New Member - frustrated by Feline DM2

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ssobhan0108

New Member
Hello all :

I am new here. My cat was diagnosed with DM last September. The vets did a curve and fructose test and we started on the long journey to bring
the glucose under control (stabilize it at an acceptable level, which according to them is below 300). But after 6 months, 2 fructose tests and
weekly glucose checks, we have been unsuccessful in maintaining a constant acceptable range. We even get the expensive brand of Purina
DM for Mussiona. We administer 2 shots daily. For the first 4 months it was straight HUMULIN NPH, started with 1 unit, went upto 3 units and
went back to 1 unit, and the BGL was still running haywire ! So, they decided they would switch to a 1/10 diluted solution. Now, thats been 2 months
now.We started with 8 units of the diluted Humulin and now its upto 16 units, after gradual increments after every weekly test !

We have already spent hundreds of dollars, and lucky to have been able to afford this at this time, but it is becoming frustrating, specially when
there doesnt seem to be any STABLE SOLUTION IN SIGHT.

The vet has discouraged us from home testing at this time. I have been hoping to reach a stabilized level so we could then continue the
treatment at home.

I have questioned that the vets glucometer might be defective, but they did not accept that. Now, I'm thinking of changing vets and not sure if that
would be the right decision. Any suggestion is appreciated ! My email : ssobhan@aol.com : THANK YOU ALL !!!!
 
Humulin H, Vetsulin, and Caninsulin are older insulins that are no longer recommended for cats because they tend to cause harsh drops and their duration is only about ~8h in cats. They are fine for humans and dogs, but cats have faster metabolisms so it is not appropriate for them.

Lantus, Levemir, and Prozinc/PZI are the 3 most frequently used insulins on here. Please ask your vet for a prescription for one of these insulins. We have a few vet-backed protocol guidelines that someone will probably post if you need to print them off to help convince your vet. It is very difficult to regulate cats on Humulin N and it is very obvious by this point that it is NOT working for your cat. Depending on what insulin you get, there are a lot of proven protocols that work for cats, especially Lantus (glargine).

About home testing - would a human doctor ever tell a mother not to test her diabetic child before injecting insulin? Never ever! So why should we inject insulin blind into our cats? Home testing is easy, fast, and you will not be left wondering if your cat is safe, or if the treatment is working. You can pick up a home testing kit for shipping cost by clicking "Home Testing Kits" at the top of the page, or you can get a ReliOn Confirm or Micro (or other meter if you are outside the USA) at Walmart for dirt cheap along with some testing strips and 25-29 gauge lancets. With home testing there will be no more paying for expensive curves and tests at the vet, and the results will be more accurate because your cat will be in a relaxed home setting!

Another important point - what is your cat eating? We highly highly recommend against dry food diets because the vast majority of them are VERY high in carbohydrates - yes, even the prescription dry diets (ie. Hills m/d). Feeding a cat dry is like feeding a human diabetic nothing but Twinkies and Coca cola. It makes their blood glucose skyrocket and you will need to inject dangerously massive doses of insulin to counterbalance all the carbs. We recommend feeding a LOW CARB, pate style, canned food. There are many choices that you can get at your local department store, grocery store, pharmacy, etc. prescription diets are NOT necessary. Fancy Feast Classics, Friskies pates, Special Kitty and Special Kitty Select, Wellness, Merricks, and EVO 95% are some popular ones on here. You want to aim for less than 10% carbs, but we recommend under 7% because a lot of cats are super sensitive to carbs. You can see the carb content on many popular canned foods on this page. If you want more information on the proper diet for your cat, please check out Dr Lisa's site, Cat Info.

Please DO NOT CHANGE YOUR CAT'S DIET UNTIL YOU ARE HOME TESTING. When a cat's carb intake drops, so does their insulin need. The large dose of insulin you are giving could kill your cat if you change his diet now.

