Merlin 16 YO Maine Coon recently diagnosed

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sheann

Member Since 2012
Hi to all,
I am new to the site and also to Feline diabetes.

I'm looking for any and all help with my old guy. We are able to do ear sticks and we are using Relion Ultima BG Monitor. Our vet had him a week ago for 24 hrs for the glucose insuline curve and the vet put him on Humulin R, started at 2 units twice a day. He still was in the middle to upper 300's after 4 days. When first diagnosed he was at 404 and the day of the curve he was close to 600. Does anyone have success with Humulin R???? The vet upped him to 3 units 3 X a day and I will notice a drop with the lowest so far being 151 at 5 hours post shot, but at 12 hours post shot it will be back up pushing close to 400 when it is time for his next dose. I do have experience with human diabetes but not kitties.
Merlin had been declining in health for several months which I just thought was old age, switched him to canned food several months ago because I thought he was having trouble digesting the dry food due to being older, he was also loosing weight especially in the rear end.(He has lost 10 pounds) He began peeing on my throw rugs and he stopped sleeping with me. He never really has been a cuddle kitty but he would sleep with me. He also was beginning to wobble in his hind legs. All of the symptoms I never connected to diabetes. DUH, but I never really thought he was having trouble, just thought he was getting old. His kitty companion that had been with him for over 8 years left us when our daughter moved out and I thought this was a cause of some of his troubles also.
Sorry to blabber, but thought you might be interested in his story.
I have read that PZI is highly recommended and I have no problem switching if my bank account can support it, and our vet will cooperate.

I took a copy of our bg log to the vet this morning so he could take a look at the numbers we had been getting but, he was in surgery and I haven't heard back from him. Any suggestions? He is currently on canned Friskies and canned 9 Lives from Binky's list, I'm trying to stay with the foods that are no higher than 4 in carbs. Any snacks are canned human chicken, mackerel or salmon. So no extra carbs for snacks. I am planning on going with a no carb raw or part cooked diet in the future. Should I wait until his BG is more under control before I switch?
I wish I had taken him earlier to the vet, time just gets away from me sometimes, farm life and all things kids = hectic.
Where can I find the google doc spread sheet template that some of you are using? Right now I am using the manual paper and pencil method which mean that when I need a copy for the vet I have to rewrite everything. Might be OCD perfectionist thing also. LOL

thanks in advance
Sheann
 
Great that you're testing - it means you'll know if it is safe to give insulin.
Until you have collected lots of blood glucose tests, do not give the insulin below a glucose level of 200. Why? It could be too much and send your cat into hypoglycemia, too low of a blood sugar. This can be fatal.

Are you sure it isn't Humulin N? R lasts maybe 4 hours, hits really hard, and can be very risky if you dose too high.

Humulin N lasts 6-8 hours in the cat, hits relatively hard and fast and often requires dosing every 8 hours to control the glucose. Current veterinary research no longer recommends using this in cats, so your vet is likely out of date in treating feline diabetes. This is not unusual, as it is difficult to keep up on every condition for every species treated. If your vet is open to articles, we have some vet articles on using Lantus in cats.

Here's one: Glargine & BG control-Roomp & Rand_2009-JFMS

We recommend the use of longer acting insulins which have been proven to work in cats: Lantus, Levemir, ProZinc, and BCCP PZI. Before you reel from sticker shock, know that 1 mL of a U-100 insulin contains 100 units. If you get Lantus or Levemir, get the pens, which have 3 mL in them for a total of 300 mL. At 1 unit every 12 hours, that is 150 days worth; at 2 units every 12 hours, it is 75 days worth. You use U-100 syringes with half unit marks to withdraw the insulin as if the pen were a mini-vial.

The vet research also starts withg a much lower dose - 0.5 to 1.0 units of insulin - as starting too high may actually raise the glucose levels when the cat's liver compensates for the sudden, unfamiliar drop in glucose.
 
