Loss of appetite after starting insulin

Status
Not open for further replies.
Milhous

Milhous

Member
I am new here and need some advice. Our 12 year old Norwegian Forest cat, Milhous, was recently diagnosed with diabetes. We started him on 1 unit of Lantus twice a day about 4 days ago. Has completely stopped eating for the last two days. Our vet wants to see him tomorrow. Has anyone had this experience?

Also, our vet does not believe in home monitoring and also seems to not have much to say about changing his food. He has been eating Fancy Feast for a few years and loves it. We recently read on this board that some FF has wheat gluten and consequently a relatively high carb count. We have switched him to FF varieties without wheat gluten (recommended list of lower carb FF found on this board). We're now thinking of finding a different vet who is more in-tune with many of the things we've read on this board (home monitoring, low carb diet, etc.)

This is all new and a little difficult right now. Any help will be appreciated.

Mike
 
Welcome to Lantus Land (LL)!!

The loss of appetite is not typical with diabetes. In fact, it's usually the opposite. Until their numbers are better regulated, cats will eat voraciously but may lose weight because the nutrition (i.e., glucose) isn't getting into the cells where it belongs. Instead, it's in the bloodstream - hence the elevated blood glucose (BG) levels. Insulin helps the glucose get into the cells.

Many vets are not big fans of home testing. There is, however, solid research in the veterinary journals that supports its use, especially with Lantus. I think many vets are simply used to people being fearful of testing or, in a more cynical vein, they want to be able to charge for doing BG curves in the office or for fructosamine testing. Vets also get minimal training in nutrition. It's not surprising that your vet is not conversant with recommending low carb food. The good news is that it doesn't sound like you were being pressured to by prescription food. (FYI: Wheat gluten is a protein. It's not a source of carbs. Many cats are allergic or sensitive to gluten which is why we discourage the use of foods containing gluten.)

The bottom line is that it's great that your are home testing and have switched Milhaus to a low carb diet. Are you checking for ketones? If not, I would get a package of Ketostix and test as soon as you can. These are inexpensive and available at most pharmacies. You simply put the Ketostix in Milhaus' urine stream, wait 15 sec. and compare the color on the strip to the key on the package. The not eating could be an early sign of other problems, like diabetic ketoacidosis or pancreatitis, both of which are problematic. If Milhaus' BG levels are bouncing up and down he may not feel so great but he should still be eating.

Please consider sticking around and posting here. The sticky notes at the top of the Board will help to orient you to pretty much everything. I recommend starting with the "New to Lantus/Levemir" sticky and the sticky that discusses our dosing protocol. We are very numbers oriented in this forum. As such, you will want to start a spreadsheet and complete a profile both of which you can attach to your signature. The spreadsheet will allow you to keep track of Milhaus' test data and will allow us to view his SS and help you with dosing decisions. A profile will contain his date of diagnosis, any medical history, food, etc. so we don't keep asking you those questions over and over.

My non-diabetic kitty, Gizmo is a Wegie. They are wonderful cats. I have pictures attached to my signature. He's a little over a year now and the photos were at about 8 mos. old.
 
Hi, Mike,

I just wanted to offer a welcome to the Lantus group, and second Sienne in encouraging you to post and read here.

Just this past Friday, my Kitty officially went into "remission" -- shot-free after 15 months. We achieved this ONLY because of the support and guidance we received on the FDMB site.

We spent the first four months of Kitty's treatment getting wrong-minded treatment from a vet who just did not have expertise in feline diabetes. I was shooting massive amounts of insulin into my cat on the wrong schedule, with NO home monitoring, and could easily have lost him.

If you have any doubt about your vet's advice, get a second opinion, just as you would for yourself.

Hope to see you around.
 
Hi Mike and welcome to this site.

You will find lots of great information here. There are many caring people to help with whatever problems or questions you have.

Sienne has given you great advice. Especially picking up some keytone strips to check Milhous's urine. Having keytones can turn into DKA which is an emergency situation.

