New to Forum - Could use some help!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lacy, Aug 6, 2020.

  1. Lacy

    Lacy Member

    Joined:
    Aug 3, 2020
    Hi everyone. My name is Lacy and my cat is Saff (short for Sapphire). We've been on a rollercoaster since she was diagnosed in March. I'll give as much information as I can here while I work on getting the spreadsheet together. I'd love to hear thoughts on our experience so far.

    We adopted Saff in 11/2018 as a rescue. There was no way to determine her age at the time. Two vets estimated 6 years old, another vet suspected she was closer to 10 years old at the time. So as of right now, we can only assume she is approximately 7.5-11.5 years old. She was very overweight when we got her and was tested for thyroid issues and diabetes, but everything came back negative. She does have Herpes which causes her to have some sneezing spells, but she has only had one upper respiratory infection that required antibiotics in the 1.5 years that we've had her. When she gets "sneezy" we give her a supplement, Viralys, with her evening meal for a few days until she recovers. She also has alopecia. She had many bald spots when we got her, but her hair growth has fully recovered at this point. She wasn't given any specific treatment for this. We believe it was stress induced and once she settled in with her new family, she recovered.

    In early March 2020, we began to notice that Saff was drinking a lot, seemed significantly hungrier than usual, but also began losing weight quickly. Which didn't make any sense to us. She was eating and drinking more, but losing weight at the same time. Since she was so fluffy before, she looked healthier with the weight loss for a short period, but eventually we got worried. We got her to the vet and she was diagnosed with diabetes. They also tested for thyroid issues again and nothing came up.

    Saff's glucose numbers at the time were in the upper 400s. We immediately began treatment with Glargine 1 unit twice daily. We also got a Freestyle Libre to check her numbers throughout the day. It only lasted a week, but numbers didn't move out of the 400s. Each week we would do a recheck with the vet and the dose would be upped slowly by 1 unit. We also changed her diet to Purina DM wet, 1 can in the morning, 1 can in the evening. After many weeks, Saff was up to taking 5 units of Glargine twice daily with no change in her numbers; they were consistently in the 400s. She was struggling to get urine inside the litter box, but she was close to it. She gained some weight after losing so much and was in a healthy weight range. She looked much better, but was still starving and drinking so much.

    The vet decided to take another approach after little to no success with Glargine. We stopped the Glargine and used no insulin for 3 days. She then started Vetsulin 1 unit twice daily. Her numbers got into the 500s and she started having problems with incontinence. She was no longer even near the litter box and she lost a full pound. Last week the vet put her dose to 3 units of Vetsulin twice daily. Her last checkin was yesterday and she clocked in at 422. Since the increase, she has been making it to the litter box again, so that is an improvement. But, still starving, still thirsty.



    Questions -

    Testing. We used the Freestlye Libre twice. It is supposed to last for a 2 week period, but we only got it to work for 1 week each time. I recently purchased a human glucose meter, CVS Advanced ProHealth. I had the vet test it yesterday against their own testing and it was almost 100 points off. Their reading was 422, the CVS meter was 335. What are the at-home monitors that seem to work best for you? I would rather test her at home than bring her to the vet once a week for their testing.

    Routine. We feed Saff twice at day at the Vets recommendation. Once at 9:00am, once at 5:00pm. We originally gave insulin about 15-30 minutes after her meals, but switched to doing every 12 hours - 9:30am and 9:30pm. Is this the route we should take? The vet mentioned we could give her a half can snack or dry food snack at lunchtime. We don't give her hard food since she's never done well with it, but will sometimes give her a mid-day snack. I'm unsure if this is helpful or not.

    Any additional advice would be great. I just don't know what to do to help her. We've tried everything the Vet has told us to do without much luck. The only progress we've seen has been with her weight. Her numbers just won't come down. Hopefully we will see more success with Vetsulin.
     
  2. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    WELCOME TO FDMB We are so glad you found us, Poor Saff sigh shes been through it hasnt she? Well today is the day for changes. We will do our darnedest to help you help your BEAUTIFUL Saffy! She is quite pretty. :bighug:

    Theres a wealth of information here with good people that WANT to help.
    I am not a expert when it comes to dosing advice. I havent had a diabetic kitty in MANY years. BUT there are MANY here that are!
    Hold on for more replies and again welcome to the best site on this planet to learn everything you thought you'd NEVER have to know.
    Saff has found a safe place at FDMB and you are now a member of this loving and caring community.
    here are the basics:
    New? How You Can Help Us Help You!
     
