New member: My cat Ivy was already getting better, but now... I regret following my vet's advice

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Sera and Ivy

Member Since 2024
Hello everyone!
(This is going to be a long post, thank you everyone who reads it)

My 9 year old cat Ivy was diagnosed with diabetes 2nd of Feb 2024. I took her to the vet because she suddenly didn't eat her morning food and was hiding under the bed. She had also lost weight, but I thought that was because of a diet food I had been giving her. Ivy is an extremely fear aggressive cat at the vet, the only was she can be examined there is by putting her in a cage and giving her a sedative shot (even giving that then is hard).

At the vet they checked her blood values, took a urine sample and did an ultrasound. Her blood glucose was 21.7 mmol/l=390.9949 mg/dl. They confirmed diabetes with fructosamine test: 587,5. There was 4+ glucose and 4+ ketones in her urine.

Vet prescribed Lantus for her, dose being 3 units twice a day 12 hours apart. Ivy was weakened when i took her home, and would not eat or drink. Starting the insulin shots was a struggle. But getting her to eat was priority at that point. During the second day I was able to get her to eat some cod, as that is her favorite food, a special treat as I usually just feed her commercial cat wet food like animonda or cosma. (I live in Europe, and order her food from Zooplus). Ivy only ate it a little bit though and was very weak and lethargic. I was already thinking that maybe she needs to be euthanized. But then I guess Lantus started kicking in after like a week, as she strarted to gradually get better. The first weeks she was fighting back every insulin-shot. I live alone, and have nobody to help me. Restraining her in any way makes her fight back more. She is a large cat too. I had my hands shaking after every shot i gave her. And before every shot, I was wondering if the shot would even be successful. I want to thank this forum for saving my cat's life at that point, as I read a post here about the alternate way to inject my cat vs. the tenting method. Ivy hated when i lifted her from her skin. But I read from these forums, how one can also lift from the cat's fur to inject. Ivy tolerated that way better.

In the beginning I tried home testing with an Alpha Track 2-meter that the vet borrowed me. But that was a terrible experience for both my cat and myself. My priority in the beginning was to give her insulin shots, and also home testing the glucose would have surely made the insulin shots fail even worse. So I bought urine dipsticks to test glucose from Ivy's urine instead.

Ivy started to let me inject her without struggling! (I'm so proud of her) I watched the dipsticks go from +4 glucose at first to gradually only trace and then negative! (no ketones at any point when I started the dipsticks after a month from diagnosis) As I kept getting only negative glucose from the tests for a few weeks, I was thinking the dose needs to be lowered based on everything I had read. I am using a Lantus pen with pen needles, so i reduced to dose to 2 units. (I know that everyone here recommends decreasing at most 1/2 unit at a time, but with the pen I could only reduce a full unit. I was not ready at that point to try syringes, as I would fear Ivy would object to them. Ivy's pen-needles are 32g 6mm) After giving Ivy 2 units twice per day for 3 days, the urine glucose stayed negative.

I then called my vet, telling her about the dipstick results and how i decreased the dose to 2 units. She was kinda angry, and told me to change the dose back to 3 units. (Ivy had been on the same dose for 2 months at that time) She also told me not to read stuff from the internet. Ivy's next vet appointment was scheduled be in a month from that call. She told me that if I changed her dose now, the lab test values and fructosamine test wouldn't be reliable.

I was hesitant, but followed my vet's advice anyway and have been giving Ivy 3 units. Her dipstick results got worse though, and for 3 weeks have now showed +1 or +2 glucose values constantly.

Yesterday I borrowed the Alpha Track from my vet again, and managed to get 3 values. Ivy was fighting and very stressed though. Ivy hates being held still so i could not warm up the ears properly, because she would run away after that and if I then tried to poke her ear, she would get aggressive. The first time I poked the ear, I failed to get blood. I gave her food and insulin shot, she objected to insulin shot a bit as she was agitated from the ear poke, but I believe I got most insulin in. After 15 mins I got a sample, but had to use the big vein from her ear, and I felt terrible. Ivy's result was 23.1 mmol/l=415.8 mg/dl. +2.5 hours from the first test it was 21.7 mmol/l=390.6 mg/dl. +5.5 hours after the first test it was 24.4 mmol/l=439.2 mg/dl.

I had to use the big vein to get blood every time and Ivy was stressed, so the values are probably higher due to stress. Either way, the curve is terrible. Looks like maybe insulin resistance? I probably have missed the nadir of the curve too. But the value started to go back up so soon... I plan to buy a libre 2 and just hope it will stay some days and not drop off right away. I simply can't do the ear pokes as Ivy is too aggressive or scared for that so values are going to be affected anyway. And the testing affects my own quality of life very negatively too. :(

I am now at a loss. My theory is, that Ivy had insulin bounces due to too high insulin dose. But as I was giving her the same high dose for so long, is it possible that Ivy developed insulin resistance due to too high amounts of insulin for prolonged period? And now her values are high all the time despite insulin. I am angry at myself for not taking Ivy to the vet when her values were good for few weeks. If the vet did fructosamine test then, she would have surely told me to decrease the dose. But now that I have a vet appointment soon, the fructosamine is going to be terrible. But is it because of too little or too much insulin? I have a feeling my vet will tell me to increase the dose and maybe it's not a good decision. I am so lost and feel terrible...
 