BJM Thank you so much for the great info. Yes, he is on Humulin R, and I wasn't aware of the 4 hour window. No wonder I am getting such terrible flucuations in numbers. Yes, I always test before each shot, would never shoot him without knowing the numbers. I've seen too many diabetics go into hypo shock and I also have a daughter who is non diabetic that will go hypo.

I will try to get my vet to prescribe one of the insulins you suggested. I will print it out for him. He is a great vet and is our all around vet for all our livestock. But like you say it would be hard to stay current on all species.

Oh, by the way - what does OTJ stand for?

Thanks again. and big hugs for your info.
 
As far as switching foods... I'm not sure that it matters if you have him regulated before you switch or not (I didn't when I went through this). Just be sure to always check his BG level so you know if you actually need to give any insulin. Switching foods can actually get the BG level under control to where insulin may not be needed at all. I won't address the insulin questions as I had a very short time with that part of the diabetes... the change in diet was all mine needed & it kept him healthy for nearly 7 years (until old age got the best of him). When I first started changing his food over, I would test before he ate, then about 15 minutes to 1/2 hour after he ate to see what was going on before I made the decision whether or not to shoot... weekends consisted of many curves until I felt sure we were in a good routine. Good luck!

OTJ = Off the Juice!! :)
 
Jill thanks, sorry you lost your kitty but I also know I will loose my old guy someday. I'm just trying to keep him around as long as I can keep him comfy.

Update from the vet:
I printed out the feline journal pages that BJM recommended and took it to our vet. He is willing to read it, so we will see if he will be able to help or willing to help with this.
He and I are a little off when it comes to checking BG, he said I was checking too much. ( I won't give insulin until I know his numbers) Too many years of being around diabetics I guess. I suppose the insulin he has my kitty on is such short acting as BJM stated that it wouldn't keep it low enough long enough to worry about, I guess that is what the vet is thinking. But, do they treat with such short acting insulins to keep the pet owners happy so the owner will think they are doing great for their pet in reality they are actually doing very little? Or something is better than nothing.
Any how, just wanted to update.

Sheann
 
You are not checking too much. The Tilly protocol for tight regulation, which has the best chance of getting to a diet-controlled state, has you test before giving insulin am and pm, plus mid-cycle when the anticipated lowest point is. And you wouldn't give a child insulin without checking that it was safe to do so and that it was working properly, so why would you do differently for your cat?

The reason for testing at the lowest point, ie nadir is that while on insulin, you don't want them going below 50, as there is potential to go too low and wind up hypoglycemic. Also, the depot insulins which build up in the body over several days have their doses adjusted based on the nadir.

If he can get Merlin on Lantus, that would be great. Our Lantus forums have a lot of information and a lot of members to give you feedback and ideas. There is a proven protocol documented in the Tight Regulation forum for managing feline diabetes with a good rate of getting off the juice. Pop over there and start reading to get oriented.

So long as you are using R, take the dose down to 0.5 units and test at 2 hours after the shot to see how low he is going. If he is above 50, at +2, he is OK, though he probably feels like he's on a yoyo of highs and lows. To get any kind of overall lowering of glucose using R, you'd need to test and dose it about every 3-4 hours, which is crazy.

Switching to Humulin N is vastly preferable to Humulin R. That's the first thing I'd do while you're waiting on him to do some reading on Lantus. It may be inconvenient to pick up the food at 8 hours (+8) when it wears off if you want to dose every 12 hours (aka 'BID'), or to schedule insulin doses every 8 hours (aka 'TID') so you cover the entire day, but it is much safer for your cat than using Humulin R.
 
Humulin R should never be used by a layperson at home new to feline diabetes and never by itself. it is to be used in an ER situation or by someone who's cat has concurrent problems that the use of a bolus insulin can help control and who's owner has a thorough understanding of this disease, insulin, and their cat's response to treatment.

personally i would stop using that R asap and tell your vet you need a regular insulin asap, preferably lantus, levemir, or even possibly prozinc. not only is R the most dangerous insulin, the wild fluctuations and the inability to get control of the diabetes with it increases the potential of complications developing like ketones.
 