The 3 most important keys to keeping your diabetic cat SAFE, HEALTHY, and PROPERLY TREATED are -
1. Proper insulin, proper dosing protocol
2. Proper low carb canned diet
3. Home testing blood glucose numbers

If your vet is good about things like routine checkups, blood tests, emergencies, x-rays, etc. then you will want to keep in contact with them for those situations. Otherwise, FDMB will assist you with anything and everything diabetes. Not a lot of vets know how to properly treat diabetes because vets need to know a LOT of things about a LOT of animals. Here, we specialize in feline diabetes. Actually, we don't just specialize in it, we live and breathe it 24/7/365. Coming here is the best thing you could do for you and your kitty. I am sorry your vet put you and your kitty through such poor, outdated treatment :(
 
Welcome to the board! You've come to a great place to get lots of great info.

A few things jump out from your post:

1. Are you feeding the wet DM or the dry? A low-carb wet diet is best for a diabetic and can help lower the numbers significantly. You want under 10% of calories from carbs. We have some charts to help us find the right foods. Here is a link: http://binkyspage.tripod.com/canfood.html The wet DM is OK, but many of use Fancy feast Classics or Friskies Pates. They are much cheaper and just as good as the DM. But, and read this a few times: if you switch to an all wet, low carb diet from dry,it's likely that your kitty will need less insulin immediately, which brings me to...

2. Hometesting is a critical part of caring for a diabetic cat! A human diabetic would never dream of not testing because it isn't safe! Cats can drop too low quickly and many don't show signs until it is a full blown hypoglycemic episode. Remember, your vet works for you, not the other way around, and you don't have to not test because he doesn't encourage it! Testing has helped many of our cats and saved some lives.

3. Humulin is not a good insulin for cats. It is very harsh and doesn't last long enough in their bodies, so that on a 12 hour schedule, they are without insulin for a few hours at the end of each shot cycle. Current veterinary protocols suggest using Lantus, Levemir, or ProZinc/PZI insulin. All of these are long lasting, gentle insulins. Many cats are very well regulated on these insulins and many go into remission on them. It seems like your vet is very behind on his understanding of feline diabetes! In fact...

4. It sounds like your cat is getting too much insulin. Too much insulin can cause perpetual high numbers. What happens is, the cat's body gets used to high numbers, and so when insulin drops them quickly into the normal range or lower, as Humulin does, the liver reacts by releasing stored glucose in an attempt to avoid a hypoglycemic crisis. This sends the glucose sky high, and may become a vicious cycle.

I'm sure you will get more useful info from everyone here, but if I were in your shoes, I would be looking for a new vet, or at least trying to educate your vet on more up-to-date information. Hopefully you can get some better advice and get your kitty on track quickly!
 
ssobhan0108 said:
Hello all :

I am new here. My cat was diagnosed with DM last September. The vets did a curve and fructose test and we started on the long journey to bring
the glucose under control (stabilize it at an acceptable level, which according to them is below 300). But after 6 months, 2 fructose tests and
weekly glucose checks, we have been unsuccessful in maintaining a constant acceptable range. We even get the expensive brand of Purina
DM for Mussiona. We administer 2 shots daily. For the first 4 months it was straight HUMULIN NPH, started with 1 unit, went upto 3 units and
went back to 1 unit, and the BGL was still running haywire ! So, they decided they would switch to a 1/10 diluted solution. Now, thats been 2 months
now.We started with 8 units of the diluted Humulin and now its upto 16 units, after gradual increments after every weekly test !

We have already spent hundreds of dollars, and lucky to have been able to afford this at this time, but it is becoming frustrating, specially when
there doesnt seem to be any STABLE SOLUTION IN SIGHT.

The vet has discouraged us from home testing at this time. I have been hoping to reach a stabilized level so we could then continue the
treatment at home.

I have questioned that the vets glucometer might be defective, but they did not accept that. Now, I'm thinking of changing vets and not sure if that
would be the right decision. Any suggestion is appreciated ! My email : ssobhan@aol.com : THANK YOU ALL !!!!
Click to expand...

Oh yeah, I would say change vets. Your insulin is very old school and not good at all. Insulins you would want would be Lantus, Levemir, or maybe PZI. Tell your vet you want to change insulin. Look around for a new vet and be sure you ask what insulin they have their clients give.... you don't want to waste your time and money on another vet like your current one.

Food is important.... low carb wet food. Many people feed fancy feast or friskies pates, and NO DRY. You are at a fairly high dose of insulin but you have no clue how your cat is doing.... curves at the vet are useless as your cat most likely is showing numbers reflecting stress. One of my cats tested higher at the vet all the time, but the other tested lower. Home testing is the only way you will know how your cat is doing on insulin.

