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Jennifer & Saima (GA)

Jennifer & Saima (GA)

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ETA: I'm in Livingston County, MI in case there is anyone nearby with advice.

Hi all--as the subject says, I'm new here and feeling pretty panicked.

My 12-year-old kitty Saima was diagnosed just yesterday. She had been "slowing down" a bit over the past few months, which looking back she was probably starting to show signs of neuropathy in her hind legs even that long ago, though she was getting up and down the stairs well, trotting over to get treats, etc. until the past week or so. Has persistent issues with allergies/ear infections, and her kidney enzymes tend to be on the high side so those were honestly the things I was the most worried about until recently. We took her in to the vet on 7/15 for an annual checkup, dental cleaning (she ended up being anesthetized and having a tooth pulled), ears checked, and blood work. Blood work came back basically fine but her blood sugar was "a little high" (277). (Vet later recommended I collect an at-home urine sample, which I never got around to doing, and I am eaten up with guilt about that right now.) The vet is extremely stressful for her (she freaks out and has to be "gassed" even for a physical exam--every time since birth except the very first time she went as a kitten. Her chart is always covered with warnings about how aggressive she is).

Immediately on arriving home from that ordeal, she started drinking a ton of water. She's gone through phases of that in the past, and blood work has always been OK, so we tried not to worry about it. Went on vacation last week and she stayed with my parents, free feeding on dry Hill's d/d duck formula and/or Now! senior formula dry food ("novel proteins" in an effort to work with the allergies). She usually eats about half that and half sort of a modified recipe of Feline Instincts Kidney Support Diet, but I didn't want my parents to have to mess with the wet food. Another thing to feel terrible about... she has always free fed dry food until a few years ago, when we started trying to get her to eat wet because we learned it was better for her. But because she has the taste for the dry stuff, she won't touch any kind of canned unless there's quite a bit of dry food on top, so at some point we gave up trying to put her on exclusively canned. It just didn't seem "that important." Yeah right. :cry:

We picked her up on Saturday from my parents' place and it didn't really look to me like she had eaten much, if at all. She ate nothing on Sunday either. Was looking unwell Monday morning so we took her to the vet, where her BG tested at 486. Vet said all other results were OK except one slightly elevated liver enzyme.

Here is where I start to panic. No one at the vet seems to know for sure, but despite us telling them that as far as we knew she had not eaten since Friday, I don't think they fed her anything yesterday. I left work early and picked up a bunch of different kinds of canned food to try (trying to stick with stuff that was under 10% carbs while not being too high in phosphorus)--I was still feeling fairly optimistic at that point. I figured we'd let the allergy stuff go out the window for now and worry about it later--especially since she has another ear infection per the vet yesterday so I don't think we even really know what she is allergic to--so I selected all kinds of stuff with chicken and other things that she usually "can't have." I figured she was bound to like one of them. Then I went and got her insulin and picked her up at the vet, where they had me inject her so that I could learn how to do it. She was prescribed 2.5 units of Lantus twice a day.

She headed for her dry food when I got her home, but I took it away and tried to feed canned instead. BIG MISTAKE. I should have let her eat if she wanted to. She wouldn't touch any of the kinds of canned that I bought. I tried putting the dry food back out--she wouldn't eat it. I was panicking and crying because it had finally occurred to me that I injected a cat with insulin after she hadn't eaten in who knows how long. We got out some canned chicken breast and she eventually ate maybe a couple of ounces of that, and over the course of the evening probably 3-4 chunks of that freeze-dried salmon that is sold as a treat. I went to bed feeling a little better after she "cleaned her plate" of the chicken, assuming she'd gotten her appetite back and would eat some dry food overnight, but she didn't touch it or the dish of wet mixed with dry that I left out. This morning I tried giving her canned and dry food again, then gave her more chicken covered with water and some of the salmon flakes (she seems to like sipping the "soupy" stuff) but she would only drink the broth, not eat the solids as she was doing last night. So basically she didn't take in any calories this morning. All she has done since she got home from the vet is lie around--she'll walk across the room to lay somewhere else, but won't stand or sit for any extended period of time. I have to bring the food to her to get her to eat anything at all, and it seems to be starting to piss her off that I keep bothering her.

Regarding her blood sugar, I tested last night around 9 p.m., fearing she would have a problem due to eating so little, and got readings of 167 and 199 or thereabouts. Tested again this morning first thing and it was 255. We called the vet this morning asking what to do, and they said give her the insulin as scheduled (which we did). They didn't have much input about the food--they suggested boiled hamburger, which I'm willing to try tonight, but knowing her I can't imagine she'll eat it. My only remaining ideas are to get some of that cat milk and see if she will take it, or get a baby syringe and try to feed her watered-down canned or Feline Instincts. If I can't get her to eat a full meal tonight, I am probably going to end up taking her back to the 24-hour vet and beg them to make her eat somehow.

To compound all this, our home phone and internet have been down since Saturday, so I can't research this stuff at home or work from home (which would normally be an option for me). I left her alone when we went to work this morning and am scared to death I'm going to find her dead when I get home. I feel like I haven't stopped crying in 2 days.

Sorry this is so long. I wanted to get all the info down, and it helped me a little to tell it. I just feel so terrible that we can't seem to do better for her. Thank you to anyone who makes it all the way through. Any advice or perspective is greatly appreciated.
 
newbie needs help here


Welcome and remember to keep breathing. There will be others with experience that will respond in due time.
 
Thank you. I really appreciate it.

