Need Advice!!

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apersing

Member Since 2014
Hello, my name is Alisha and my 12-14 yr? old cat Boo Boo was diagnosed with diabetes Friday. I'm worried about how this diagnosis and subsequent management will effect her quality of life because she has so many underlying problems/treatments already. I adopted her from a local vet. clinic in 2012. She was the 'clinic kitty' and a fairly pitiful one at that. Boo had battled stomatitis (inflammation of mouth parts, in Boo's case, the gums and tongue) for years. She had been losing hair for awhile, due to allergic dermatits, and then the mouth pain became so severe she would mutilate herself by pulling out the remaining tufts of hair and biting herself until she was naked and covered in sores from the waist down. No fleas were present, as the clinic always applied monthly flea prevention and I do (like clockwork) now. Also, she is an obese cat (small framed, but 13 lbs) and has been so for the majority of her life.
The feline stomatitis was attributed to an autoimmune disorder in which the immune system over-react to plaque/tartar on the teeth and bacteria in the mouth. Boo's case was severe. Her gums were always blood-red, tongue was ulcerated, and the smell... oh the smell that came out of her mouth was putrid. You could smell her infected mouth across the room. She drooled ALL the time. I had to cover my furniture in blankets so the smell wouldn't leach through... and sometimes it did anyway. She would try to groom herself and just spread that horrible smell all over her body. She wasn't getting the affection she deserved because you couldn't pet her like a normal cat; the top of her head was the only spot that didn't wreak, so I would rub her little head with my pointer finger to show affection. Weekly baths were a must.
Until the diabetes Dx Friday, Tx has been as follows:
-Lincocin aquadrops, then 25 mg Clindamycin (antibiotics), to combat the skin and mouth infections.
- Megesterol Acetate (ovaban) a hormone for estrogen deficient cats. This helped with the hair loss (not from self-mutilation) and skin and coat condition.
- Prednisone 5 mg every day. This really managed the hair loss due to mutilation, and the discomfort from the stomatitis since pred. decreases itchiness and inflammation.... I knew that pred. could have future side effects, but her lack of quality of life at that point far outweighed the risk... she is a geriatric cat, after all.
- We tried atopica (cyclosporine) for several months. It also helped with the dermatitis, but didn't do a whole lot for the stomatits. We gave this daily, until this past year, when I decided the stomatits wasn't improving.
- Full mouth extraction was my last resort. I had been in opposition, of course, but then saw two other cats come into the clinic, who had both had this terrible procedure done, due to stomatitis and were complete success stories. Since bacteria/plaque seat on the teeth, fewer teeth = less stomatits.
Although it was a brutal procedure and a somewhat touch-and-go recovery, Boo was much happier without teeth. I was able to stop the atopica, and continue feeding the same cat food (Hills sensitive skin/stomach formula), just watered down so she could gum it. the drooling stopped. The lip-smacking stopped. The smell was gone. Boo ate without hesitation and quit pawing at her mouth. The baths are only needed about every month now, and that's just cause she's a bigger kitty who can't groom her back end so easily. We tried to take her off the prednisone, but had to give it every other day, as without it, minor stomatits occurred. There may be a few tiny tooth fragments/dislodged bone fragments/tooth roots still hanging around, causing problems. They resedated once and dug a few pieces out....
Last week, Boo got sick. She had been having diarrhea since the beginning of October, but I figured that was because we switched her food abruptly (i know i shouldn't have) to Purina hypoallergenic, since I could get my hands on a free bag of it. I found piles of throw-up this week too, but wasn't sure which cat it was. Her energy level was down a bit, and the final straw was that she didn't want to eat her dinner, then breakfast the next morning. That is UNLIKE Booboo. Like I mentioned before, she is obese, on prednisone (which increases appetite and thirst) and never missed a meal, especially after the teeth were extracted. I brought her to the vet., Monday or Tuesday and they put her on a week of metronidazole (GI antibiotic), gave her a VBG diarrhea control gel, and sub-cutaneous fluids. She perked up for a day, but then the diarrhea came back. So we decided to run a general health profile (CBC and blood chemistry panel) on Friday. I expected to see that I had done liver damage with the prednisone, or that she was in kiney failure, but low-and-behold, she has diabetes. Her BG was around 380 mg/dL. We reran just the BG later in the day, to make sure it wasn't a fluke and it came back around 340. We had just run this panel this past June, at the time of her full mouth extraction, and BG was about 127, I think, so this condition must have developed in the past few months.
I was advised to take Boo off of prednisone and ovaban, as they are not recommended to be given to a diabetic cat on insulin. I don't really understand why though; can anyone explain that? They put her on .25 g. Sucralfate two to three times a day and back on atopica (cyclosporine) once a day, since she can't take pred. now. I started vetsulin injections Saturday, at one unit once a day, then we'll recheck the BG on Monday to see if the dose or the frequency of giving insulin needs to be adjusted. She's been eating fine again, but I'm worried about making her hypoglycemic and not being able to recognize the symptoms, since she sleeps a lot and is not very active, on normal days. As long as she eats a decent amount when i give insulin, should I just not worry myself? Or is there a formula you can use to determine how far one unit of insulin will cause BG to drop? What about the recommended daily or per feeding amount of carbohydrates for a diabetic cat? Also, I was wondering how to determine whether my cat has type 1 or type 2 diabetes? I'm curious about this because I've read that type 2 diabetic cats' condition can go into remission. I know that's not likely, but I just want to know if it's possible for Boo.
I feel that if it were diabetes alone, I could manage it, even though hypoglycemia scares me to no end. I'm just worried that with all of her preexisting conditions, she'll start deteriorating. I know some ppl may think I'm crazy for trying to continue treatment, instead of just euthanizing.... But we've gone this far. I can't just give up on her without at least trying. Love her too much now. Please anyone, any advice?
Thanks,
Alisha
 