Hope to see you around daily. Read the stickys at the top of this forum. They are full of information that is very helpful.

Keep us posted on Milhous's situation.

Again, welcome. :smile:

jan and sara
 
Correction - we just TRIED to do a home test and failed miserably. We were never able to find the vein in the ear and the paw pricks did not yield enough blood. We stopped because we were ALL getting frustrated. Also I looked at the spreadsheet and do not see a key or legend telling what certain things mean (i.e AMPS, "U") I did a search of the hole website for AMPS and couldn't find anything. Is there an explanation somewhere?

We'll definitely get a second opinion, but we have no choice about taking him back to our regular vet tomorrow. It's Sunday and hard to research "diabetes knowledgeable" vets in our area. Our vet has been really great in the past, we're not sure whether he is just not as up on all this as he should be or whether he just hasn't gone into enough detail yet because he has just started treatment and needs to have enough time to see what works. Milhous has hat appears to be low grade pancreatitis, but the vet wanted to start insulin before treating for pancreatitis as it may well be a symptom of the diabetes - most likely not the other way around as the numbers were quite low. Also, perhaps our change of diet along with the starting the insulin shots have created a variable. Bottom line: I feel impotent and frustrated because I do not know enough about this to even know whether my current vet is god at it or not! :-|

We're really bummed out about this. We know it'll will either get better, or worse, but in time we'll at least know more, but right now we feel like we know nothing and are not even sure who to go to. I live in Minneapolis and the Univ. of Minnesota Veterinary hospital is very well regarded and that is where we'll take him for a second opinion, but for right now I feel like it would be easier for ME to have diabetes than Milhous!!!!! (of course, I'm quite happy I do not).


Regardless, thank you all for your help and suggestions.

Mike


Sienne and Gabby said:
Welcome to Lantus Land (LL)!!

The loss of appetite is not typical with diabetes. In fact, it's usually the opposite. Until their numbers are better regulated, cats will eat voraciously but may lose weight because the nutrition (i.e., glucose) isn't getting into the cells where it belongs. Instead, it's in the bloodstream - hence the elevated blood glucose (BG) levels. Insulin helps the glucose get into the cells.

Many vets are not big fans of home testing. There is, however, solid research in the veterinary journals that supports its use, especially with Lantus. I think many vets are simply used to people being fearful of testing or, in a more cynical vein, they want to be able to charge for doing BG curves in the office or for fructosamine testing. Vets also get minimal training in nutrition. It's not surprising that your vet is not conversant with recommending low carb food. The good news is that it doesn't sound like you were being pressured to by prescription food. (FYI: Wheat gluten is a protein. It's not a source of carbs. Many cats are allergic or sensitive to gluten which is why we discourage the use of foods containing gluten.)

The bottom line is that it's great that your are home testing and have switched Milhaus to a low carb diet. Are you checking for ketones? If not, I would get a package of Ketostix and test as soon as you can. These are inexpensive and available at most pharmacies. You simply put the Ketostix in Milhaus' urine stream, wait 15 sec. and compare the color on the strip to the key on the package. The not eating could be an early sign of other problems, like diabetic ketoacidosis or pancreatitis, both of which are problematic. If Milhaus' BG levels are bouncing up and down he may not feel so great but he should still be eating.

Please consider sticking around and posting here. The sticky notes at the top of the Board will help to orient you to pretty much everything. I recommend starting with the "New to Lantus/Levemir" sticky and the sticky that discusses our dosing protocol. We are very numbers oriented in this forum. As such, you will want to start a spreadsheet and complete a profile both of which you can attach to your signature. The spreadsheet will allow you to keep track of Milhaus' test data and will allow us to view his SS and help you with dosing decisions. A profile will contain his date of diagnosis, any medical history, food, etc. so we don't keep asking you those questions over and over.

My non-diabetic kitty, Gizmo is a Wegie. They are wonderful cats. I have pictures attached to my signature. He's a little over a year now and the photos were at about 8 mos. old.
Click to expand...
 