Update, the food situation may not be quite as bad as I thought. My husband talked to the vet about an hour ago and he said that when she was in their office yesterday, she threw up quite a lot of food. I'm sure she didn't touch her food Saturday night or Sunday... maybe she just gorged herself at my parents' house and hadn't quite digested all of it yet? Doesn't make a lot of sense to me but at least it hasn't been as long as I thought. I'm going to run home at lunchtime and check on her.
 
Saimasmom,

WELCOME!! You have found a great place.....When will you have the internet back??? I love this place and you will too.

I fed Sugar Bean and CRF Gumpy.. Friskies Special Diet, there is also a phos. blocker you can put on the food to help with the CRF. There is methyl B12 for the neuropathy that helps, you can get from a health food store.

Glad you are home testing!

I would definately find out about taking up all the dry food and keeping the same insulin amount going.

There is a list of dry food that might be lower in carbs, but the ones I found, my girls dont like.

I resently got some foraflora for my girls, and they love it....makes them eat.

Just used it today for my Sugar Bean as she is not wanting to eat for some reason last nite or this a.m.??????????????

I also have been syringe/dropper feeding my Civvie Slappy for days.... But she is not a Sugar baby, so I have been using baby food - just meat, dulited with tuna or sardine water or a/d from the vet. She is getting better with the sessions and I am finally able to do this by myself.

I hope you take time to relax, not panick and soak all of the information and welcomes that you are going to receive here and your baby Saima will be fine! We all try not to let ourselves feel guilty over what we have done with our furry loved ones in the past and just move forward!

You might try fresh or cooked chicken livers as well...I have my 3 month old HOOKED ON THOSE THINGS~I do cook up batches for her at a time.....cut fresh with scissors (dont know why that makes a difference, but I heard it does). Sardines, tuna, must get her to eat something!!!!!

Again, WELCOME!!!!
 
ohbell--thank you so much for the welcome and the suggestions. Unfortunately I don't know when the internet at home will be back. The recording gave an estimate of a week to get the phone line repaired, but who knows.

I tried to get FortiFlora from the vet and at PetSmart. They had it but wouldn't sell it to me. I'll have to try and find it elsewhere...

In my past experience, she won't eat liver (my MIL cooked her some during the pet food recalls... so sweet) but I guess I could try it again.
 
For feeding, try Baby food Chicken or Turkey. Beechnut brand is good (does not contain onions).

You can get Forti Flora on-line. Do a google search for it:
 
2.5u is a very high starting dose. The recommended starting dose for Lantus is 1u--and I'm especially concerned about shooting 2.5u if she's not eating right. Please do not shoot that much insulin.

I would talk to your vet about dropping the starting dose down to 1u. If your vet disapproves, I would drop the dose down to 1u anyway, because it's dangerous for your cat, especially once the dry food is removed. Most cats on a low carb wet diet do not need more than 1u of insulin.

I find it very odd that your vet won't sell you fortiflora. You don't need a prescription so there's no reason why they shouldn't...it's very strange and would make me question the vet's knowledge and commitment to your cat's care. I buy mine on amazon anyway because it's cheaper than at the vet's office: http://www.amazon.com/FortiFlora-Fe...0OE0/ref=sr_1_2?ie=UTF8&qid=1313508453&sr=8-2

I have some food suggestions. EVO 95% Venison and EVO 95% Beef are low in phosphorus, carbs, and the venison at least is a novel protein source. Merricks' Before Grain Beef, and Turkey flavors as well as Cowboy Cookout are all low carb, and low phosphorus. Nature's variety Instinct Rabbit is low in carbs and a novel food source, but not so low in phosphorus. Wellness turkey is low phosphorus and low carb as well.

I've used canned Tuna, or the powder from freeze-dried Beefeaters Salmon and Chicken treats from Petsmart to get my cats eating a new wet food. Fortiflora also works REALLY well.

If I'm understanding correctly, she's still eating the dry but doesn't want to eat the canned food? Or is she giving you trouble eating everything? It's very important she eat something, even if it's not the food you want her to eat.
 
Here's a link to the dosing protocol for Lantus: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

Note Phase 1--If determining a starting dose based on weight (AAHA guidelines recommend a blanket starting dose of 1u), cats should be dosed .25u per kg of ideal weight. So if your cat is 15 lbs, and she should weigh 12 lbs(5.4 kg), then the starting dose would be 5.4 X .25u = 1.3u, which we would round down to 1u anyway.

If your vet disagrees with you lowering the dose, I would print both of these out to bring to your vet. If your vet still insists on keeping the high dose, I would not take any more dosing advice from that vet.
 
fortifora is great. just a wee bit sprinkled over their normal food.
raw chicken livers seems particularly tempting to them. My Tom wouldn't eat for a month but succombed to those.
ummmm, parmessan cheese sprinkled over food.
smelly tuna or fish dish.
baby food (chicken and gravy, turkey and gravey)
when all else fails the dry crunch food....they have to eat something.
 
Thanks so much, guys. I'm going to try the baby food, and maybe call the vet again to get the FortiFlora so I can get it right away. Maybe if I talk to someone different, and just say I want it rather than telling them why, they will give it to me.

I went home to check on her just now--still not doing much, just lying there. Tried to tempt her with some Fancy Feast, but she didn't want it. I did get her to take about 2 tablespoons of Cat Sip. I tested her BG again and it came back at 220. Oh, and yes, she is still refusing her normal dry food. I poured some "fresh out of the bag" just now to see if she would show some interest, but she wouldn't touch it. I had to put the Cat Sip under her nose to get her to drink it.

