New to the forum, kitty not doing so well....

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erin_mc

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Hello,

I have been a reader on this website ever since my cat was diagnosed with diabetes in August 2010, but this is the first time I have thought to post because I need some help. I have looked through the FAQs and health forum to see if there is anything that sounds like it could help, but no such luck.

I have 3 cats, of various ages, but it is my oldest one, Black B@stard that is seeming to have a series of health issues. He is 10 years old, black domestic longhair (neutered) male, overweight, and strictly an indoor cat. My company sent me away for 2 weeks in July 2010, and while I was gone Black B developed diabetes.I got him to the vets as soon as I got home, and the vet started him on insulin. Everything seemed to be better, he was getting his insulin on schedule, controlled diet, had even lost almost 5lbs. November 2010 he started excessively, and urinating constantly, I couldnt even keep up with keeping the litter boxes clean, they would turn into cement within two days. I noticed his back legs were starting to slip out, troubles walking, he never wanted to leave the side of the water dish, and he started to vomit more often, and was having accidents around the house. I suspected signs of kidney failure and neuropathy, and took him to the vet. The vet said he had neither kidney failure or neuropathy, but had an infection, and did some bloodwork. He said the blood sugar level was better then it was in the summer, but not quite where it needed to be. Black B ended up being on penicillan (Clovamox?) for 4 weeks, and he stopped having accidents around the house, but the excessive drinking and urination did not go away, and his back legs have gotten worse and worse. I have a water dish, a food bowl and little box upstairs for him all within 20 steps, he pretty much didn't leave the upper level of the house anymore. Approx two weeks ago I bought some methylcobalamin and have been grinding up the pills and mixing it into his water, and his back legs seem a wee bit better, he comes downstairs once in awhile. I put just a pinch into the water since the pills I bought are 1000mg. He is starting to urinate almost anywhere now, in the closets, laundry baskets, the welcome mat.... I dont know if he is incontinent and cant control his bladder anymore, or if its due to the excessive drinking. He drinks between 750 - 1000ml of water a day (1.5 to 2 bottles of water) gets fed twice daily, 1/2 cup of food each time, food that is recommended by the vet, and gets insulin twice a day same time he gets fed, and is up to 5 units each time.

I am frustrated with where things are. In the last 7 months, since his diagnosis, I have spent at least $1000 trying to treat this, and he does not seem to be getting better. I hate to say it, but he is starting to become a burden... coming home to find out he has peed in the laundry basket when there is a litter box within kitty steps makes things very stressful. My life revolves around insulin shots, and my company is sending me away for 4 days next month, and I am already stressed about finding someone to come and give him his shots twice a day. He is one of the nicest, most mellow cats I have ever had, and seems to still be loving life, doesnt seem to be in any pain and is content. I dont know what treatment to pursue anymore, or what quality of life he is starting to have. He sleeps on the water dish now.

Has anyone else had a cat go through this? Any suggestions for treatment? Any comments are welcome, and anything else you would like to know I will do my best to answer. Thank you everyone in advance!!
 
Erin, you say you've been lurking and reading....if so, you should know the answer... (I say this not harshly...) you need to be testing blood glucose levels at home. You are going by symptoms and tests done at the vet clinic. You've got a cat who is getting sicker and the one tool you aren't doing is testing.

Until you are testing, you've no clue how that insulin is really working. 5 units of lantus twice a day is a lot, so you need to really see how he is responding to those shots. and once you do, you'll have a better idea. You also need to tell us if there has been recent bloodwork done

We can help, we really can, we just need more info and so do you

Jen
 
What kind of insulin are you giving and what dose? Do you test his blood glucose levels at home? What kind of food do you feed?

He sounds like a diabetic cat that is unregulated. So he is hungry and peeing everywhere and may also have neuropathy. All these symptoms are normal for a diabetic cat whose insulin needs are not being met.

We have a protocol that has worked for thousands of cats - gotten them regulated and sometimes off insulin all together. We fed wet lo carb. We test our cats at home so we know that it is safe to give the insulin and we know how the insulin is working. We have lots of possible food recommendations. We have taught lots of people how to hometest over the internet and we would be happy to teach you.

My story is that my vet sent us home with too much insulin and no information on food or hometesting. I came here, changed the food, started hometesting and then immediately changed the dose. Although every cat is different, Oliver was off insulin in six months, at his ideal weight and looking and feeling better than ever.

It is discouraging when they are so sick but this is a very manageable disease and we'd love to help you help your kitty.
 