Hello.
How wonderful that you aren't giving up.

My first question is about the prednisone.

it needs to be prednisilone, not prednisone. Not all cats can convert prednisone to prednisilone but the latter is the form they need. You might have to get the prednisilone compounded as they don't make the pills anymore.


It IS possible for remission. The pancreas of a cat can heal with the right insulin ( lantus, levemir)
You do have a lot to learn quickly but it sounds like you are willing.
You have lots of support here at fdmb. Everyone wants to help and pay it forward.


there a formula you can use to determine how far one unit of insulin will cause BG to drop?
There is no formula. Each cat is different and there is no set amount that gets a specific response.
You start with a low dose ( like 1 unit or even less) and you monitor.
You will want to get a human glucose meter and strips.
You will want to check at shot times....and during the cycle ( 12 hours until next shot time)
We all have spreadsheets where we keep a log for ourselves and for others to see . The chart helps those giving advice to see your cats patterns.
If you are monitoring her, you will be able to interfere if she were to have a hypo.

I am curious about her allergies and how they determined the cause.
It could be a food allergy in which case people here can help with that as well.
 
Hi Alisha and boo boo

You are one dedicated mom to boo boo.

As a newbie I can only give you the benefit of my very limited knowledge. If you are like me your aim is to get Boo boo into remission and if not remission then tightly regulated. In order to do that there are a number of things you will want to think about:

Firstly you need to make sure that the food you are giving has less than 8% of its calories coming from carbohydrates. Dr Pierson has a great list that you can double check against.

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Secondly it is recommended that you test boo boo's blood glucose at home at least twice a day-just before each shot. This will help to ensure that she is safe to give the shot. You then try to get another shot during each 12 hour cycle so again make sure she isn't going too low and to fine tune the dose. Most members use a human monitor from somewhere like Walmart. I hear the name relion mentioned. The meters aren't expensive but the test strips can be and I think this brand is quite reasonable

Here is a link about meters viewtopic.php?f=28&t=103511

It isn't the easiest thing to begin doing but it does get easier. Here is a great link about how to test a cats blood glucose. I make sure I hear remi's ear with a rice sock and also give a treat each time.

viewtopic.php?f=14&t=287

Thirdly you may want to discuss with your vet the possibility of switching to a longer acting insulin like lantus or levemir. When you get the dose right it keeps then in a good range for many hours and allows the pancreas to begin to heal. The link in the document below May be useful to discuss with your vet.

viewtopic.php?f=14&t=80813

Finally hypo info is contained here. Make sure you read beforehand and print then out and keep them handy. If you test boo boo blood glucose you cans pick up possible danger early and just steer here with food:

viewtopic.php?f=14&t=1122
viewtopic.php?f=14&t=2354

Best wishes

Sarah
 
It is possible to use steroid with a diabetic; it requires adjusting the insulin dose to compensate for the rise in glucose due to the steroid. It also limits the chances of getting off insulin at some point.


In case you might need it, there is a Feline Stomatitis group on Yahoo.
 
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