I know we should probably look into changing vets (vet just told my husband we shouldn't necessarily home-test other than doing curves, because it could be "confusing"... I don't see why, seeing as a human diabetic would never inject insulin without testing) but it's pretty overwhelming right now with all of the other changes. Considering all of her BG have been 167 or above (and in the case of fasting, pre-insulin this a.m., up to 250) do you still think it's unsafe to continue with the prescribed amount of Lantus?

Thanks again.

ETA: Thanks for all the food recommendations. I did buy several of those so it helps to know I am on the right track. Of course she won't eat any of them right now... :roll:

ETA again: I guess what I mean is, is it weird that her BG is still as high as it is considering the relatively high dose of Lantus? Of course, she has only had two shots so far. I'd say 12 lbs. would be a good weight for her. She's always been about 13, which seems really overweight, but she is a long cat with a big body and it seemed to sit OK on her. Nowadays she's up to 14.15 (down about 1/2 lb from a month ago... she gained a bunch of weight while we were messing with her allergy diet).
 
Just wondering, do you know if your vet tested her for Ketones when they tested her for diabetes? Her numbers aren't all that high for a newly diagnosed diabetic, so the lack of appetite and just laying around has me concerned that she might have the onset of DKA.

To find out for sure you would need to pick up some Ketostixs like human diabetics use and then try to catch her peeing in the litter box, you can then either hold the strip in the urine stream, or if she is a very private little girl, you can either cover the litter with plastic wrap, or replace it with aquarium gravel so that the urine pools, and then dip into that pool of urine.

Mel, Maxwell, Musette & The Fur Gang.
 
They said they tested for it and there was no sign of ketones in the urine (if there had been, I believe the vet would have kept her there overnight as ketones were what he seemed initially most worried about when we told him her symptoms). But I was thinking of getting some of the ketostix to see for myself anyway, particularly as she hasn't been eating much. Thanks for the advice about the aquarium gravel.
 
saimasmom said:
lori and tom said:
you can buy fortifora at petsmart!
Click to expand...

Well, I tried, but our local Petsmart told me I had to bring her in to be seen by their vet in order to sell it to me. :evil:
Click to expand...

What the meow?! That shoulds like a crock of poo.
Welcome BTW!
 
I could only find at a vets if I did not want to order online...My vet only sells by the box and I did not want to do that, so I called another vet, they sold me 2 ea to start with...without seeing the cat! After I found out they like it, I went and purchased w/ vet as I wanted it fast and did not want to wait for the mail.
 
saimasmom said:
I know we should probably look into changing vets (vet just told my husband we shouldn't necessarily home-test other than doing curves, because it could be "confusing"... I don't see why, seeing as a human diabetic would never inject insulin without testing) but it's pretty overwhelming right now with all of the other changes. Considering all of her BG have been 167 or above (and in the case of fasting, pre-insulin this a.m., up to 250) do you still think it's unsafe to continue with the prescribed amount of Lantus?


ETA again: I guess what I mean is, is it weird that her BG is still as high as it is considering the relatively high dose of Lantus? Of course, she has only had two shots so far. I'd say 12 lbs. would be a good weight for her. She's always been about 13, which seems really overweight, but she is a long cat with a big body and it seemed to sit OK on her. Nowadays she's up to 14.15 (down about 1/2 lb from a month ago... she gained a bunch of weight while we were messing with her allergy diet).
Click to expand...


Yes, I think the prescribed amount of Lantus you're currently shooting is unsafe, especially considering the diet issues right now. We've had several cats show up in just the past few days on too high doses their vets prescribed and diet changes that had dangerous hypoglycemic incidents, which you can find if you look through some of the threads on this board.

Whether or not those higher numbers make it safe to shoot depends on where those high numbers are in the cycle and how much you're testing. High numbers can also be a result of too much insulin. That's why you should never start with a too high dose, because it's not going to help lower blood sugar. When a cat gets too much insulin, their liver dumps glucose into the bloodstream in order to combat low blood sugar.

Lantus also needs to have a reservoir under the skin in order to work, so you will not see the effects of a dose of insulin until at least 24 hours after you give it. You do not dose base off of the preshot numbers, but instead the lowest number of the cycle. Please, please do not shoot 2.5u of insulin if your cat is not eating right. Even if she was eating right, 2.5u would be dangerous for her to start out on, and a diet change/inappetence is doubly dangerous.

I know it's a lot of information to take in right now, but when you are able I would strongly recommend you read the stickies in the Lantus forum--there is lots of information and guidelines that would help you understand how it works and how it should be dosed: http://felinediabetes.com/FDMB/viewforum.php?f=9. In the meantime, drop that dose down to 1u until you get some data through home testing and she starts eating normal again.

Edit: I forgot to add--someone else suggested syringe feeding and I agree. I would also take her back in, perhaps to a different vet. Not eating can be a sign of many different problems, but extended periods without eating can cause liver damage, and I don't want to alarm you but this sounds like it could be fatty liver disease: http://en.wikipedia.org/wiki/Feline_hepatic_lipidosis. It has a very good recovery rate if you catch it early, but a very bad prognosis if you wait to treat it.

You mentioned that your cats were staying with your parents when the inappetence started. Sometimes, it seems the stress of being in a different environment without their owners can cause anorexia, which in turn can cause fatty liver disease. I'm not a vet, but it's one scenario that is not unlikely that should be investigated fully by your vet. A good friend of mine just lost her cat on Sunday to fatty liver disease, in a very similar situation.
 