Mike -- AMPS is A.M (as in morning) pre-shot , and PMPS is P.M. pre-shot. We do a test before each shot, to make sure the cat's blood glucose is in a safe range to shoot insulin. It is also encouraged to get tests in the middle of the cycle. Sienne or others can explain it better, but Lantus dosing is based on the "nadir" (how low the blood glucose, or BG) is.

Many, many people have had difficulty getting comfortable with testing. There are lots of tricks that can help you. For example, some of us use the lancet freehand; some of us use a lancing pen, as I did. I found it made it very easy to get a good stick. Also, many of us warm the ear first, using something like a rice-filled sock that you warm in the microwave for about 20 seconds. It gets the blood flowing in the ear. You can put a little smear of vaseline on the ear just before sticking, which will make the blood droplet pool, instead of spread through the fur.

There's a lot to learn at the beginning, but it gets much easier. You're lucky to have such a renowned facility nearby, and you'll find wonderful support here.

There are also links on this website of academic papers written for vets that provide clinical support for home testing. Maybe your vet will be interested in reading some of them -- sounds like he is a caring person.
 
Mike
Welcome!!!! Try not to get too frustrated, I know it is so hard in the beginning, I thought I would rip my hair out! We have been here now almost 3 months and Scrabble is off of insulin for a week already! I learned everything from this site and not from my vet. I could go into the vet stuff but I won't! There are so many great people here to help at all hours!!! The home testing gets easier I promise! Have you tried warming the ear first? You can use a rice sock (a baby bootie filled with rice or pasta) and put it in the microwave for about 15 secs and that helps a lot!!! Hope you will stick around and welcome!!!!
 
Hi Mike...welcome.
It can be very frustrating to test at first so don't give up. If you would like some help testing you can go to the health forum and say you are looking for help learning how to test and post what town and state you live in. Many people on this board have learned to test with the help of another board member that lives nearby.
 
Mike:

There are at least 2 members of the Lantus forum who are in Minneapolis. I am certain they can recommend a good vet either at the U or in the community. (I'm a U of MN grad.) I'm going to send them a private message (PM) and ask them to stop by your condo (this thread -- it's what we call each of our daily threads -- condos). Likewise, either Amy or Carolyn may be able to give you a hand with home testing.

Also, not to completely overwhelm you, if you read the sticky note at the top of the board, Lantus/Levemir: New to the Group?, in addition to the ton of useful information in there and in the links, there is also a link to the slang dictionary we use here.
 
Hi Mike
Welcome to Lantus Land and I hope you stick around.
I woud like to tell you a little bit about our story to get you to stay.
Max was diagnosed in Nov/09 after his first missed it in Oct/09.
I went through 4 vets, non ofthem supported what I did and the first vet was at the animal
hospital that I have used for 20 years.
(ETA 20 years)
April 3, 2010 was the last date Max had an insulin shot. He is OTJ now, "off the juice" only because of the board here, and of course my help too, :-D

Many of us use a baby sock with uncooked rice in it, microwaved 15 secs to warm up.
Then it is held to the ear to make the blood flow easier.
http://www.sugarpet.net/bloodtst.html
Have a look at this sight. Also, rubbing a bit of vaseline on the ear will make the blood pool.

This is the best place to be and I would not have my Max back wothout the incredible knowledge support and encouragement that you will find here.
Have a look at our signature and video and ss too. Max was a tough one.
 
Hi Mike. Welcome, and glad you found the group!
The good folks here have covered a lot of ground for you.

I just wanted to comment on vets in mpls...
If you have the means to go to the U, DO IT!!!! They are the best. But the best always cost! You will probably have to do an eval, which may cost a few hundred dollars. They will be very, very thorough, and dont think you will regret it. They should cover your cat's complete health..not just the FD. Be prepared with all the possible info you can provide. You will also then be in their "system" which makes it easier if you need to call or set up an appt. The initial connection there is key. I had to call the ER tonight and I guarantee they would have not said peep to me, if my cat had not been seen there numerous times in the past. We see a specialist at the U (not FD specific) for those times when her regular vet may not seem up to speed, or I want further opinions. I do not regret one penny I have spent there.