Thanks Cindy & BJM

Cindy, I was thinking of stopping his insulin since he is having such a roller coaster ride and starting him on zero carbs, then hope the vet will prescribe Lantus or start vet shopping for a vet who is a little more current on FD. Another thought was to test at 5 hours post shot and give .05-1 unit to help keep it more stable until I either find a new vet or my current vet agrees to a better treatment plan as suggested by BJM. The lowest BG so far that I have caught was 151 and that was 2 days ago when the vet had me up his insulin to 3 units and then it was 151 @ 1 1/2 hours post shot and it hasn't been that low since. But pre shot BG is still almost 400. 391 in the AM pre shot and 355'ish for the PM pre shot.
So, thanks again. I didn't feel that testing 3 X a day was too much. There was one day I did test him more but one reason was an adjustment in insulin per the vet and then 2 hours after Merlins evening meal he vomited his entire stomach contents. so I did test more that day, I wasn't going to bed until I knew his BG wasn't too low and have him crash during the night.
My M-I-L is type 1 diabetic and has been for over 50 yrs. She will never take insulin until she tests her BG.
Thanks BJM I will head over to Lantus forum.

Thanks so much, wish me luck with our vet that he will give this a try.
 
While you're trying to locate a vet and get a good long-acting insulin, take a look in my signature link for questions to ask when interviewing vet candidates.

Until you can get onto a long acting insulin, if you're in the US, I believe you can get Humulin N without a prescription at a pharmacy. Given the glucose levels you are reporting, completely stopping any insulin may risk ketoacidosis, an expensive and potentially fatal complication of diabetes. I was able to buy it without an Rx in Ohio. If you do that, start low at 0.5 to 1.0 and test mid-cycle around 3 or 4 hours after the shot to make sure he's not going too low. You'll need to pick up the food at 8 hours post-shot if you want to dose only twice a day. Not optimal, but way better than Humulin R!!!

And yes, stop the R - it is completely the wrong thing for managing diabetes; it is normally used in an ER situation with ketones and overly high glucose in an IV infusion at a slow, controlled rate, something injections can't give you.
 
BJM, I am in Kentucky and I had already checked with walmart yesterday to find out what insulins I could get without a prescription. I can get R, N & 70/30.
I had already read your questions to ask a vet. And I will get those printed out.

I have decided to take him off all carbs for a few days to see if that would help reduce his high numbers without him crashing.
As far as food goes, he doesn't have food available free choice but, I do give him a snack in the afternoon when he is begging me for something.
So, I wouldn't give him any snacks after the 8 hour mark? So, I would then check BG @ 12 hours and next dose of insulin and feed his meal?
If I go with the longer acting N, should I feed him the reg canned food with carbs? or just keep a close eye on his BG with no carbs? Either way I wont go off and leave him during a critical time without knowing what his BG is doing.

Thanks again, I really appreciate your help. I will give my vet until Tuesday to come up with a different plan and if he doesn't then I will be finding a new vet.

Sheann
 
Is your vet refusing to write you the prescription for Lantus? Insulin is expensive, so if you haven't gone the route of calling up your vet or other vets (if yours won't write the script) and seeing if you can get the script asap, I would do that before running out and getting the N. While N is better than R or no insulin, you don't want your cat on it for any extended period of time.

The large majority of vets will write the script for Lantus (glargine) after reading the article that's linked above, or the American Animal Hospital Association guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Just be firm; say you want the script right away because you want your cat on the recommended insulin right away. If your vet refuses, keep calling vets, explain your situation about your vet refusing to write the script and tell them what you need until you find one who will write it for you.

Honestly, your vet gave you R for your cat which shows a serious lack of knowledge about feline diabetes, so I wouldn't worry about staying with that vet if he gives you any resistance.
 
Thanks Julia,
I just gave the article to our vet yesterday so I am giving him until Tuesday because of the Holliday weekend. That should give him time to read it and do his research. I think he will follow thru with this, he isn't stuck in his ways but, just behind the times. We live in a very low income area where most people probably would have their cat put to sleep because of the expense or they are not aware of a better treatment. There is a lot of farmers who has cattle, and the such and their isn't much coddling of animals unfortunately especially cats.
Our vet also has a sister who is a MD so I'm sure he will consult with her aswell as the veterinary journals.