Ugh... so stressed right now. Vet insists we must give the dose he prescribed, which came from a study that he printed out for me saying 0.5u per kg of body weight and only to decrease if pre-insulin test is 180 or less (*EDIT: Here is the protocol in the study he gave me: http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf. Her BG reading in her office was 486--though I haven't seen anything anywhere near that high at home). I didn't see your most recent reply, Julia & Bandit (phone and internet still not working at home), so we have been giving her the 2.5u last night and this morning because I was too afraid not to do what the vet told me. I'm willing to switch to 1u and will try to talk my husband into that tonight. I think he will be OK with it. Honestly her readings don't seem that high to me, so I am willing to err on the side of caution except her neuropathy seems to be getting worse, so it makes me worried that these ongoing BG levels may be worse for her than I realize.

Here are all of her glucose readings. She had insulin at 7:00 yesterday morning, about 7:30 last night and 7:00 again this morning. I will educate myself more about Lantus. Thanks for pointing me to that board. I really appreciate all of you reading and offering advice.

8/15:
2.5u Lantus at ~6 p.m.
two readings very close together (about 8:10 p.m.) of 164 and 199, respectively

8/16:
5:52 a.m., pre-insulin reading of 255
2.5u Lantus at 7 a.m.
8:30 a.m., post-insulin reading of 238
11:50 a.m., reading of 220
5:06 p.m., reading of 206
6:11 p.m., reading of 155 (I thought this one might be invalid because the strip wasn't totally full of blood, so I took it again)
6:18 p.m., reading of 209
7:24 p.m., pre-insulin reading of 215 (the study the vet gave me said to keep dose the same if pre-insulin reading was 180-216)
2.5u Lantus at 7:30 p.m.
9:53 p.m., reading of 190

8/17:
7:01 a.m., pre-insulin reading (after eating a very small amount of canned cat food) of 231
2.5u Lantus at ~7:10 a.m.
I will go home and check again about 11 a.m.

I tried the Ketostix but wasn't able to get it into the urine stream. I just pressed it into what went through the litter and pooled on the liner, and it was negative for ketones. But that may have either been urine from earlier in the day, or maybe the ketones get sorbed to the clay or something, so I don't really have a lot of faith in that result. I will try to get a better test today.

Yesterday afternoon she seemed to have eaten a little (a few tablespoons?) of her dry food on her own, and a few treats that we left lying on the floor. She was also interested in treats this morning. Even this was a huge improvement because she turned her nose up at treats previously. She also ate about 1/2 can of Fancy Feast in the evening when I put some FortiFlora on it. And she came upstairs last night, and apparently got herself back downstairs OK, which she has seemed incapable of for the past few days. All good news. But this morning the FortiFlora was no longer tempting her that much, and she only ate a bite or two of a different kind of Fancy Feast. Wouldn't eat turkey baby food. I got her to eat a few tablespoons of Cat Sip and a tiny bit of chicken pureed up. I guess I will start syringe feeding her tonight if she doesn't eat dry food during the day, but I'm pretty sure this is going to be so stressful for her that it will just make the problem worse. It's hard to describe how completely uninterested this cat is in wet food even under the best of circumstances. We've tried to get her to eat various kinds of it for years, but without luck unless it is mixed with dry food, and even then she eats around it about half the time. The fact that she is not that interested in her dry food right now effectively means that our bag of tricks is pretty much empty.

I know the answer is out there but I am too exhausted to search for it. How much/how many calories do I need to get into her by syringe?

I am completely at my wit's end. I know she is at risk for fatty liver but I don't think it's an exaggeration to say that another couple of visits to the vet may kill her. It is that stressful for her. (Not specific to this vet--it's just always been that way no matter where we take her.) My husband is extremely reluctant to take her back in for this reason. We have also called them and told them how much/little she is eating, and they are not that concerned about it and say to stay the course. I *know* from my own research that fatty liver is a big risk, but when the vet isn't that concerned, and you are so new to this disease, it really messes with your head to try and go against the vet's opinion. It is messing with my husband's head in particular. I'm pretty sure he would rather see her put to sleep than put her through the ordeal of going back to the vet for a feeding tube, etc. I'm not saying this is right or wrong, but it's how he feels.

At this point, even though I can't imagine life without her, I am almost wishing we had just put her to sleep to save all of us this pain. Between this and work, my husband is the most stressed I have ever seen him, and I'm pretty sure she is going to die anyway if she continues to not eat. I wish I was the one dead right now, frankly.

Edited because I got mixed up about the timing of the readings yesterday--the clock in the meter is a little weird
 
Also keep in mind that the vet observed her to throw up "a lot" of food on Monday while she was in their office, so from his standpoint she had eaten pretty recently--it makes it a little easier to see why he is less concerned than I am. I guess that must have happened as he said, but I don't know where the food came from (maybe they fed her and just didn't put it in her chart?). It didn't look to me like her food dishes had really been touched on Monday morning.

ETA: DH called again this morning with the list of what she had eaten over the past day or so. Vet still not concerned--either about fatty liver (which DH asked about specifically--vet said as long as she was eating something, he wasn't that worried) or the dose. I think we need to find a new vet but I am comfortable taking the advice here for now on insulin dose. The eating is much more difficult. I am going to see how she eats this evening and whether she has any more energy, then make a decision about whether I need to take her in somewhere else to be checked for fatty liver.
 
Hi!
I just wanted to give you a belated welcome and touch on a couple things in your most recent post.