I use Kenwood Pet Clinic. I like them a lot. They have worked with me and my cat's multiple complications for years. Ive introduced them to home testing and they are very interested/supportive. If you would like further information on who I think would be good to see, phone number, etc. let me know. I will send a pm.

Good luck tomorrow. Do listen to what others are saying in this group. A thousand trained vets could never know as much as the cumulative experience of this group.
 
I forgot to add...if you need help with home testing, give me a holler and let me know. I could come over and help you out!
 
Mike, I cannot tell you how nervous and confused I was when our cat Brutus was dx with DB .Testing at home seemed overwhelming, let alone giving him a shot! But guess what , now it is so easy and routine we don't even think about it.once you find the ear vein(remember it is at the outside edge of the ear, and some times the round lancet device will poke to far in) We had to take Brutus health into our own hands because the vet that dx him was uncooperative and uninformed.You can do this , it is not as hard as it seems.

Steve And Brutus
 
carolynandlatte said:
I forgot to add...if you need help with home testing, give me a holler and let me know. I could come over and help you out!
Click to expand...

Hi Folks,

First, I want to thank everyone who has responded here. Very nice to feel the support and get some great advice. Carolyn, I want to particularly thank you for your offer of help and we will probably take you up on it, we would love to have someone with experience show us the way! Right now Milhous is off insulin while they try a few things to get his appetite back to normal. I forgot to mention that he showed signs of mild pancreatitis on his blood test and the vet cannot say whether it is a result of the diabetes or the other way around. We ended up taking him the U of MN clinic for an emergency visit very late last night. They check his glucose level and it was 220 and that's with no insulin for a day and a half, so they said hold off on the insulin and I am going over to pick up some meds to stimulate his appetite and a mild steroid to help with the pancreas inflammation.

That's all we know for now. Milhous started drinking water and again and stopped vomiting. He seems attentive and very social this morning, but still seems hesitant to eat even though he displays signs of hunger. I will certainly be writing more as we find out more.

Carolyn, well be in touch.

Thanks again everybody!

Mike
 
Hi Mike.

Those are great numbers for Milhous but the 220 is still not a normal BG. As far as the pancreatitis, there are lots of people here who's kitties have chronic p'titis. In addition to the appetite stimulant (I'm assuming either cyproheptadine or mirtazepine), you might want to ask about giving Pepsid to help settle Milhaus' stomach. Also, pain meds are very important. P'titis is incredibly painful. You might ask about giving buprenex.

I'm linking a post that Jojo, one of the very experienced vet techs who's on FDMB put together about managing pancreatitis.
 
Hey Mike,

Some on the board directed me to your post. I'm in Mpls as well. (Only a mile or 2 from Carolynn) I use Lake Harriet Vet on 42nd & Bryant. I can highly recommend Dr. Cathy Sinning, but would steer you away from her husband in the practice (Dr. Jim.) For a married couple, and vet practice partners, they are very different in their philosophies and approach.

I echo her thoughts on the U - FABULOUS, if you can afford it. They knew Winston quite well for a time. :roll:

If you need help woth the home testing, or want the number for the vet, just send me a PM, happy to help.
 
Sienne and Gabby said:
Hi Mike.

Those are great numbers for Milhous but the 220 is still not a normal BG. As far as the pancreatitis, there are lots of people here who's kitties have chronic p'titis. In addition to the appetite stimulant (I'm assuming either cyproheptadine or mirtazepine), you might want to ask about giving Pepsid to help settle Milhaus' stomach. Also, pain meds are very important. P'titis is incredibly painful. You might ask about giving buprenex.