I guess the first thing you should do is pick up a glucose meter at the pharmacy - Relion is good and the strips are very inexpensive when compared to other meter strips.... DO NOT get any FreeStyle meters as they're giving false readings to cats. Once you are testing at home, you can see your cats numbers.

The second thing would be to transition off any dry food and onto low carb wet food. You'll need to be testing because you may find your cat needs little or no insulin. Once you are testing, you can adjust the dose down to allow for the food changes.

The dose you are giving is quite high, but I would not say that it is too high without having info about the food you are feeding, and seeing some numbers from your testing. Some cats truly do need such a high dose, and there are tests that can be done for conditions which require high doses, but it could be a case of giving too much insulin, your cat's numbers dropping very low and then bouncing up high, like a bouncing ball.

Start home testing, correct diet, adjust dose as needed.
And get a decent vet.
 
I would definitely get a 2nd opinion. Having a vet that isn't "up" on FD isn't the end of the world. If you are hometesting, and if you can get a more appropriate insulin prescription for Lantus, Levemir, or Prozinc, then you won't really need the vet for much relating to the diabetes. You can still use them for vaccinations, the occasional 'script for anti-biotics, yearly checkups, etc. Finding a new vet isn't always an easy task, especially if it's a vet you've used for a long time and have built up some sort of a relationship with. Some vets, unfortunately, just aren't up to date with everything. But that's true of every profession.

But most of "this", you can do by yourself (with help from all of us) at home. There's also always that chance that you could help to educate your vet so he'd be more current with treating feline diabetes. In the long run, that would help any other cat that shows up there with diabetes. Many of us have been able to get our vet on board - my vet now directs people to Binky's food charts, always recommends home testing, and doesn't ask people to bring kitty in for periodic "curves". She even gives out my name in case people have problems with home testing or insulin injections and need some help getting started.

Carl
 
Hello everybody !

We saw the Vet yesterday and when I expressed our concern that Humulin is not working for Mussiona, his reponse was Humulin is the the most currently used insulin for cats. He has not used Lantus or PZI for cats either (according to him THESE are outdated !). So we have reverted back to straight 2 units of Humulin as we were upto 16 units of DILUTED Humulin (1 part Humulin and 9 parts sterilized water). He is also of the opinion that most cat owners DO NOT prefer home-tesing (which I also find hard to believe) I have requested him to "research" the possibility of changing Insulin, while we try the new dosage the next couple or few weeks. If there is no marked progress, I have made preliminary contact with another Vet facility where we can take Mussiona to start all over again. This was recommended by Galina's co-worker who has used them for the past 10 years and has been satisfied with them.

This is th 8th month after first diagnosis, and we should have achieved some level of stability by this time. In the meantime, Mussiona clearly is weaker. She can no longer jump on to the sofa or bed like she used to before. We put her on there when we see her laying down nnear the bed. I put a short step-ladder next to the bed and trying to train her using it.

Thank you all again for your feedback and support !

Sy & Galina
 
We saw the Vet yesterday and when I expressed our concern that Humulin is not working for Mussiona, his reponse was Humulin is the the most currently used insulin for cats. He has not used Lantus or PZI for cats either (according to him THESE are outdated !).
Click to expand...

That's just mind-boggling. Lantus, Levemir and Prozinc have only become the popular cat treatment insulin over the past five years ago. How can they be "outdated". Prozinc was only put on the market, intended just for use on cats, within the past few years. All three of these have been researched on cats because insulin like Humulin was found to not work well at all for cats. I wonder where he's getting his information from? The information on lantus, lev and prozinc comes from labs, studies and vets.

He is also of the opinion that most cat owners DO NOT prefer home-tesing
Click to expand...
Actually, he might be right on that. Nobody here feels that way of course, but most diabetic cat owners unfortunately aren't "here". We wish they all were. Most owners probably just listen to the vet, follow the instructions given, and never take the time, or think of, going to Google and typing "feline diabetes". I have spoken to a couple of vets who told me they didn't recommend home testing simply because they didn't believe the owners would be willing to do it. Sad.