Vet insists we must give the dose he prescribed, which came from a study that he printed out for me saying 0.5u per kg of body weight and only to decrease if pre-insulin test is 180 or less.
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At least that helps us understand where he got the dose info from. BUT, and keep this uppermost in your mind - Saima is YOUR cat. It isn't your vet who watches her all day worried, it isn't your vet who is going to have to deal with a hypo crisis if her BG goes really really low, and it isn't your vet who is going to pay for emergency care if something happens to her due to his advice.
I would cut her back to 1u, twice a day, twelve hours apart for at least 2 or 3 days. Continue to test her BG regularly, and keep track of the times you dose her and test her, and when she eats. Compile that data, post it here, and we can explain to you what it all means. You will see what 1u does for her, and how it interacts with food and with time over a 24 hour period. At that point, this will start to make more sense to you. If after a few days on that dose it is obvious that it isn't working well, then you will be able to determine if or how much of an adjustment needs to take place. When you adjust, you will only do so in small (no more than 1/2 unit) increments, and then you will see how even that small adjustment shows results. Vet advice is great, and sometimes it is really good advice. But that's all it is - advice. He doesn't know "everything" about diabetes. You're the customer in this relationship. You're paying him, so he should be willing to at least listen and read what you tell or show him. He's working for you, not the other way around.

6:11 p.m., reading of 155 (I thought this one might be invalid because the strip wasn't totally full of blood, so I took it again)
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Not sure what sort of meter you use, but I think all of them "beep" when enough blood is present on the strip. If it beeped and didn't give some sort of error code, then there was sufficient blood for the test.

About lack of appetite - She's not wanting wet, dry, treats, etc. So that means you'll most likely have to "force feed" her. Eventually, she will eat canned food and no longer want dry. It's just going to take a while. She isn't eating because she still feels like poop. Once the insulin starts to heal her, her appetite will improve. It could take a few days. Once she starts eating better, you'll see a general improvement with everything. Same with the muscle weakness. It will take a little while for that to improve too. But it will. Around here you will hear this frequently - "This is a marathon, not a sprint". Very true.


At this point, even though I can't imagine life without her, I am almost wishing we had just put her to sleep to save all of us this pain. Between this and work, my husband is the most stressed I have ever seen him, and I'm pretty sure she is going to die anyway if she continues to not eat. I wish I was the one dead right now, frankly
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Please don't even go there, or anywhere close to there. Please get your husband to read this too - you and he are not feeling anything that everyone here has felt. All of us were in the same place you are right now. What I can tell you both is this - if you are willing to deal with this much for just a little bit longer, I promise you that you will, within a couple weeks, be posting something along these lines: "We were so overwhelmed on the day we first visited this board and I can't believe we made it past that feeling. Kitty is doing so much better, we've adjusted to this new treatment routine, and all I can say is a big thank you to all the wonderfull people here!!!!". Everyone of us has been there, and done that. Maybe not those exact words, but search for my post on the day that Bob went OTJ. Look at any post with and OTJ icon on it. Ask anyone who has responded to this thread so far.
Diabetes is NOT a death sentence for Saima. It is managable. There is no reason why you and your husband should believe that you are any less likely to achieve "success" than I was or hundreds (thousands even) of others have. You can do this, and we can help you out every step of the way.

Carl and Bob in SC
 
Oh dear. First off, take a deep breath...you'll make it through this! I know how hard it is when your kitty is sick and you're fighting the vet on what to do about it. I also know how guilty and awful you can feel when you have all these choices and are trying to pick the best one, hoping it will be the one that helps your kitty. You do what your gut and your research tells you is the right thing to do, and even if things don't work out right you know that you did the best you could. And you can't blame yourself if things don't work out the way that you hope, because sometimes you do the best you can and that's all you can do.

I would very much like to see the study your vet is referring to, because everything I've read (and I posted that information for you) use the .25u per kg formula or a blanket 1u for a starting dose. I know you're super stressed and busy with Saima right now, but when things settle down would you mind posting the name, date, and authors of the study so I can look it up? I have a feeling he's referring to dosing guidelines catered to a different insulin, like PZI/Prozinc, Humulin, or Vetsulin. Lantus works differently than these insulins and is not dosed the same way. For example, you adjust the dose based off of the nadir, not the pre-shot like your vet has told you. Here's a link to the breakdown of the dosing guidelines in the Lantus forum: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

I have attached a copy of the 2009 study for you, and you have the link to the Queensland protocol it refers to up above. I would print both of these out, along with the current AAHA guidelines (which refer to the Queensland Protocol), and give them to your vet. He's either using an outdated study or one for a different insulin. Or he is using the dosing guidelines for Lantus for dogs, which is .5u per kg.

Her numbers aren't that bad, actually, and not indicative of hypoglycemia...yet. Like I said, it takes a day or two for Lantus to start working, because it has to build up a depot under the skin before it starts lowering blood glucose. You should start seeing the effects of the 2.5u in today's numbers. If you can, try and get a test about 6 hours in to your cycles. That point should be the nadir, or, the lowest number in your cycle. However, if hypoglycemia occurs numbers can drop much earlier in the cycle.

