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scottmurphy

Member Since 2017
Hello,
I've been visiting this site with interest. It's terrific with a lot of avid and concerned cat lovers.
Thanks in advance.

Background:
Evu--10 year old male (great cat and my good friend).
First had a pancreatitis episode in August (his first ever...health was fine before that).
He was given fluids at the vet and put on one unit of Lansulin. Blood sugar levels were high and went a bit lower. He recovered until a few weeks ago. Same process. He was put on two units of insulin twice a day. They claim his kidneys and liver are fine. However, they could not do an ultrasound on his pancreas citing costs.

Around Wednesday he had a relapse. The catch is that I'm between jobs at the moment and money is extremely tight. I put him on a new drip and gave him an appetite pill...little success.

He's moving around but losing weight. He's also drinking a lot of water. I'd estimate that he's consumed 24 ounces in the past day. While he ate a can and then some yesterday, today I have to force feed him. He does not have a fever.

The vets have been helpful, but given my economic situation at the moment, I'm wondering what I can do at home. Should I reduce insulin? Increase it? Continue to force feed him? Appeal to the vets? Home testing for me has been difficult, simply because I can't get the hang of it yet.

I'd appreciate any feedback and will check in to this site regularly. Thank you
 
Welcome Scottmurphy and Evu!

scottmurphy said:
Home testing for me has been difficult, simply because I can't get the hang of it yet.
Click to expand...

Home testing was hard for all of us at first. But it's one of the most important things we can do - it's the only way to really understand what's happening with our sugar cat's blood glucose. You can't know how well your insulin is working (and whether you should maintain, increase, or decrease it) unless you are able to see how it's affecting the glucose levels.
Perhaps if you let us know what part you're struggling with, we can offer some tips. We all had challenges getting started with it, and have found different ways of adapting. What are you trying, and where are things breaking down for you? We can help you through it!
 
Here's something I wrote up for others that needed help with testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!
 
Thanks for the advice. The hardest problem so far is getting him comfortable with the ear prick, then extracting enough blood to be scooped into strip.
 
You can also test from the large pawpad in the center of a foot. With this method you wrap them up in a towel leaving one back foot accessible. The stick closes quickly and the towel keeps the cat immobile.

Also for pancreatitis flares, I found that a B12 injection helped considerably.
 
Others have offered advice for the diabetes.

For the pancreatitis and the diabetes, it is important they keep eating. Having meds for nausea, vomiting, appetite stimulant and pain are necessary. And maybe needed for quite some time. Extra fluids such as subq can be done at home.
 
Be sure to let us know how you get on. If you can get an Rx for a supply of anti-nausea meds it should make a real difference.

BTW cyproheptadine and ondansetron generic are both human meds; if your vet doesn't carry them you should be able to get the Rx filled at a human pharmacy with a written scrip from your vet.


Mogs
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Thank you for your replies. This is an update on my cat Evu.

He's been at the vet for two days now...and we're now into the third day.

I'll talk about the first two full days.
On Monday, his dose of Lantus was 1ml. His blood reading was initially high, then reduced over the course of the day from 24 to 11 (at around 7pm).
At that point, the vet suggested I take him home to watch him and NOT give him an insulin dose. He was also given a shot of B-12 on Monday. I think he was on a drip as well, but I'm not sure.

I returned to the vet yesterday morning, when his blood level was high off the charts. At 3:15 it was 21.6. at 5:15 it was at 26.

They talked about upping the dose to two ml units (twice a day) for today. A blood test has not been given.

Aside from the high reading, my other concern is his weight, which is dropping by the day. They also plan to do a scan today to make sure he doesn't have a tumor on his pancreas.

At the moment, my cat is alert and has no fever...and is not vomiting. He's just not really eating that much. There's also been preliminary talk by the vets of putting him to sleep if his blood sugar can't get under control.

But I think, surely, there must be a way to get a handle on this. I welcome advice.

Thank you.
 