I'm linking a post that Jojo, one of the very experienced vet techs who's on FDMB put together about managing pancreatitis.
Click to expand...
Sienne,

He is on Buprenorphine for pain, cyproheptadine for appetite stimulation and he is already on Pepcid. He's doing better today, hanging out with me as I type and even enjoyed going out in the backyard! If only he could talk, this would be far easier! :smile:

Mike
 
That's wonderful that you and your vet are on top of this. Many vets are not as proactive as it sounds like yours -- or the ones at the U of MN -- are. I'm glad Carolyn and Amy stopped by. Hopefully, they can get you situated with home testing.

The only thing I might suggest is that if they are wanting you to hold off on the insulin, I would continue to test on occasion and please test for ketones. If there is an infection/inflammation present and you are holding off on insulin, there is an increased risk for diabetic ketoacidosis (DKA). You use Ketostix, which are available at any drug store, to test. A trace amount of ketones can be managed at home with increasing the amount of water you put in Milhaus' food. More than a trace amount is serious. DKA can be life threatening. Most of us will test routinely if our cats are in high numbers.

I hope your guy is feeling better. (I'm dying to see a picture of your Wegie!!)
 
Amy,

Thanks so much. I will keep you posted and certainly ask for your help when the time comes - maybe you and Carolyn can come over together for tea and crumpets with Milhous when he's up to baking again! :smile:

The U is great, I don't mind the cost, they know their stuff. Both of the vets at the place we go to, Parkview Cat Clinic in Mendota Heights, are U of MN grads.

Thanks for your advice and support. We'll be in touch as soon as we settle in on something. Milly really has to tell us what he needs, but he's a wee bit confused about it all right now. We'll figure it out eventually!

Oh, one question about home testing. Bought the smallest gauge lancets available and we're wondering what size most people use. We may have better luck getting large enough samples with a larger lancet, but I don't want Milhous to be too uncomfortable. We also think his mild dehydration may have made the blood flow slower and thinker so that may have been a contributing factor. I'd love to hear what size lancets people use.

Mike

Amy'sWinston (GA) said:
Hey Mike,

Some on the board directed me to your post. I'm in Mpls as well. (Only a mile or 2 from Carolynn) I use Lake Harriet Vet on 42nd & Bryant. I can highly recommend Dr. Cathy Sinning, but would steer you away from her husband in the practice (Dr. Jim.) For a married couple, and vet practice partners, they are very different in their philosophies and approach.

I echo her thoughts on the U - FABULOUS, if you can afford it. They knew Winston quite well for a time. :roll:

If you need help woth the home testing, or want the number for the vet, just send me a PM, happy to help.
Click to expand...
 
Hi Mike and Milhous, Just stopping by to welcome you and to say that you have come to the right place. You've gotten some excellent information already from some very knowledgeable and compassionate people. If it were not for this board my cat, Stu, might not have made it. He was diabetic and I was shooting insulin "blind" for 4 years before I learned how to test his blood glucose and how to evaluate the results (I'm still learning the evaluation part!). Lancets do vary and probably it is best to use one that is not too thin. The rice sock really works, as does the dab of vaseline. Also, it takes a while for the ears to be "trained" to bleed. One of Stu's bleeds better than the other, so I mostly test on that one (it is too frustrating for both me and him to stick and stick and not get any blood out of the other). You will find what works for you. Good luck and welcome. I hope your visit to the vet will go well.

Ella & Stu
 
Milhous said:
Oh, one question about home testing. Bought the smallest gauge lancets available and we're wondering what size most people use. We may have better luck getting large enough samples with a larger lancet, but I don't want Milhous to be too uncomfortable. We also think his mild dehydration may have made the blood flow slower and thinker so that may have been a contributing factor. I'd love to hear what size lancets people use.

Mike

People who are currently actively testing can respond to the gauge of the lancet, but as someone earlier said, you might not want to go too thin, too soon. For early days, a thicker lancet is going to get better results from ears that don't know how to bleed yet.

Lots of tricks in the bag to make it easier. First, get some Neosporin with Paid Relief, will help the blood bead up to get a good test, and will numb the ear a bit so he doesn't really feel it. It will continue to offer numbing affects for quite a few hours after too - good for curve days.