I definitely agree with your decision to be in the better safe than sorry camp. Even if the dry food she's still eating (and it's ok to give her dry right now if that's what she wants to eat) raises her BG a bit to where 2.5u won't cause hypoglycemia, that is a huge gamble with her current inappetence. And if 2.5u is too much (which it probably will be), then you'll be stuck in an unsafe situation with both very high and very low numbers, and trying to lower the dose anyway. If she's negative for ketones (if she was positive you would have to be more aggressive in dosing), then it's far better to start low and safely work your way up to her correct dose. Bandit has had two rounds of insulin therapy and remission now, and both of those times he never needed more than 1.25u. If I had started him higher than that, I would have missed his correct dose and overdosed him. With insulin therapy, it's better to be too high for a little while than too low for a second.

Here's some tips for transitioning to wet food--I know that your priority right now is getting her to eat regularly but some of these can also double as tips to get a cat interested in any food. http://catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_.

When my Gabby had stomach cancer, she lost her appetite and it was a daily struggle to get her to consume enough calories. The best strategy I employed was to try an assortment of people foods and see what she gobbled down that week--Canned tuna, Canned Salmon, Sardines packed in water, Raw beef, Deli Turkey, Rotisserie Chicken, cheese, and yes, even Spam for a little while. If she readily ate any of these, I would mix it in a small amount of food (I fed her 6 times a day, 1/6 of a 5.5 oz can of cat food at a time). Then I spaced out those small feedings throughout the day so that she was getting all the food she needed to survive. We did this for 7 months until the cancer finally took her, and she was getting all the calories she needed right up until the very end. I also went through all different types of wet food. Merrick's Cowboy Cookout was usually the big winner with her, that and BFF. Her cancer made her get "sick" of foods easily, so I would pick up an assortment of different foods to try every week. The big winners were usually the higher quality novel foods like Merrick's, EVO 95%, Nature's Variety Instinct, BFF, and Weruva.

I'm not sharing this because I think Saima has stomach cancer. I think it's likely her inappetence was caused by separation anxiety, or her renal insufficiency (I never asked--how far along is her kidney disease?). Kidney disease can make her stomach acidic, in which case some Pepcid AC can help (1/4 of a regular tablet). But I think you might be able to employ a similar strategy that I used long-term with Gabby short-term with Saima right now to get her eating. Keep her on 1u and once she's eating normal again then you can adjust the dose based off of the dosing protocol I've provided for you.

I really hope something in here helps--please keep me updated and let me know how Saima's doing.
 

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Thank you, Carl and Julia. It's confusing and weird to me that the insulin doesn't really seem to be doing anything. I just took a reading at noon (couldn't quite do the 6 hours timing, but it was 5) and it was still about 220--not significantly lower than her first reading this morning. Her "curve" seems flat and always around 200. Maybe it just hasn't been long enough yet. When my husband talked to the vet this morning, some things he said made me feel better but some made me want to cry. He said something about just doing the best we can and giving her the best quality of life we can. I think he was trying to get my husband to relax and not obsess, but made it sound like he expects her to die. Right now it is beyond my wildest dreams that things might be better in a couple of weeks, but I will try to keep up hope.

I finally found the "paper" or whatever it is that the vet gave me. Here it is just for reference. http://www.uq.edu.au/ccah/docs/diabetesinfo/article5.pdf I believe you about the dosing... actually the protocol in the study does agree with 0.25 u/kg ideal body weight, so it is the same to some extent as the protocol you posted--but only if initial BG reading is <360. Hers was well over 360 at the vet, but she hates the vet so much that I wouldn't be shocked if it was artificially high, making the lower dose more appropriate anyway. The vet keeps insisting that the dose is "not very much considering her weight." I'm just so confused. Is it possible for excessive insulin to result in a cat feeling crappy, losing appetite, etc. even if they are not hypo? I could hear her stomach "gurgling" some when I went home just now. Sounded like mine would if I was gassy or had a slightly upset stomach.

I guess I'm going to have to get a bunch of different people foods and see if anything tempts her. It's just so upsetting to put food after food in front of her and have her reject it all. I got her to eat about 15 small crunchy treats when I went home for lunch, and syringe-fed her about 5 mLs of pureed canned chicken and Cat Sip (all I could get into her before she got fed up... I don't want to completely freak her out over the process). So almost nothing.

I hadn't started her on methyl-B12 yet, but I need to. Thanks for the reminder. Regarding her kidneys, nobody has ever actually said "CRF" to me... it's just that one of her enzymes is typically a touch high. I try to feed in a way that is easy on her kidneys (e.g. low phosphorus, trying to get her to eat wet food for the moisture) as sort of a precautionary measure considering that and her age, and based on my own research into the subject, but there is no diagnosis.

I really need to get some work done but I can't concentrate on anything the past 3 days. Thanks again for all your help, everybody.
 
Thank you for posting that article! If you notice, the protocol your vet gave you is from 2006, where the updated protocol I gave you here is from 2008. It's published by the same authors. The reason why the .5u/kg if <360 was removed from the protocol in 2008 was because (as the 2006 study your vet provided you states on p. 3),

"Only 1 cat treated with glargine required an increase in insulin dose above 0.5U/kg BID, and 7 of 8 cats had their insulin dose reduced in the first 3 days of treatment. This is an important factor when initiating treatment with glargine, as there is usually a carry-over effect from the previous dose that may take several days to become apparent."

I would give your vet the protocol from 2008 and the article from 2009 I attached, and point out that a starting dose of .5u/kg has been eliminated from it because it was noted that most cats did not need that high a dose. Hopefully, that will get him to take a closer look at the updated protocol so you can be more confident in his dosing advice. It sounds to me like he's done his research (which is good!) but is just a little out of date.

