New Member 28th January - Diabetic Cat with Chronic Pancreatitis

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CSquiggy

Member Since 2020
Hi Everyone,

I’ve been treating my cat, Milo with Prozinc since April 2017. My husband and I rescued him in February 2016 after he was abandoned by his previous owners. As far as we know, he’s around 11 or 12 years old and he weighs 7.4 kg. He was well controlled (based on fructosamine levels) until December 2018.

Recently, we used a Freestyle Libre sensor to better understand his blood glucose on Prozinc. His fructosamine was high at 3.5 units twice daily and at 4 units twice daily, his blood glucose plummets 4-6 hours after his dose. 2 weeks later, we’ve found that his levels fluctuate a lot throughout the day and night. In the mornings, he is often over 27 mmol/L (486 mg/dL) and he had 2 hypoglycaemic events in two weeks: one at night and one while my husband and I were at work.

After a couple of long conversations with his vet, I’ve been told that his numbers are good enough and that he’s probably a patient that will need to be monitored based on clinical signs. He is happy and healthy overall but I worry about the stress on his body with such fluctuations. I’ve been pushing to change his insulin to Lantus in hopes that his BG levels won’t rise and plummet so much but I’m not sure if that’s the best option for him.

Thanks for reading and sorry for the long post. I really appreciate any guidance/support you can offer.
 
Hello Milo, you were lucky for being rescued.

Is is the vet who doesn't want to give Milo the Lantus insulin to try?
 
Lantus has been used for cat diabetes for 13 years, since 2007. So I might say in that regard that vet/those vets of yours are a little behind.

We are many Lantus user here, I as for one who only spend my time in the Main and Cat Health form, and a whole bunch in the specific Insulin Support Forum for Lantus group were most of them manage their cats.

So if you could persuade you vet to give Lantus a try, know you won't be alone here.
 
Lantus is a good insulin for cats and may be worth trying. However, if he’s going very low and then very high again, the insulin dose is probably too high. What were his readings when you say he had a hypoglycemic incident? I actually discovered the same thing for the very short time my cat was wearing the freestyle libre. The low numbers (or lower than your cat is used to) can cause their body to dump sugar and make their blood glucose super high, which you’re right, can be very hard on their body. The libre is a great tool, but if you are able to home test, that will also give you a much better picture of how milo is responding to the insulin and what a good dose for him is.

My cat also has chronic pancreatitis, and since her diabetes has been under control, her flare ups are much less frequent. This is of course just anecdotal and I’m not sure if there’s any correlation, but it probably wouldn’t hurt things if Milo’s pancreas wasn’t having to work quite as hard to keep his blood glucose in check.

Welcome to both of you and we’re glad to have you here :cat:
 
Which country do you live in? Lantus is a very common insulin for cats......it's a great one for cats.
If your current vet will not prescribe Lantus, can you go to another vet.? I would continue to push for it. If a cat is not doing well on one insulin, they often do much better on another.
Alternatively give the vet some information about Lantus or get them to look at this site.

I disagree completely that Milo could be treated just by monitoring clinical signs.
The high BGs and the hypos prove that would not work and certainly puts Milo at risk.

It is possible Milo is getting too much insulin. It also sounds as if he is bouncing from the low numbers up high.....very common in cats.
Have you been home testing the blood glucose levels or have they been done at the vets?
Was the Freestyle libre the first time you have had testing done at home?

I would strongly recommend you think about home testing the BG levels. It is the only way to keep Milo safe and you can see what the BG levels are doing at any given time. Almost all of us here home test. We can help you get started with it with tips, what to buy and support as you learn. Milo will not hate you....in fact most cats learn to run towards the testing because they know they will get a treat.
Here is a link for you to look at about home testing
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Are you feeding Milo several times a day? Do you leave food out for him during the day and at night?

I am sure we can help you get Milo into a much better situation. This is a very knowledgeable and supportive community and we all look out for each other's kitties.
Here is another useful link
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Hope to hear back from you. Keep asking lots of questions.
Bron
 
Hi Milo kitty! Would you introduce your mom to us? First name is fine.

From the fact you gave us the BG readings in mmol tells me you don't live in the US. Where are you located? I'm asking because we have members from all over the world and they have created some documents that we could share with you for country specific information.

What food are you feeding Milo now?

Thinking the insulin dose is too high.
You say your cat Milo had 2 hypoglycemic episodes. What are you basing that on? Lowest BG reading was what? Hypoglycemic signs were what? Did you see any signs such as these?
SYMPTOMS
Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness

More info on hypo and how to treat it is in this link How to treat HYPOS - THEY CAN KILL! Print this Out!!