Oh diabetes can be treated. YOU can get the glucose under control. Home testing is the way and posting here for advice. Absolutely no reason to put to sleep because of diabetes. Another thing is Lantus is best when given every 12 hrs. Your vet said to skip a dose then wanted to double it. It's not how it's done. Lantus needs to build a depot up. It takes a couple of days. The first week you hold the dose then make changes of 0.25u at a time.

You might want to call around to other vets and see what their views are.
 
The latest on Evu:

Yesterday his blood sugar was ultra high in the morning and went to 13 by the evening. He ate full meals overnight, then had diarrhea this morning. His blood sugar is again high. He's still at the vets. I'm assuming he's on 2 units of Lantus today. Anyone have any advice?
 
Here are today's readings for Evu, starting at 11am (with about two hours intervals):
HI, HI, 24.0, 22.2, 17.2, 19.4. He is receiving two units of Lantus, twice a day.
He is also on an antibiotic today for diarrhea (meta...).

He was at 5.5 kilos three months ago. He is now down to 3.5kilos. I would appreciate any guidance. Thanks...
 
Hi Scott,

scottmurphy said:
In their defence, they wanted to skip a dose to avoid a hypoglycemic episode....is there merit to that argument?
Click to expand...

Member @Meya14 has posted before about insulin administration problems with BG regulation in underweight cats. I've tagged her here in the hope that she may be online later and perhaps give you some more specific advice. In the meantime, here are excerpts from two of her posts on treatment recommendations for 'brittle' diabetics which I hope may be of help to you and your vets:

Meya14 said:
Too low calorie intake: You should look at a cat body chart and see where your cat falls as far as weight. Basically, if you can see the outline of the shoulder blades, your cat may be too thin. Any cat that is on the thin side and having issues with BS control or DKA should -NEVER- be restricted in the amount of food they eat. Low body weight makes "brittle diabetes" more of an issue, makes BS harder to control, and predisposes to illness. Also, not all calories are processed the same way, proteins and fats have a complex metabolism that relies on several enzymes that may not be present in certain illnesses. Carbs are a much simpler pathway, and may allow faster weight gain and glucose stabilization in skinny cats. Ultra-low carb diets in skinny cats may lead to DKA if prone.
Click to expand...

Link to original post:

http://www.felinediabetes.com/FDMB/threads/cat-not-improving.169098/#post-1836148

Meya14 said:
As far as the "insulin not working" part - When there are no fat stores left in a diabetic the liver has a very hard time compensating for insulin doses. This in humans is referred to as "brittle" diabetes. What happens is that the blood sugars go very high, then insulin is given, then you get dangerously low sugars, and back and forth. The solution is actually to increase the amount of carbs you are feeding, so that you can give larger insulin doses - this will allow her to gain weight faster and for her sugars to be less "brittle". Once she is more stable, slowly reduce the carbs in the food, and monitor weight closely. The only way she'll gain weight and be healthier is with larger insulin doses than what she's been getting and that's going to mean increasing intake.

DKA happens when the body either isn't getting enough calories (in starvation or chronic illness) or not enough insulin to allow for food to be used as energy and stored as fat. The body starts burning fat instead as an emergency fuel, but over a few days, the biproducts of this, ketones, build up in the blood and cause problems.

So, it's good that she's eating by herself and sounds like she is in good hands at the current vet. When she comes out, if it were my cat, I would aim for about 20% carb food - wet or dry (other's will disagree, I know) and increase insulin to match the intake until she gains some weight. Because she can't compensate when she goes low, you need the extra carbs from the diet to even out the blood sugar swings.
Click to expand...

Link to original post:

http://www.felinediabetes.com/FDMB/threads/vets-cant-stabilize-glucose-levels.165787/#post-1790343

[Emphasis mine]

If Evu's dose was only increased to 2IU Lantus twice a day yesterday the depot will still be filling; from the time the increased dose is first given it typically takes about 3 days before you'll see the full effect of the 2 IU dose. I'm tagging member @Wendy&Neko, again in the hope that she will be online later and may be able to suggest something to help with adjusting the dose on the insulin side of things to get numbers into a better range and also allow for feeding of a higher carb food to try to help Evu start regaining weight.