Unlike dogs, how heavy a cat is makes no difference on their insulin needs--a 15 lb cat might need .75u while a 10lb cat might need 1.5u. This why a blanket starting dose of 1u is now recommended, because most cats need about that much insulin--maybe a little less, maybe a little more.

Check out the feline assisted feeding forum: http://pets.groups.yahoo.com/group/Feline-Assisted-Feeding/. Hopefully you'll find some tips there to help you out. I recommend you syringe feed a cat food instead of chicken, because chicken or treats don't have the right nutrients for her to recover(cat-sip is good, though). You want something high calorie, like Wellness Kitten or EVO 95% Venison. These are low carb and the high calorie content will minimize the amount of food you actually have to get in her. Keep syringe feeding so that she's getting a good amount of calories even if it upsets her--unless you think she'd handle a feeding tube better in which case you should take her in for that. It sounds like you think the syringe feeding is the better option, though.

Sometimes once you syringe feed for a bit and get calories back in the cat, the anorexia will subside and they'll recover. However, if she presents late stage symptoms like jaundice or seizures, she will need immediate hospitalization. Here's a great article: http://cats.about.com/cs/healthissues/a/fatty_liver.htm The second page has some good tips on how to get an anorexic cat to eat.

Good luck...I really hope she gets better for you soon.
 
Hi again!

I guess I'm going to have to get a bunch of different people foods and see if anything tempts her. It's just so upsetting to put food after food in front of her and have her reject it all. I got her to eat about 15 small crunchy treats when I went home for lunch, and syringe-fed her about 5 mLs of pureed canned chicken and Cat Sip (all I could get into her before she got fed up... I don't want to completely freak her out over the process). So almost nothing.
Click to expand...

Please follow this link to a great thread all about trying to get kitty to eat. It was started by Lori (who posted in this thread earlier, and took place a few weeks ago when her Tom refused to eat all of a sudden. Parts of it will make you teary, and parts will make you LOL (especially the "liver shake" bits). Importantly, Tom has improved a great deal in terms of eating since then.
viewtopic.php?f=4&t=48391&p=521527&hilit=liver+blender#p521527

I'm just so confused. Is it possible for excessive insulin to result in a cat feeling crappy, losing appetite, etc. even if they are not hypo?
Click to expand...
Yes! Too much insulin can have the same sort of effect on BG levels as not enough insulin. If she is getting too high a dose, it can cause her liver to dump glucagon (?) - "sugar" into her bloodstream, which will push up her numbers. Her liver "panics" when her BG goes too low, and tries to compensate. There's a too-low dose, a too-high dose, and a dose that is just-right. The difficult part of this "sugardance" is learning the steps that help you find that just-right dose. You will.

Carl in SC
 
Thanks to you and Lori for that thread. Poor Tom... I am glad he found something that was appetizing to him. I bought some livers yesterday but haven't had to bust them out yet. I definitely will if I have to.

Saima has improved slightly. I hate to use the word "improved" because it implies some kind of progress, and of course I don't know yet if that is the case. But at least there are things she will eat. Yesterday afternoon she ate a crap ton of Pounce treats (yes, I know, horrible for any cat much less a diabetic one, but that was all I could get her to eat, so I gave her as many as she wanted) and a little of her dry food soaked in tuna juice and Cat Sip. That I would barely even count because she ate mostly the liquid and I think took in very few calories. The best part, though... and thank goodness my husband had decided to thaw some steaks for dinner and Julia had mentioned it earlier in the thread... was that I let her sniff the steaks after I finished thawing them in the microwave, and she seemed interested. So I cut her off a piece, and she gobbled it up. She ate three pieces total, each about the size of a small bite that I would take. Then she ate 10 g of dry food overnight, and this morning about half a can of Fancy Feast cod, sole, and shrimp thinned down with Cat Sip. Plus a couple small pieces of deli turkey and a freeze-dried salmon treat. I won't say she's "recovering" or anything like that, but AT LEAST SHE ATE, and that is good enough for me for now. I also still have the livers to try if she isn't eating later today.

If it's not one thing it's another--right now I'm really worried about her blood sugar. I dropped the insulin dose to 1u last night and this morning, and her blood sugar seems to have been steadily creeping up since yesterday. Yesterday's midday reading (about 5 hours after receiving 2.5u Lantus) was 224, then 239 at 5:30 p.m., 248 just before her 7 p.m. shot of 1u, and 260 at 10:20 p.m. This morning's pre-insulin reading was 317, the highest I've seen. I'm afraid I'm killing my cat by reducing the Lantus dose against my vet's advice.

I did get what I think is a better sample with the Ketostix... I couldn't get it into the urine stream, but managed to touch it to what was running down the liner just before it soaked into the litter. Still not ideal but the best I could do. It was negative for ketones.

Last question... does anyone know if any of the commercially available raw diets (such as Primal) is suitable for a diabetic cat? I have my doubts about the safety of that option, but she really doesn't like canned food, and last night gave me some hope that perhaps she might eat raw (which frankly would be the answer to a lot of our problems since some varieties are novel proteins, and I assume it's low-carb. I just always assumed she wouldn't eat it). She may get used to canned yet, but it's tough to have hope when we have tried for a few years now to convert her without much success.

Thanks again to everyone for all your help.
 
Just wanted to stop by and try to give you an encouraging word. We were in the same boat as you about 8 months ago. There is so much information and it is hard to keep it all straight. Your kitty will be fine with a lot of patience and time.

