

This is from scratch. There are others that you can buy the supplement to add to the chicken that you grind yourself but I found it cheaper to do it all myself. There is a $5 off coupon from iHerb- to get all the supplements needed was less than $45 plus shipping.
 

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brickyard said:
I'm emailing Natural Balance, Merrick, etc. for as-fed info,
Click to expand...

All of the Merrick as-feds and %KCals were updated on this spreadsheet just a couple of months ago, if that helps.


When you get the information on Natural Balance, if you would like to share that with me it would be greatly appreciated as I will add it to the above Hobo's Guide. :)

Suze
 
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