Lost Regulation

Status
Not open for further replies.
babyg

babyg

Member Since 2019
Hi, everyone,

My 13-year-old cat got diagnosed with diabetes at age 9 and has been on Lantus ever since. We started her on 1 unit and upped slowly by half units until she got to 2 units and then left it at that. I still thought her BGs were high (240-320) and that she drank a lot, but vets seemed to consider her regulated based on her ability to gain and maintain weight, so we left it at that.
Last August/September, she weighed the most she ever weighed and then very slowly started to gradually lose weight since then (basically a little over a pound). I weigh her once a week. She also started having issues with pasty poo and some blood with it at times. I had her checked out. They ran bloodwork; everything came back fine; vet was not concerned since weight loss was gradual. I was still concerned, though, because back when she first got diagnosed with diabetes, she also had weight loss and hepatic lipidosis and pancreatitis, so I took her to an internal medicine specialist for a second opinion. They ran bloodwork (unremarkable; glucose in urine though), did an ultrasound (unremarkable), fructosamine (high; 470ish), and a test for acromegaly (results pending). They also placed a Freestyle Libre sensor on her. They told me she to raise her to 3 units, which I didn't feel comfortable with since I am used to raising slow in half units, so I started her at 2 and a half on last Wednesday night. Numbers looked better already (lower 200s) and she ate good. Next day I think she was stressed with company being over, so she didn't eat good and her numbers were high. Looks like her back might be bothering her too because when I touch it she tremors there and does not want to be touched (maybe from the sensor or being on her back from the ultrasound?).
Anyway, to make a long story short, even though I would have preferred to hold the 2 and a half units for a week before raising, Friday night I gave her the 3 units because now I was worried about the other end of the spectrum: DKA, plus the vet and my brother (who had a diabetic dog) were both urging me to do the 3 to get her sugars better asap. She ate good and acted more normal, but numbers dropped to 188 by next preshot, so per the vet skipped the morning dose. Evening shot gave the 3 units and she stayed high (300s) all night but ate good. I figured this was probably a bounce and filling of the shed. Gave her 3 units this morning. Numbers not that great (300s/200s; the sensor gave me a scare at one point and said she was 117 but my ear poke showed her around 250 so not sure what happened there). She is giving me even more trouble with eating today and just wants to sleep. Tested for ketones a couple times today and negative.
I might think of more to add later, but basically said all that to ask this:
1) why would a "regulated" diabetic cat lose regulation?
2) should I stick with the 3 units or go back to the 2 and a half and hold it for a week before going back to 3?
 
The answer to question (2) we cannot give without a spreadsheet showing us her blood sugar values over time. Details on how to do that are in this post:
New? How You Can Help Us Help You!

Besides her values before you gave the shot, we need to know at what time the subsequent tests you gave were, or how long after the shot. Also, what food is she eating now? That can make a difference. If you are finding yourself skipping shots because the numbers are too low for you to shoot, then the dose needs to be lowered. Are you using pen needles or syringes to give the shots? We make changes by 0.25 units at a time, which means eyeballing on 1/2 unit marked syringes.

The answer to questions (1) is, it depends. How well regulated was she before hand? Maybe dosing was the issue. Do you notice any differences in her behaviour? There could be secondary issues causing inflammation or infection, such as pancreatitis, dental issues, or other endocrine conditions like hyperthyroidism or acromegaly. BTW, when are you expecting those results back?

With the "nasty poo", did you have a GI panel done as part of the bloodwork?

Diabetic dog treatment is different than diabetic cats.
 
I still need to update the spreadsheet with the latest info, so I can work on updating that tonight. I keep a physical notebook on everything and then transfer over to the spreadsheet.
I know wet is preferred and I wish she would eat it, but ever since diagnosis she has been on Purina DM dry.
I use the pens but draw with the syringe.
She's so weird. Sometimes she acts normal and like herself and then sometimes she acts like she doesn't feel good.
They said results can take a week, so expecting to hear something soon (tests were on Tuesday). They didn't do GI panel; they brought it up but made it sound like it was more for looking at the pancreas, so I declined because she didn't have a GI panel done before when she had pancreatitis so it didn't seem necessary. Now I'm wondering if I should have had it done after all and should do next.
She gets her shot at 6 so I am going to test her, see if I can get her to eat more, measure out how much she ate, and then decide whether to shoot. But I'm thinking not to do the 3 tonight.
 
The Texas A&M GI panel looks at more than pancreatitis. You get B12 and folate levels (which can signal problems with bowel absorption) and TLI. They do need to be fasted for this test, so needs some planning ahead, maybe something late in the cycle when they haven't eaten a while.

The tests for acromegaly are run on Wednesdays only. So they (MSU) have to get the blood by Tuesday. If the draw was this Tuesday, it likely didn't get there in time and you'll have to wait another week for the results.

I don't have access or permission to see the spreadsheets.
 
Sorry, I just updated the settings on the spreadsheets now. Looks like I haven't entered info since April so I will work on getting it caught up.
 