Let me start off by saying that your vet is giving you advice based on a very general rule. Our original vet did not want us home testing and put Tarragon on a very high dose of Lantus to begin (3U) with based on BGs at the vet office. Tarragon stresses a LOT at the vet and his BG can jump 100 - 150 just because of the trip, so his BG reading at the vet was very inflated. We changed vets and made it very clear from the beginning that WE were in control of Tarragon's diabetes and that we would be home testing and this vet has been great. The first thing we did was to drop Tarragon to 1U and start following the protocol on this board. It does take a few days for the "shed" to fill with Lantus.

Lantus dosing is not based on preshot numbers, but on nadir, or lowest point in the 12 hour cycle. It is very important to get regular mid cycle tests to know what and where that low point in your kitties cycle is. We both work during the day so I make sure to do testing at AMPS, PMPS, +2, +4, and +6 at night, as well as a full curve each weekend.

Tarragon was also a crunch addicted cat and turned his nose up to every canned food I tried, and, believe me, I tried them all! :lol: We also used boiled chicken breast, chicken dust, salmon dust, ForitFlora, mixing dry with wet, etc. to get things going for him. I still have to trick him every now and then to eat it. Also, one thing that really worked well for us was to mix 1/2 can of Fancy Feast chicken classic with 1/2 can of Fancy Feast gravy food. Then add water to it so it is like a heavy soup. I still do this to get water into Tarragon and keep his kidneys healthy, I just use Fancy Feast roasted or flaked instead of the gravy since it is lower carb. (Side note: Flortiflora can be bought on Amazon at a reduced price.)

Remember to breath. This is a marathon, not a sprint. You are doing great and your kitty will be fine. Be sure to get on here and ask lots of questions. This is an amazing place.

Melissa
 
I'm so glad she's getting some of her appetite back! Don't be afraid to syringe feed her to get enough calories in her, even if she's eating a little. If she really likes her pounce treats, instead of feeding then to her straight try crumbling one up and sprinkling it on a tbsp of wet food? You want to get nutrients in her any way you can.

You are most certainly not killing your cat by going against your vet's advice. You are, in fact, helping. Your numbers are not rising dramatically, and Saima is not super high right now. The best thing you can do for her is dose her correctly, so that you can get her regulated. If you supercede the correct dose, she is not going to improve. The ONLY way to find her correct dose safely is to follow the dosing protocol, which means lowering the dose and slowly raising it based off of her mid-cycle numbers. Your vet was using an out of date study and was not following the correct procedure.

Do not worry about her numbers being a little high right now (and believe me, her numbers are a little high, not super high). Stress and illness can keep numbers high, no matter the dose. Dry food will also keep her numbers high. However, right now priority one is getting her eating again, which is the biggest danger facing her. After she's eating normally, then we can worry about lowering her blood sugar. However, she is at a large risk for hypoglycemia on 2.5u in the midst of a diet change without eating properly. Hypoglycemia can be deadly, and is a much bigger risk than her high blood sugar right now and should be treated as such.

Do you think you can set up a spreadsheet? http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0 It will be much easier to give you dose advice if we can see your numbers charted. There are people in the Lantus forum that have tons of experience in dosing that can help you adjust Saima's dose safely and correctly. They have helped bring hundreds of cats into remission. I've brought my own cat into remission twice. We really do know what works. I know it sounds crazy to tell you to trust people on the internet over your vet, but we are all people that ended up here because we did end up getting better treatment recommendations here than from our vets. I'm not saying you have a bad vet--in fact, your vet has been far better than most we see here. But vets are general practitioners that have to know a lot about many different diseases for many different animals, and they can't always keep current about everything. I've given you the information that shows that 1u is the right dose for Saima to be on, so you have to trust your head that you're doing the right thing.
 
Just wanted to say THANK YOU to both of you. I feel better now. I need to get my husband here too. We are both worried sick about our cat, and both engineers, but he is probably the one with the more truly analytical mind and I think it would benefit him to do some research and ask some questions. I also don't want him to feel like I am making all the decisions. Thanks again. I'll stay the course, test when I go home for lunch and make sure she eats something nutritious, and go from there.
 
saimasmom said:
Just wanted to say THANK YOU to both of you. I feel better now. I need to get my husband here too. We are both worried sick about our cat, and both engineers, but he is probably the one with the more truly analytical mind and I think it would benefit him to do some research and ask some questions. I also don't want him to feel like I am making all the decisions. Thanks again. I'll stay the course, test when I go home for lunch and make sure she eats something nutritious, and go from there.
Click to expand...

You guys definitely need to get your spreadsheet up and running, then. I am also a very analytical person, and it's hard to explain sometimes how comforting the level of control is when you have your data charted before you to base your decisions on. It's like the difference between using a formula to figure out the exact area of a room, and eyeing the room and taking a guess on now big it is. :-D
 
Oh, and I completely missed the raw diet question. Actually, a raw diet is great for a diabetic cat and about the best thing you can feed. I don't have experience with them (the commercial raw diets are a bit too pricy for me and I don't have the time with two jobs and grad school to make my own), but I know that a few of my friends in town feed Feline's Pride raw and their cats do incredibly well on it. I have a couple friends that also make their own raw cat food, and their cats are doing great (pretty much all of my vegan friends make their own raw diets for their cats, which I think is kinda funny). The advantage to a commercial diet is that it's completely balanced and so you don't have to worry about adding supplements, but you do need to pay attention to the ingredients to make sure the meat content is high enough. Here's some information about home and commercial raw diets: http://catinfo.org/#Home-Prepared_Diets
 
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