They really do become acclimated to it, and it becomes routine. It's just establishing the success of the task, to create the routine! I agree, dehydration could affect the blood flow and make it peter out a bit. But in the early days of testing warmth is going to be your biggest asset. Warm ears bleed, cold ears do not. I know it sounds weird, but their ears DO learn to bleed as time goes on. With Winston, first test of the morning was always a bit tough, and by pmps, he's ears would be gushing. I was always turning the lancet depth up and down depending on time of day, etc.

Try the rice sock, try rubbing his ears good between your thumb and finger. If you can't get enough out of one poke, many of us have done 2-3 pokes near each other to get enough. Or if you get a small bit, "milk" the ear to get more blood. It's a bit like gently squeezing a zit.

Does he sit through the process well? Not wiggling or fighting? Just not getting enough blood?
Click to expand...
 
Amy, no wiggling or fighting, just not enough blood. He was probably dehydrated so that would effect blood flow. I have to say, we're pretty discouraged right now by his decline due to the pancreatitis. He is just not eating and the appetite stimulant is not working. He doesn't appear to be in a lot of pain and he still hangs out with us, but he a completely different cat! The vet wants to see him again today. It is looking to me like the pancreatitis is the bigger of the two problems now and the diabetes was caused by it. From what I hear pancreatitis is not something that can be cured, you can only treat the symtoms. Not a good prognosis :sad:

Mike, Dale and Milhous


-------

Mike

People who are currently actively testing can respond to the gauge of the lancet, but as someone earlier said, you might not want to go too thin, too soon. For early days, a thicker lancet is going to get better results from ears that don't know how to bleed yet.

Lots of tricks in the bag to make it easier. First, get some Neosporin with Paid Relief, will help the blood bead up to get a good test, and will numb the ear a bit so he doesn't really feel it. It will continue to offer numbing affects for quite a few hours after too - good for curve days.

They really do become acclimated to it, and it becomes routine. It's just establishing the success of the task, to create the routine! I agree, dehydration could affect the blood flow and make it peter out a bit. But in the early days of testing warmth is going to be your biggest asset. Warm ears bleed, cold ears do not. I know it sounds weird, but their ears DO learn to bleed as time goes on. With Winston, first test of the morning was always a bit tough, and by pmps, he's ears would be gushing. I was always turning the lancet depth up and down depending on time of day, etc.

Try the rice sock, try rubbing his ears good between your thumb and finger. If you can't get enough out of one poke, many of us have done 2-3 pokes near each other to get enough. Or if you get a small bit, "milk" the ear to get more blood. It's a bit like gently squeezing a zit.

Does he sit through the process well? Not wiggling or fighting? Just not getting enough blood?[/quote]
 
I really wouldn't assume by your cat's behavior that he's not in pain. Cats compartmentalize illness and pain in a truly remarkable way. There was a post on the "old" board (FDMB migrated to this format and location at the end of last year) from one of the members who had gone through her own bout of pancreatitis and said the pain was incredible. I'd try the pain meds and see if it helps. You can always discontinue them if you see no change after a couple of days.
 
My cat had a horrible p-titis attack, and the test confirmed the attack, but I did not have any indication of any pain at all, none at all. I took her to the vet because she was not eating or drinking and was just sitting in a ball.
After giving her liquids and pain meds, followed by giving her 100ml SQuids myself each day, she came around quickly. The food I had to make into almost a soup. She was just not eating but if you stop and think about it, if you had some terrible pains and all doubled over, would you feel like eating? Nope.
I had shots for her for the pain meds for the first 3 days, and then I had gel to apply to her ear flaps. At the time, I was giving her pepcid as well. The food was offered but she ate little for the first few days, just more and more laps of the stuff each day.
I would definitely give the pain meds, because it is painful.
As for being worse than the FD I suppose in the immediate it is important to address it. I don't know about the no cure part; Shadoe has not had another attack, so it could well be that she will be ok.
To this day, I always add water to her food to make sure she keeps having enough water in her.
 
Status
Not open for further replies.
Back
Top