Hi Sera and Ivy and welcome to the forum.
Please don’t feel terrible…you have been doing a very good job despite having a difficult kitty to manage and getting some bad advice from your vet. Feline diabetes is a very treatable disease. Unfortunately some vets are not very up to date with how to treat cats with diabetes..
I think it is a very good idea to get a libre fitted so you can see what is happening. What country do you live in.? We do have some members who live in Europe and may be able to help with various things.
I will try and answer your questions.
I think the vet was wrong to tell you to go back to 3 units when the urine test was telling you the glucose was negative. I would have suggested reducing the dose further and see what happened.
I would recommend you look into getting some syringes so you can give smaller decreases than 1 unit at a time.
The syringes you will need are these…U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings if possible.
Here is a picture of one of the brands.
upload_2024-4-21_18-15-30.png

I don’t think your kitty has developed insulin resistance. I would say Ivy is bouncing from dropping too low because the dose is too high. Bounces can last for up to 3 days.
If the ketones are still negative I would reduce the dose back down to 2 units and continue to test for them daily.
Because she had 4+ ketones at diagnosis, I would make sure she eats very well all the time and continue to test for ketones. Did the vet comment on the ketones at diagnosis and did he give you any advice as to what to do about them?

Are you giving Ivy snacks of her low carb food during the cycles as well as the 2 main meals? If not I would start to do so. Some vets say only feed twice a day but that is old thinking and not advised today with the newer insulins.

Please do not let the vet increase the insulin any further until you know what the blood glucose is doing.
A fructosamine test will only give you the average of the past 2 weeks BGs. While this is good to diagnose the disease, hometesting with a hand held meter or a libre will tell you exactly what is happening a you move forward.
With the fructosamine test the BGs could be very high and very low and you would not know because you only get one number and that is the average. So it does not tell you if the dose is too high and the kitty is bouncing.

Do you have any honey or high carb food at home which you can give Ivy is she shows symptoms of a hypo? Do you know the symptoms of a hypo? HERE is a link to information about hypos.
I would try and get the libre fitted asap so you can see what is happening.
I hope this has been helpful. Please keep posting so we can help you get this sorted
Bron
 

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Hi Bron, thank you for your support, advice and words of encouragement! I'm from Finland btw! :)

I have just ordered the Libre 2, and will have it fitted by my vet on the next appointment. I hope it stays on long enough for me to get complete stress-free glucose curves to adjust Ivy's dose. And I think I'm ready to try the syringes too, thanks for posting info about them also. I think and hope that Ivy can tolerate the 31G ones. Do you also need to wait like 6 seconds keeping the needle in after injecting Lantus with syringe or is that needed with the pen only?

Luckily Ivy has good appetite now, perhaps too good. She wants to eat double the amount she did before she got diabetes. At first my vet told me to feed her during injection times, but she clarified later during the first diabetes checkup that I can also feed her other times. She said cat blood sugar won't spike the same way as with humans after meal, and Lantus is also long lasting insulin. I haven't changed Ivy's diet a lot as she ate low carb wet foods even before diabetes, but she was overweight which probably caused her to become diabetic. She had lost a lot of weight but luckily has gained a bit back since the diagnosis. I now calculate the carbs of the wet foods i order too to find the best options. I don't remember if the vet commented on the ketones specifically, but I understood already it's because Ivy's diabetes was already quite bad and Ivy was using her own muscle and fat for energy cos she couldn't use the glucose as energy because of the lack of insulin. Luckily she didn't develop DKA yet, but I have a feeling she wasn't far from it.

I have read the hypo guidelines here, and have some liquid cat treats with high carbs and also honey in storage. One of the reasons I kept worrying a lot about Ivy when the vet told me to increase the dose was that I have to go to work after her morning shot and so I can't monitor her during the day for signs of hypo. The vet just told me to leave out food for her during the day. I did get a timed feeder to give her a portion of food when I'm at work.

I understood that fructosamine test isn't good for determining dose adjustments, because like you said it won't tell about the lows and the bouncing and I do think Ivy is having them. :/ Even so I just found it hard to go against my vets advice, because she is a professional and I am not. I will give Ivy 2 units for now and continue monitoring glucose and ketones with urine dipsticks to see the result, until I get the libre 2. And also I'll buy some syringes so I can make more adjustments to dosing. :)
 
Hi Bron, thank you for your support, advice and words of encouragement! I'm from Finland btw! :)

I have just ordered the Libre 2, and will have it fitted by my vet on the next appointment. I hope it stays on long enough for me to get complete stress-free glucose curves to adjust Ivy's dose. And I think I'm ready to try the syringes too, thanks for posting info about them also. I think and hope that Ivy can tolerate the 31G ones. Do you also need to wait like 6 seconds keeping the needle in after injecting Lantus with syringe or is that needed with the pen only?