    Panic likes this.
  3. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Hello Lacy and Saff! Welcome to FDMB! :) I am going to try to answer all of your questions without overwhelming you, okay? If you need clarification on anything just ask.

    Insulin:
    Glargine (Lantus) is an excellent choice for cats. Number #1 actually. Cats do extremely well on it. Vetsulin, while some members here use it for one reason or another, really isn't recommended. It's for dogs, the duration is too short in cats due to their fast metabolism. I would consider switching back to the Lantus.

    Dosage:
    In cats we recommend only increase by 0.25 units at a time. 1 full unit is way too fast for kitties (kitties are so tiny - generally you won't see a cat needing more than 3 units unless there's a high-dose condition involved. Not all the time, but usually.) and it's possible that Saff needed more than 1 unit, but not quite 2. Bypassing the ideal dose like that will make things worse, as you're seeing now.

    Food:
    We use low-carb food. Purina DM wet does technically count as low-carb (10%) but it's on the higher end. We try for anything below 10%, ideally under 5%. Common food that fits this description is Fancy Feast Classics and Friskies Pate. Tons of other options though! The dry food snack only worsens Saff's BG. We also feed multiple times a day, anywhere from 4-10 meals! Bigger meals at breakfast/dinner before shot-time, and then small snacks of food throughout the day (and night! we use autofeeders to achieve this). It's better for all cats to do this actually, but especially diabetics. It's easier on the pancreas.

    Your Questions:
    Some people here have used the Libre, but like you said, it usually falls off too soon to use reliably. Human meters like the one you bought from CVS are perfectly fine. Be aware that there is meter varience (up to 20%) so a 335 and 422 are very close to the same number. Also be aware that human meters run slightly lower than pet meters like your vet has. The larger the number, the higher the discrepancy. The lower the number, the more accurate. This is still useful for us, because 1) pet meter strips are outrageously expensive and 2) the high numbers don't matter. If it's too high it's too high, doesn't matter if it's 400 or 450. and 3) the low numbers are what matter and that's what works. And accuracy in low numbers is more important than accuracy in high numbers. If you are in the US which I suspect you are, most of us use the ReliOn Prime from Walmart, it has the cheapest test strips at $18 for 100. Any human meter works though, we just stick with the cheapest because we go through a lot. Testing at home is a great plan - tests at the vet are stressful, and stress falsely increases blood sugar. Then your vet judges their BG based on false numbers ... etc.

    As stated above, we feed multiple meals a day. Cats are grazers, they do not do well on just two meals a day like dogs. It's also vital for cats - especially on fast-acting insulin like Vetsulin - to have food access. Vetsulin drops the BG hard and fast - usually about an hour or two after injection. They need a snack at that time to steer the drop. A cat with low BG will also seek out food, and if it's unavailable you run the risk of hypoglycemia. I do recommend as long as Saff is on Vetsulin to give her plenty of snacks (of her regular food, not dry) before her nadir, or when her BG is at it's lowest. If you have any numbers from your Libre indicating when she's at her lowest on Vetsulin (because insulins give different nadirs) you can be sure to offer food prior to this. And then normally you give very little/no food once they start going back up, because you don't want to "use up" the insulin with food too early. Also with Vetsulin you want to test, feed, wait 20-30 minutes, and then give insulin. Because Vetsulin hits fast, you need food on board first, unlike Lantus where you can test, feed, shoot within 10 minutes.

    Don't despair! It's a common story for new members to come here with stories exactly like yours and Saff's with the vet unable to get the numbers regulated. They just don't have the education and experience to help unfortunately.
     
    Last edited: Aug 6, 2020
  4. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Oops sorry I added a Y to Saff. :oops:
     
  5. Lacy

    Lacy Member

    Joined:
    Aug 3, 2020
    Totally fine! We call her many things. Saff, Saffy, Sassafrass, Sapphire. She answers to anything that starts with an S at this point.

    And thank you for the warm welcome!
     