I'm reposting the link to the IDEXX guidelines again below. It contains information on all the treatments that can help with pancreatitis and it may help you in your discussions with the vets:

IDEXX pancreatitis treatment guidelines

I suggest asking your vets about the brittle diabetes thing as soon as possible because it may help with Evu's treatment.

It's a very positive thing that Evu is eating by himself. If the vets can keep food and fluids going in it will help treatment greatly (with anti-nausea and appetite stimulant meds if required).


Mogs
.
 
Mogs tagged me for dosing suggestions, but first a comment. My Neko was "very difficult to regulate". My vet never mentioned PTS because she saw enough of clients doing that when they got the diabetes diagnosis and she's rather work with them to treat if they were willing to do so. My "difficult" girl had another 5 years on insulin, most of them good days. Neko was complicated (two high dose conditions) but the vet learned with me. The most important thing that helped me help her was learning how to home test. Keep trying when he comes home. Low carb or pure meat treats as rewards really helps. Soon enough you'll get purrs through testing or they'll lead you to the testing spot when it's time for that test before dinner and the shot.

OK - onto dose. What type of meter is your vet testing with? If it's a pet meter or human meter, the blood sugar numbers you've given us will be a bit different on those two meters. Was Evu on one unit up until he went into the vets? If one unit (not 1 ml) of Lantus got Evu down to 11 (198), that's a pretty decent dose. Once you are home testing, that's a very shootable number with Lantus. We tell people new to testing that it's OK to shoot everything over 200 (11.1) and once they can monitor properly, people gradually lower that number. A cats blood sugars go a lot flatter when you shoot Lantus into a lower number.

The jump from 1 unit (which we know got him down to 11) to 2 units was probably too big a jump. On this board, we typically increase by 0.5 or 0.25 units. That little bit of insulin can make a big difference. Do you have syringes with 1/2 unit markings on them?
 
Thank you for answering my queries. Evu was on two units until he went back to the vets. He has been on two units for about three weeks (before that...1 unit). I use U-100 insulin needles. I believe they are testing with a pet meter.
 
Underweight cats are much harder to regulate, and if there is inflammation in the pancreas, it might be kicking out insulin at times, and not at others. This can lead to numbers being all over the place. The best thing you can do right now is to regularly test the blood sugar. After a few days of testing, it will be easier to see patterns and what might potentially help with regulating. With underweight kitties, too low carbs can make it harder to give enough insulin, so a medium carb food or some higher carb at times will help with weight gain, and this might mean adjusting insulin. Weight loss can lead to ketoacidosis which can make a cat very sick, so it's important you test for this as well when your cat gets home. Ketone urine sticks are available for about $10 at almost every pharmacy and are easy to use.

It takes a while to get regulated - my cat was in the 500 BS for almost the first few months. Not good, but eventually he even went into remission for a while. PTS wouldn't be my first option, but vets often encounter people who don't have the time, money, or desire to treat their cats for their disease.
 
Evu is down to 3 tonight and has had a cortisone shot. He's eating and quite happy. We'll see what the coming days bring...
 
scottmurphy said:
Evu is down to 3 tonight and has had a cortisone shot. He's eating and quite happy. We'll see what the coming days bring...
Click to expand...
Hi-- sorry, can you clarify? Is that "3" a mmol/L blood glucose reading? That is a great number (and he's clearly feeling pretty good on it!), but it's on the border of hypoglycemic for a human meter and below that if a pet meter, so if there's insulin in the mix you have to be very very careful at this level.

When was his last (insulin) shot, and how many units?
 
Hello all...
I wanted to check in here as it's after hours at the vets. Evu has been home and fine with me all month. He has gained some weight and is eating regularly. He's on two ML of insulin twice a day. About midday today however, he started vomiting and has continued periodically. He also has a touch of diarrhea. It could be something he ate -- but I'm wondering what I should do in the next 12-24 hours. He's drinking water and his appetite is obviously good....a bit lethargic though. What should I watch for....thanks...
 
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