Luckily Ivy has good appetite now, perhaps too good. She wants to eat double the amount she did before she got diabetes. At first my vet told me to feed her during injection times, but she clarified later during the first diabetes checkup that I can also feed her other times. She said cat blood sugar won't spike the same way as with humans after meal, and Lantus is also long lasting insulin. I haven't changed Ivy's diet a lot as she ate low carb wet foods even before diabetes, but she was overweight which probably caused her to become diabetic. She had lost a lot of weight but luckily has gained a bit back since the diagnosis. I now calculate the carbs of the wet foods i order too to find the best options. I don't remember if the vet commented on the ketones specifically, but I understood already it's because Ivy's diabetes was already quite bad and Ivy was using her own muscle and fat for energy cos she couldn't use the glucose as energy because of the lack of insulin. Luckily she didn't develop DKA yet, but I have a feeling she wasn't far from it.

I have read the hypo guidelines here, and have some liquid cat treats with high carbs and also honey in storage. One of the reasons I kept worrying a lot about Ivy when the vet told me to increase the dose was that I have to go to work after her morning shot and so I can't monitor her during the day for signs of hypo. The vet just told me to leave out food for her during the day. I did get a timed feeder to give her a portion of food when I'm at work.

I understood that fructosamine test isn't good for determining dose adjustments, because like you said it won't tell about the lows and the bouncing and I do think Ivy is having them. :/ Even so I just found it hard to go against my vets advice, because she is a professional and I am not. I will give Ivy 2 units for now and continue monitoring glucose and ketones with urine dipsticks to see the result, until I get the libre 2. And also I'll buy some syringes so I can make more adjustments to dosing. :)

Welcome to the Forum, Sera & Ivy, you are in the right place, you mentioned the Libre2 Monitor and Sensor, when you get the prescription for both make sure you get a PRN prescription, it means is a 1 year refills, the sensors only last 14 days, I had the experience that they fall off and the monitor did not read quite accurate especially when on low BG's, when your Vet places the sensor she will shave the area where is to be placed, learned how to place replace it, you do not need to take Ivy every 14 days and spend the money for that , you re-shave with a razor any new hair in the spot, it is very very simple, always keep an extra on hand, in case it falls off or it stops before the 14 days, it happened to me at the beginning of Corky's diagnosed and I went nuts, if it falls off or stops working they are guaranteed, you call customer service number( number on the back of box, do not throw away the box until you replace it with a new one, you'll need the serial number) they will replace it, you cannot tell them is for your cat though, because they will not replace it. I ended buying at Walmart, the ReliOn Classic monitor and strips, recommended by this Forum and almost all members use it is very inexpensive, and reliable, I test my Corky on the tip of upper ear, there are instructions here on how to test and where to administer the insulin, I give the shot to Corky while he has eaten 1/2 of his food, while eating, doesn't even notices, and I feed him 4 meals daily, I am always home, 2 full main meals before shot, and two small meals in between. Almost all of us use the Fancy Feast wet Pate cans, there is also a DR's food chart of 0-8% carb flavors. You are in the right place here, I wouldn't let your Vet intimidate you, most Vets are not up to date on cats' diabetes, and your baby will probably be going up and down in and out of the Vets office. I always mention to +members that have these issues with their Vets, and again that is me speaking, Since Corky was diagnosed January 2, 2023 and left the hospital, after 8 days, I am yet to take him to a Vet, this Forum has been able to stabilize him, helped me with the food, feeding increase/decrease dose, when Bg's has been dangerously low, they have been here with me until stabilized. I trust their input blindly, especially when it comes to increases or decreases of insulin, we all have a spreadsheet, I test my Corky every 2 hours, you can open the SS and read that everything about our cats' information is there, where all members see, where the experts analyze and can give the correct advice. I myself wish you the best with your Ivy, she is beautiful:bighug:;):cat::cat:
 
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Sera -

I worked full time throughout my cat's diabetes and I was her solo caregiver. This post on using Lantus and working full time may have some helpful suggestions for your consideration.

No disrespect to your vet, but this forum has been around for 25 years. We have had well over 600 cats using Lantus go into remission since we started tracking in 2009. We didn't track the cats using other insulin. I somehow doubt your vet has that amount of experience. We are truly not crazy cat ladies (and men) on the internet.

My understanding is that there is a good Facebook group for using the Libre with cats. I'm tagging one of our members who has more experience with both the Libre and the FB group and can offer specifics. @Larry and Kitties The Libre should give you a clearer sense of how Ivy is responding to insulin.
 
Thank you all for the info about Libre! That facebook group seems really useful, I'll take a closer look. :)

It's nice to know that so many people have managed to treat their sugarkitties well and so many of them have reached remission even. Thanks Sienne for the link to the post: Lantus and working full time, the tips will be helpful for sure.
Also thanks Corky's mom for the compliments to Ivy, she is indeed my beloved beauty and I will do my best for her. :cat:
 
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