  6. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    hahahahaha Sassafrass! I LOVE IT! she sure is a cutie :bighug:

    What I lack in knowledge, I make up in support! ;):coffee:
     
  7. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    At 50 on a human meter you take action to bring the numbers up.
    At 68 on a pet meter you take action to bring the numbers up.

    If she had no litter box problems with Lantus, it could be the Vetsulin that is the problem. It drops a cat hard and fast and she might not feel the best. That is why, if staying with Vetsulin, you should feed a couple of snacks during the first half of the cycle.

    It could be that she needs a high dose. It could be that the best dose for her was missing completely.

    With numbers so high, ketones are a worry. Ketones are very serious and expensive. The recipe for ketones is: not enough insulin + not enough food + something else going on.
    You can read about ketones here:
    Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

    You may want to go to a drug store and pick up some ketostixs or keto-diastix to check her urine in the litter box.

    You've come to the best place you never thought you would be for Saffy (sorry, I'm a big fan of Absolutely Fabulous). There is a wealth of information and 24/7 lived experience on this forum. We can help you keep Saffy safe.
     
  8. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Hi there! Not much to add to what Elizabeth (@Panic) and Jeanne (@jt and trouble (GA)) [ETA and @Red & Rover (GA) , who posted simultaneous with me, making the points I made below, but more concisely ;)] have already said.

    One thing that I don't think was mentioned, although that was a rapid increase in dose, it doesn't necessarily mean that it was too much insulin. There are several high-dose conditions that can lead to (in some cases) incredibly high insulin needs. Once you get home testing and your spreadsheet up and running we'll have a better idea of that-- the basic issue is, were there any occasional low numbers mixed in with the highs? Sounds like there weren't on the 1U when you had the Libre, but the other doses are an open question because you only had the weekly vet checks to go by (please correct me if I'm wrong and you have more home data than that).

    If you still have the Lantus, I really would encourage you to consider switching back. Most cats do much better on Lantus than Vetsulin, which tends to be a pretty blunt instrument. A lot of cats just seem to feel worse overall on that insulin, separate from any effects on their BG.
     
  9. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    Welcome Lacy and Staff!!!

    good for you for adopting a rescue! :bighug::bighug::bighug:

    Panic already covered all my thoughts very well. I just want to add a few things.

    I’m glad you’re home testing and I do use Walmart’s Relion and really love it. The test strips are very easy to use. They have a chip at the end that literally sucks in the blood and you can visually see when the chip is full and it’s ready to give you a reading.

    as far as feeding Panic is 110% right. I want to add that I suspect Staff needs more food. Do you know her ideal weight? If you don’t, you can ask your vet. The rule of thumb is ideal weight x 20 to get her calorie intake. Minnie is 16 so that x 20 means that she should be getting a little over 300 calories a day. Also please keep in mind that diabetic cats cannot process all the nutrients in the food efficiently, so they eat but are still hungry and lose weight. They also burn calories just by peeing since there’s sugar in their urine. You may want to feed her even more that the number you get at first until she gains some weight back and is at her ideal weight

    lastly, I second going back to a gentler long lasting insulin. I think your vet is treating Staff as if she were a dog. I say that because of the eating twice a day, which works better for dogs not cats, and Vetsulin which is also called caninsulin since it was designed for canines aka dogs. I’d strongly suggest you go back to something like Lantus or prozync and manage the dose increase/decrease by .25 unit rather than full units like everyone else already said above!

    welcome again and she’s a cutie pie! Let’s get her regulated :bighug::bighug::bighug:
     
    jt and trouble (GA) likes this.
  10. Lacy

    Lacy Member

    Joined:
    Aug 3, 2020



    Ok. First, thank you so much for this information.

    My questions is if I should search for a new Vet? It doesn't seem like she's able to get Saff's numbers under control. She said she's had experience with many diabetic cats and told me initially that she felt like Saff would go into remission within about 2 weeks. Obviously, 5 months later, that hasn't happened.

    I ask this because she's never changed a dose by 0.25 units. It's always been a full unit or more. I'm also not even sure that she would agree to go back to the Glargine, since in her eyes, it didn't work.

    On the food - are you telling me that this $2/can Purina DM is not as good as a Fancy Feast $0.50 can??? I looked it up, and you are absolutely right. I'm just having a moment to process how much money I've spent on food that wasn't even the best choice. Also, at my Vet's recommendation. I chose not to use the dry she recommended that I just looked up that has an 18% carb content! I've got an unopened $50 bag of dry food.