I updated the 2022 spreadsheet and added another tab that contains the sensor data and blood work results first done at her primary vet. The first time we placed the sensor, something was clearly wrong with it because it showed her abnormally low, so had it replaced on June 2nd. The sensor sometimes matches my meter but is usually about 50 points different, so it's not as trustworthy but at least it gives an idea so I don't have to poke her incessantly. Tonight she ate enough of her meal so I put her back on the 2 and a half like I originally wanted.
She is eating more now. Seems like she "wakes up" in the evening and eats more and is more active. I am really nervous about leaving her tomorrow to go to work because if I am not here to encourage and coax her to eat during the day, I do not think she will eat much at all. There is also still not enough data on the 2 and a half to feel comfortable with it, so may just stay home. How do you feel comfortable changing your cat's dose and then leaving them alone? I also would like to eventually try again to transition her to canned food because I know that is better for her. I have tried a couple times but she bores of it quickly, even if I change up the flavors (the Fancy Feast classic pates). If the next time she poops she has that pasty poo again, I may ask the vet to do that GI panel. It was not explained to me like that and it sounds like something that might have been good to do.
 
Last edited:
Wanted to update: have an appointment tomorrow to get the GI panel. So far no one knows why her appetite is the way it is. They did say the ultrasound showed a little thickening of the intestine wall but that could be a host of things from just some simple temporary inflammation to something serious like cancer. The plan is to get the GI panel to see if she needs probiotics or an appetite stimulant or basically to just rule out anything medical besides diabetes. I kind of wonder if it's a mental issue, as weird as that sounds, because I have been working a lot. Could she be depressed? She definitely eats more when I am home.
Vet says if glucose over 200, give 3 units; if between 200-100, give 1.5 units; and if less than 100, skip. Last night I put her on 2 and a half and was thinking to just hold that for 6 cycles instead. Any thoughts/opinions would be greatly appreciated! I'm so worried about her.
 
Another update: tried different things and now she is liking and eating the Fancy Feast classic chicken pate and the Friskies salmon pate. Since I found something she is eating on her own, debating whether to cancel the GI panel this morning since she gets so stressed going to the vet, but then I know cats can be like a Jekyll and Hyde and it'd probably be my luck I'd cancel and then right afterwards she'd give me problems eating again, lol. The GI panel can show if she has IBD, though, I believe, correct? She has had issues on and off over the years with occasional diarrhea. Any thoughts on continuing with the GI panel?
 
Last edited:
It’s good she’s eating pate now. Dry DM is very high in carbs so if she stops eating that or eats a lot less her insulin needs will more than likely decrease. I’d get all the tests if she were my cat so you will have enough information to see if she has other issues. Pancreatitis can be chronic where it comes and goes. My cat had that for a couple years before becoming diabetic. The pasty stool could indicate absorption issues with food and the panel will help decide if that’s an issue. I’m sorry she’s not doing well and hope the tests will help you to help her.

A quick glance at your ss shows me one thing. Lantus likes consistency. I would not skip with a bg over 150. Since it has gone down to high 200’s, I don’t think it’s likely she has glucose toxicity. We always suggest testing before every shot and with SLGS a curve every 7 days.

I’m glad you gave reached out and hope some of this is helpful. Keep us posted. :bighug:
 
babyg said:
The GI panel can show if she has IBD, though, I believe, correct?
Click to expand...
No, but it can show several things about how their GI system is working. For example, is there pancreatitis, does she need B12 supplementation. Pancreatitis can be a reason cats don't eat. Many cats with GI issues do need B12 supplementation, though not all. To tell if there is IBD you can first try a food trial with a novel protein. The ultimate test to see if a cat has IBD or small cell lymphoma is with a biopsy. Don't let SCL words scare you. With proper treatment cats can go into remission from this condition.

We had a discussion about dosing in this post: https://felinediabetes.com/FDMB/threads/2-and-1-2-or-3-units.264260/
 
Results from the GI panel show a little pancreatitis. She once had pancreatitis real bad when she first got diagnosed with diabetes (was hospitalized and had a feeding tube), so definitely want to prevent it from getting that bad. She ate really well for me last night and also today while I was at work (still preferring the wet food so I'm happily hoping she sticks with that!). Vet said to let her keep eating the Friskies pates and the Purina DM dry if she wants, but if she starts vomiting or not eating then we may want to change her diet or give her fluid therapy. Her poop yesterday and today was pasty but it looks different from the previous poop (not as nasty looking or smelling). I think it's because of her transitioning to wet food, so I'm not really concerned about it. Vet also said Monday we'll look over her numbers from the 2.5 dose trial since that will be a full week on it, and decide from there if we need to continue or up it. This was our first time seeing this vet, so glad she seems a little more agreeable and willing to work with me.
 
Did you shoot 2.5 units this morning? The PMPS Units column is empty. Glad the vet agreed with the idea of holding this dose for a week. Unless of course she were to go under 90.
 
Status
Not open for further replies.
Back
Top