After a couple of long conversations with his vet, I’ve been told that his numbers are good enough and that he’s probably a patient that will need to be monitored based on clinical signs. He is happy and healthy overall but I worry about the stress on his body with such fluctuations.
Why did your vet say your cat would be better to monitor only by "clinical signs"?

Please ask your vet if he personally is an uncontrolled diabetic. If your vet was diabetic and had a BG of 27 mmol (486 mg/dL) he would be feeling like crap and might not say that your cat is "good enough".

Let's see if we can help you make Milo feel better.
 
Thank you for all of the support and tips. I’m Christina. Apologies for not introducing myself earlier. We’re in Canada so Lantus should be readily available.

I’ve been considering home testing but I wasn’t sure where to start. We tried once at home but didn’t have much success. The Freestyle was the first true picture of his BG numbers at home. I’m looking forward to learning better techniques for more accurate monitoring.

Milo is on Nulo wet food. He usually likes the shredded or minced varieties but he’ll occasionally eat the pâté ones.

His lowest BG was less than 3 mmol/L and it happened while we were sleeping so I don’t know if he had any symptoms. The Libre bottomed out for about 2-3 hours. I’m not comfortable with his BG going that low and skyrocketing to over 20 mmol/L in the mornings.
 
Hi Milo, thank you for introducing your mom to us. Hi Christina! Sometimes in our busyness to get a thread started, we forget to introduce ourselves. No worries.

To get you started, would you read this please. New? How You Can Help Us Help You!

While you are doing that setup, I'll be working on answering some of your other questions, the implied ones as well as those you asked.
 
I’m not comfortable with his BG going that low and skyrocketing to over 20 mmol/L in the mornings.
Me neither.

1. Lucky you! Lantus insulin is so much more easily available in Canada and so much less expensive than here in the USA. Walk into any drugstore and buy it without a prescription. On the flip side, meters and test strips are more expensive. Not sure which meters are best up in Canada. One Touch Ultra 2 and Countour Next One are 2 meters I know people in Canada use. I'm sure there are others.

2. Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos
Tons of information for you in that link. It's buried in the Health Links/FAQS Index "sticky".

My 2 favorites within that are
3. Nulo wet foods are ok for a diabetic. We recommend 10% or under here. We use the Catinfo food Chart by Dr. Lisa Pierson.
The shredded and minced Nulos are in the 9-10% carb range. The Nulo pates are in the 1-5% range. Lowest carb does NOT always mean better. Could have something to do with the BG's yo-yo ing. Discussion on that here. Feeding Lowest/Zero Carb vs Lower Carb Foods

4. 3 mmol/L (54 mg/dL) is pretty low, That was with the Libre continuous glucose monitor and you say it bottomed out, so could have been even lower. When in the cycle did that occur? A cycle being a 12 hour period. 0 is Pre-shot test, +1 is 1 hour after shot of insulin, +2 2 hours after, +3 3 hours after, etc.

Do you know at what + hour of the nighttime that low occurred?

You should be glad his body's self protection mechanism kicked in and dumped sugars and hormones into his bloodstream to bring him back up to a 'safe' level. It's not good to have him dive from the high diving platform into the swimming pool and then climb Mt Washington to get back up. But it's better than the alternative. 20 mmol/L (360 mg/dL)
 
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I’ve been considering home testing but I wasn’t sure where to start. We tried once at home but didn’t have much success. The Freestyle was the first true picture of his BG numbers at home. I’m looking forward to learning better techniques for more accurate monitoring.

I think many of us had this same experience :p My cat was NOT into home testing when I started trying and she was a little nightmare. But most cats are very trainable if you stick to a routine and find a reward they like, which for my kitty is treats! If your cat is particularly difficult like mine was, or even just needs some persuading to cooperate, a good place to start is with establishing a routine and getting them used to the testing process. So you could rub his ears a few times with a treat, hold him in place for a few seconds (my cat’s least favorite part) with a treat, etc. That way he associates test time with positive things. And I say treats, but it’s whatever reward works for your cat. Some cats like brushing, others like pets.

The freestyle libre is great, but I know they can be kind of pricey to keep applying. There is also a delay in the readings compared to blood testing, so it would be good to learn how to home test in case you catch low numbers as well
 
3 mmol/L (54 mg/dL) is pretty low, That was with the Libre continuous glucose monitor and you say it bottomed out, so could have been even lower. When in the cycle did that occur? A cycle being a 12 hour period. 0 is Pre-shot test, +1 is 1 hour after, +2 2 hours after, +3 3 hours after, etc.

Do you know at what + hour of the nighttime that low occurred?
Thanks for the information!
His low BG occurred at +5 and ended at about +8.

His vet wrote a prescription for Lantus today and we’ll be switching him tonight. He’s being started at 2 units twice daily.
 
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