    And thank you for the testing answers. It's the part I feel most confused about. The Vet hasn't explained testing curves or anything to me. The Libre numbers I have are from Glargine days and they all stayed within the 400 range. Maybe dropping once to a high 300 and once into a low 500.
     
  11. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    Oh and thanks for having your signature set up already!
     
  12. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    If you think the vet won’t switch insulin, I would recommend looking for another vet yes. I’ve been through 3 and I’m on the 4th now. As for the full unit part, unfortunately most vets control dose that way. I have yet to meet one that would suggest the .25 adjustments we do here. Vets spend very little time on feline diabetes in vet school while the member here have been studying only that for years. It’s mind blowing how much I didn’t know until I found this site and now I feel I could give lectures on it. You will soon too! :D

    sadly, yes. The “special” food vets recommend has nothing special about it other than the price and clever marketing. It’s not even human grade quality.
     
  13. Lacy

    Lacy Member

    Joined:
    Aug 3, 2020

    The Vet only ever recommended coming in once a week for a glucose test. We go in at least 6 hours after her morning dose and before her evening dose. Her numbers have consistently been in the 400s every Vet visit. (We saw a high 300 and a low 500 once each on the Libre). The Vet did tell me initially about the signs to look for with low numbers. However, we've never gotten close. We had the Libre in the Glargine days, not Vetsulin.
     
  14. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    This is unacceptable. You wouldnt shoot insulin into a child without testing that child first. My hubby is diabetic and he would NEVER shoot insulin without testing his blood sugar..(Mostly because I would kill him!) We've had 2 hypo incidents and I cant afford the paramedic bills!):p
     
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  15. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Yes, good catch. I just threw a low number out for example, not thinking about 50 being comparable to 68 on the meters. :confused: Basically Lacy, lows numbers are important to know about - high is just high, you don't change how you handle it.

    Yes to all of this - new diabetic cats usually need to eat more in general anyway. My cat was eating double for a while, but just depends on the cat.
    Like Ale said, you're probably not going to find a vet who knows much about feline diabetes, alas! You need a vet who's going to work with you and let you be in charge of Saffy's treatment. My vet prescribed Purina DM dry, bumped my girl up to 5 units of NPH (worse than Vetsulin) and then started discussing shooting 3 times a DAY. She had no idea what she was doing! Luckily for Panic I was doing research and told my vet, I am switching her food, I want a better insulin, I am doing the testing myself. And my vet basically put her hands in the air and let me do what I wanted. Didn't argue, didn't give advice, just looked at the spreadsheets I sent in every week.I basically just kept her in the loop in exchange for prescription access. :woot: I still don't think she was a good choice for Panic in the end, but she let me run the show and that's what Panic needed. If your current vet isn't willing to work with you about food/insulin changes, yes I would ditch. You hold the syringe, you pay for the food, you are in charge!
    Crazy right?? I would take that unopened bag and return it, you said she doesn't care for it anyway so just tell them that. And don't let a vet convince you otherwise - my vet tried to send my can of Fancy Feast back out and said she wouldn't get regulated on it and I told her that Dr. Lisa Pierson's food chart shows it is BETTER quality than Purina DM. She made some phone calls who confirmed what I said and relented.
    I don't think any vets do a good job explaining curves, when they do decide to explain them. :rolleyes: It's not unusual but it is discouraging when the doctor doesn't know what they're talking about!

    Once you get your spreadsheet set up we can take a peek and start discussing dosage plans! :)
     
  16. Lacy

    Lacy Member

    Joined:
    Aug 3, 2020
    I've got 2 special needs children, and this is basically what I've had to do for them too. I've made behavior charts and done my own research and found doctors and school districts that would listen to me and essentially do what I asked. My kids are in a great place now for it. I didn't realize I would have to advocate for my cat too! Luckily (or maybe unluckily) I am incredibly experienced in getting firm with medical professionals. It looks like it's going to be a feline diabetes research night for me!
     
  17. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    I say this here all the time. We have to advocate for our sugar babies just like we would for children. And the more you know, the more leverage you have to back you up!
     
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