Yeah, I don't want to spend the money on the N when I am sure with in a few days I will have something better.

So, I'm just keeping my fingers crossed until the mean time. I'm doing BG checks at 6 hours and dosing with insulin if he is too high, which right now pushing 400. I would rather treat every 6 hours rather than letting him go untreated. This is just a temporary treatment. I just have to get my sugar kitty in a lower range for now. Along with all the info from everyone who has posted and consulting with my in-laws (MIL type 1 diabetic since childhood) for their guidance also.

I really appreciate your post and I will read your article that you linked.
 
Great that you're going low carb, but that may not be enough right now to keep him safe if the vet won't give you a better insulin. If your vet hasn't agreed to give Lantus a go, I also am concerned about ketoacidosis, a potentially fatal condition when the body burns fat for fuel because it can't use the glucose. That is why he hungry - he doesn't have the correct amount of longer lasting insulin. And that is why the glucose levels have been high a lot. R is a roller coaster when it comes to controlling glucose - up and down, over and over.

If you are now in vet search mode, please pick up some Humulin N to help control him while you are searching. His glucose needs to get down below 200-300 with something other than R as soon as possible (though a few cats do develop ketoacidosis around this level). You might start around 0.5 to 1.0 units every 12 hours, picking up the food around +8 hours after the shot and testing him before every shot, and at +4 hours after the shot.

You can check Craigslist for Lantus, however you need to verify
- if the vial or pen has been used (could be contaminated if answer is yes),
- if it has been kept refrigerated (answer should be YES),
- if it has been rolled (answer should be NO), and
- what the expiration date is (answer should be UNEXPIRED).

And it is buyer beware on Craigslist - always meet in a safe, public place!
 
Update on Merlin,
Waited through the holiday weekend and I heard nothing from my vet. Tuesday morning I grabbed the phone book and searched for a new vet. I currently have Merlin with a small animal vet who does not handle livestock. So far the new vet has been great, he put Merlin on Novolin N, 2 Units twice a day. He told me to discontinue the Humulin R which I did. I know it will take a few days for the new insulin to start getting him leveled out. Merlins readings were high this morning, nearly 500. I did see a mid 300 reading at +6. He was 437 at the PM dose. I will continue to test him and if he has high numbers in the morning I will be calling the vet to find out what else we need to do. I have noticed Merlin being more even tempered today and sits quietly while I check his BG so I know I am not getting a stress BG reading. The new vet will let me do my own curve but he wants me to wait a few days. I know this isn't lantus but at least it isn't R and he can get off the roller coaster. I felt so sorry for him, and there wasn't anything more I could or would do without veterinary advice. I did discuss Lantus with the new vet and he will work with me and doesn't think I was testing too much. He said he has had great success with Novolin N and has had cats go into remission on it. So, I'm keeping my fingers crossed. He does want me to switch Merlins food to Purina DM which I'm sceptical about, but it isn't a change he wants to make any time soon, he wants Merlin to get use to the insulin change first.
I feel really confident with my new vet, he talked with me for almost a half hour before I took Merlin from his carrier to be examined. He answered a lot of questions and didn't make me feel rushed.
Merlin was also put on Clavamox liquid for a possible dental infection. The vet noticed Merlin had a rear tooth that was very inflamed and felt that to make sure that the tooth wasn't part of the problem he felt that a course of anti-biotic was appropriate. Once Merlins diabetes is more under control the vet will take care of the tooth.
 
The Novolin N is better - I believe it is the equivalent of Humulin N.

That dose 2 units is high to start, so please check his glucose within 2 hours of the shot.

Values lower than 50 are in hypo territory. If seen, get online in the main forum and post a new topic of HYPO HELP to get immediate assistance. You can also post in the main Lantus forum for help, if no one is

Also, read this post thoroughly: How to treat HYPOS - THEY CAN KILL! Print this Out!! and make sure you have the needed supplies ready.