Carl
 
If there is no marked progress, I have made preliminary contact with another Vet facility where we can take Mussiona to start all over again. This was recommended by Galina's co-worker who has used them for the past 10 years and has been satisfied with them.
Click to expand...

If I were "vet shopping", I would ask two simple questions: (And I would also recommend you ask your current vet these questions).

1 - how many cats have you treated for feline diabetes?
2 - what has been the remission rate so far?

If the answers to both of the questions are not pretty high numbers, I'd keep shopping.

Carl
 
his reponse was Humulin is the the most currently used insulin for cats. He has not used Lantus or PZI for cats either (according to him THESE are outdated !).
Click to expand...

I would definitely change vets. This is an an outright untruth, which even a simple wikipedia search will tell you: http://en.wikipedia.org/wiki/Diabetes_in_cats#Insulin_injections. Finding a vet that is up to date with every aspect of Feline Diabetes is rare, but you do need a vet that is willing to put your cat's health and safety over his own ego.

Here are the current diabetes guidelines released by the American Animal Hospital Association (2010): http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Note where it says on p. 218 (4)

The insulin preparations with the appropriate duration of action in most diabetic cats are glargine(U-100) or the veterinary-approved human protamine zinc insulin(PZIU-40). This panel does not recommend the veterinary-approved porcine zinc(lente) insulin suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor.
Click to expand...
.

Note that Humulin N (NPH) is not even mentioned because it's duration of action is even LESS than Vetsulin (lente) and not appropriate for use in cats. It is the most popular insulin and appropriate for use in DOGS (p. 221). Cats' metabolisms are twice as fast as people or dogs and they need a long acting insulin in order to properly control their blood glucose levels.

Also note in p. 218 where it says:

Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose relative to clinical signs. Most owners are able to learn to do this with a little encouragement, and interpretation of glucose results is much easier for the clinician.
Click to expand...

I've attached a couple articles for you to print out and give to your NEW vet (I would not continue to go to any vet that will make stuff up and recommend a treatment that is harmful to your cat rather than take 5 minutes to google the topic). Cats on a low carb, canned diet, a long acting insulin like Lantus and Levemir, have a very high remission rate when combined with dose adjustments via daily home testing.


A friend of mine was in the exact situation as you a few months ago. Her vet had her cat on a dry prescription diet that was too high in carbs, 5u of Humulin N, and told her not to home test. She went along with his treatment for 4 months, and her cat's condition continued to worsen until he had diabetic neuropathy so bad he couldn't walk for more than a few steps, and had to urinate on a puppy pad in the middle of her floor. She got in touch with me and I convinced her to switch to Lantus, home test, and change the diet. 5 months later, Sydney has regained nearly full mobility, and he started a remission trial last week. Even if you don't start the right treatment right away, there IS still hope for remission, and the sooner you get on the right treatment path the better your odds will be.
 

Attachments

Also, concerning her diabetic neuropathy (the weakness in her limbs):

The neuropathy will improve as you change insulins and diet, and get better control over her glucose levels via home testing. One thing that helps cats with neuropathy a lot is a supplement called Methyl-B12. You can buy the capsules on Amazon: http://www.amazon.com/Vitacost-Vita...UTF8&qid=1321902593&sr=8-13&fb_source=message. Recommended dose is 3000-5000mcg per day, but you can't overdose Methyl B12 (the cat pees out the excess, so I would go with one capsule (5000mcg) mixed with food a day (you just break it open and mix).

This litter pan is helpful for cats with neuropathy, because they often have trouble climbing into regular litter boxes: http://www.amazon.com/gp/product/B0...&pf_rd_t=101&pf_rd_p=470938811&pf_rd_i=507846

More info on Neuropathy: http://www.laurieulrich.com/jasper/
 
We saw the Vet yesterday and when I expressed our concern that Humulin is not working for Mussiona, his reponse was Humulin is the the most currently used insulin for cats. He has not used Lantus or PZI for cats either (according to him THESE are outdated !)
Click to expand...

Please. Please. Please get a different vet. Unless he just arrived from the past in a time machine there is absolutely no reason he should be making a statement like that. NOTHING in veterinary medicine would support that statement. Ask him for documentation and sources for his research on the subject. How maddening that he would be lying to his clients in such a way.
 
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