Novolin N will last roughly 6-8 hours, so around +3 to +4 hours is the expected nadir (lowest BG). Pick up the food around +9 hours after the shot until your evening test time if all is going well.
 
Also, Merlin can have dental work done prior to the diabetes being fully controlled and after the antibiotic is done. Watch the glucose level as the antibiotic kicks in - it may drop, and as I noted, the 2 units could wind up being too high.

If you notice a really sharp upswing in glucose after 8 hours, it is due to the insulin wearing off. You may find you need to dose every 8 hours for better control. In that case, instead of picking up the food at +8 hours, you'd be testing and shooting.

Do provide the new vet with the articles you've printed out so far, and provide him with the Cat Info link for nutrition info from a vet.
 
It will really help you and the vet see what his glucose is doing if you set up a spreadsheet to track his glucose readings and note what is happening at the time (ex antibiotics, food changes, stressors, etc.)

Here are spreadsheet instructions for a template we use, which color codes the glucose levels to help you see how his diabetes is doing.
 
Morning,
Thanks to all who have posted info and links, I really do appreciate everyones help with Merlin.

As of right now I'm waiting for the vet to call. Merlins AMPS numbers were so hi I couldn't get a number.
I did give Merlin 2 units of R just to get him down in the readable numbers. But no N yet, waiting for the vet to call before I do anything else.
1 hour later I tested and he is down to 492.

Question. This is our feeding schedule, please let me know if I am feeding too late and that could be the cause of high numbers.

I feed Merlin his breakfast of 1 can 9 lives 4% carb, after taking his BG in the AM but before his shot.
He gets a snack of plain human chicken, cheese, or some other human grade no carb snack about mid day, when he is circling my feet begging
for food.
I then feed him again usually about a half to 1 full can of 9 lives 4% carb, before his PM shot.

Am I feeding him wrong, is that the cause for the wonky numbers???

Finally got thru to the vet after calling again and having it out with the girl who answered the phone.
He increased dose to 3 u. bid.

So, I know everyone keeps telling me about Lantus and Levermir and I did discuss these with the vet on Tuesday. How many vets does it take before I can find
one that will go with these Insulins? There is a feline only vet clinic but it is 3 hours away.
 
PLEASE never use the R like that! It is far too easy to overdose your cat. You cannot get the insulin out once it has gone in - there are no antidotes!

That high number may have been after the insulin wore off - remember, Novolin only lasts about 8 hours, so if he's still eating after that, it is going to zoom! Some folks use timed feeders to control how much food is available and when. It is OK to free feed and may help save him if he goes into a hypoglycemic level.

That high number also may be that he went down fast enough, or to a low enough number, that the liver released its stored glucose to prevent problems.

Please test around 3 or 4 hours after injection, to see how low he is going. And remember that the antibiotic may start working and dropping his glucose levels too. Better somewhat high, than too low.

Novolin is an insulin where you can adjust the dose based on the preshot AND nadir values over its duration - you don't want it ever going lower than 50 over the 8 hours.

If duration is the problem (and it very likely is), moving to a schedule of every 8 hours - ex 8am, 4 pm, midnight - may smooth out the glucose levels

Could you list the tests you've gotten in a format like this?
AMPS for morning pre-shot
and as applicable, any additional tests as
+ # for # hours after shot
 
BJM, I'm sorry if you feel that I used Regular insulin in an improper way. But what should I have done? I would have given that dose of regular even if I hadn't received a prescription for Novolin N. High blood sugar is not safe and is a problem if untreated, correct? Blood glucose in the oh my gosh range and knowing that the regular insulin would bring it down fast or wait for the Novolin N to maybe bring it down? I'm sorry, but it seems as though when I did finally get a chance to talk to the vet he said I did exactly right by using the Regular insulin to bring him down into more manageable levels. Yes and I do test my cats BG frequently and I sure as heck wouldn't give him a dose of insulin and leave for the day. And as far as the dental work goes only my vets knows what is going on with my cat. So he will get his dental work done when the vet feels that he can handle the sedation.

Now, my regular vet did contact me this afternoon to tell me he was calling a prescription in to the pharmacy for Lantus.
I will keep in touch with my regular vet for further recomendations as far as my cats health goes.

This forum is great to help with the little things but I feel that other than giving helpful information as far as what works and what doesn't is great, not telling someone what they should or shouldn't do. Moderator or not. Especially sending private messages telling me to update on my cat. GEE Wizz
 
sheann said:
... Especially sending private messages telling me to update on my cat....
Click to expand...

Uh ...That was intended to be friendly - I wanted to know how he was doing and I figured others might, too.
 
Sheann, we do send pm's out sometimes asking about how the kitty is doing because we care, we are concerned, and we want to help. Some people come on here, post, and then we never hear from them again and it is hard not knowing. As far as telling people sometimes what they should or shouldn't do then I think many of us are quilty of that because we know for a fact that the vet advice is totally off and they risk losing their cat. We are all guilty of caring, maybe too much, but we deal with FD 24/7/365 whereas a lot of vets do not see that many diabetic cats, do not keep up with the all the info on it or the newer insulins, and just start a cat on W/D and N insulin, etc. We read the sad stories of people who come on and post after finding FDMB too late and their kitty is dead. I personally will get into it with any vet that puts down hometesting. We all care even to the point of donating money to someone whose cat has ended up in DKA and they have no money to treat. We send out supplies, meters,......we care and that is our only fault.
 
BJM, I want to appologize for any misunderstanding. I believe I must have taken it as being scolded.

I understand about caring because I also care but, possibly sometimes too much.

So, Merlin was started on 1 Unit of Lantis bid. I have also consulted with a friend of mine who is a vet tech in another state.
Merlins numbers are still high but at least readable by the glucometer.
I will post later with his numbers since starting Lantus. I really do appreciate everyones help.
I do know this will take time to get under control so I'm not expecting the magic bullet, although it would be nice if there was one.

Thanks again and please understand that I misunderstood.
 
BJM, I'm sorry if you feel that I used Regular insulin in an improper way. But what should I have done? I would have given that dose of regular even if I hadn't received a prescription for Novolin N. High blood sugar is not safe and is a problem if untreated, correct? Blood glucose in the oh my gosh range and knowing that the regular insulin would bring it down fast or wait for the Novolin N to maybe bring it down?
Click to expand...

Yes high blood glucose is not good, but being in the high numbers for a few days is FAR FAR less dangerous than being severely hypo for even ONE minute. I don't mean to accuse you of anything but this is something we have to stress on here all the time. People get paranoid about high numbers and want to give more insulin to see those numbers go down. It doesn't work like that. Regulation doesn't happen overnight. Rushing things and perhaps being a bit reckless can wind up with a cat in severe hypo that could end up dead or with permanent blindness and brain damage. Clearly you don't mean to hurt your cat, you want him to get better or you wouldn't be here to begin with, but you have to remember to BREATHE. Slow down and relax - this is a marathon, not a sprint! You might see some high numbers every now and then - but you will learn to take it in stride and work with it.

I'm sorry, but it seems as though when I did finally get a chance to talk to the vet he said I did exactly right by using the Regular insulin to bring him down into more manageable levels.
Click to expand...

You're still trusting the advice of the vet who prescribed you this completely inappropriate insulin to begin with?

I am glad you're on Lantus now but R is not an insulin that should be administered at home and especially not by a newbie. And your vet giving it to you and encouraging to use it is even worse. :shock:
 
I'm just glad he is OK.
When you didn't post for a bit ... I was afraid of what might have happened.

Now you're on Lantus, at a reasonable dose, which should be much safer for the two of you.

It will help everyone, including the vet, to give you feedback if you'll set up a spreadsheet using the template. Plus, the color coding will help you spot patterns quickly.

The Lantus forums have a bunch of info posts at the top with tons of info on successfully using Lantus. Take some time to read those thoroughly as they will help you get the best use of it. And reading the posts of others will help you learn how it works in other cats, as there can be differences among cats responses to any external insulin.
 
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