He is on caninsulin, this is the same insulin he has been on since vet diagnosed him. I cant remember what exactly the food is he is on, I throw the bag away after I fill the giant food container. Its one I can only buy at the vets, some kind of an MD formula? I had all 3 cats eating Blue Buffalo Wilderness no carb food until November, and when he went into the vets in Nov 2010, the vet disagreed with the no carb diet. My research (mostly from this site) made low/no carb diet seem to be the way to go, but my vet believes in the high fibre diet. The cats eat mostly dry food, they dont like wet food. Wet food makes one cat vomit uncontrollably, or they will refuse to eat and leave the food until it hardens and fossilizes. I tried switching them entirely to wet food in the beginning, and they seriously have more willpower then I do, and will go on hunger strike. I have not been doing blood testing at home, have no idea where to start, especially since it doesnt seem like his diabeties has come under control.

I live in a small city, and there is a shortage of vets that specialize in domestic pets, and there doesnt seem to be any here that have a lot of experience with diabeties.
 
Are you in the US or Canada? Canninsulin (or Vetsulin as it is called in the US) has been recalled because of quality control problems.

Vetsulin issues No vetsulin available in US: http://www.fda.gov/AnimalVeterinary/New ... 242368.htm

There are certainly better insulins. Canninsulin tends to be harsh, taking the cat fast and then not lasting until the next shot is due. Most people here use Lantus, Levemir or PZI. All are milder insulins and last a full 12 hour cycle.

If you are in Europe, Canninsulin seems to be the only thing vets will prescribe, but it does seem to be of better quality than the Canninsulin here.

Here is some information on hometesting. A good beginning site: Newbie hometesting site and video: Video for hometesting

And everything you will need to get started:


A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 25-26 gauge is good. Any brand will work.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

It is sometimes hard to get blood the first time, but we all have tricks that helped us. So come on and ask for help.

Once you know what range his blood glucose levels are in, you can start to get a handle on this whole thing.
 
I am in Canada, and I think I will be asking the vet to switch his insulin if Caninsulin has issues.

I will look into getting a glucometer as soon as possible, and see if we can test at home and get some readings. Have you had issues switching insulins? I'm wondering if I can get a different type, and if he should go into the vets for a check up if I would like to switch him to something new.
 
You can just switch over - no problem. But I would get the testing down first so you can know from the beginning how he is doing. If your canninsulin has been ineffective for months, it is possible that you are way over his ideal dose. With an insulin that works, you will want to be cautious about your first dose.

I don't know how well you like your vet, but he/she should have received all the warnings on Canninsulin and should have changed you a year ago to a better insulin. And if he/she didn't tell you about hometesting, they have done you a real disservice.

We have lots of Canadian members who can help you find out where to buy supplies and insulin at the best prices. If you don't get replies tonight, come on in the morning and check.
 
Go to Shoppers and ask which meter is free with the purchase of 100 strips - there's usually one! Or check WalMart - I have seen the One Touch for under $10, and that's a great deal.

You really need to ditch that dry food. (But don't do anything before you learn to hometest since switching food can cause the sugars to drop.) If you still want to feed the food your vet insists on (sounds like Hills m/d), then at least go for the canned version. It is a low carb food, but has low quality ingredients, and can be expensive, but at least it contains the moisture that a cat needs for kidney health- especially a diabetic!

Your vet is adhering to old school teaching - the high fibre route is no longer the way to go. Good protein, low carb is. Janet and Binky's food charts will show you a lot of alternatives if he gets tired of the same food (and a lot of cats grow to hate it quite fast!). Regular ol' Fancy Feast or Friskies has lots of better quality, low carb canned food, for example.

Please read Dr. Lisa's site about feline nutrition, and send the link to your vet, as well : http://www.catinfo.org/

Pop into a pharmacy and get a bottle of ketostix. Test the urine daily while regulating. This monitors for a very dangerous diabetic condition called DKA, and can give you early warning before it progresses. Some info on DKA: http://petdiabetes.wikia.com/wiki/Ketoacidosis

Your vet may be interested in reading this. The Canadian Veterinary Assoc has a site for information for pet owners. Their official advice for treatment of feline diabetes is to hometest. http://www.animalhealthcare.ca/contents ... s=diabetes

Recently, a home blood glucose monitoring initiative was reported in the literature that provided a practical method for owners to check blood sugar at home by doing a small prick in the ear and using a low volume automated glucose meter. This is a big step forward in feline diabetes management because it is well known that while in hospital for monitoring, cats tend to not eat well and are stressed, both of which can interfere with blood sugar assessment. It is important to have a blood glucose curve done after insulin therapy is begun so that the veterinarian can check how quickly a particular cat processes the insulin type prescribed. Cats have a very wide spectrum of time that it takes to metabolize the insulin, and this test is very important for the safety of long-term insulin therapy.
Click to expand...

There are lots of Canucks on this board. If you can tell us where you are, one of us may be close enough to give you a hand.

Glad you finally posted!
 
You cant figure this out on your own, you need to ask for help, and you will get it :) My cat just passed away, I participate on another forum, but come around here ever now and again. I have some supplies that may help you get going.

Are you anywhere near Ottawa?
 
Its a sad day for me today. I called the vet hoping to make an appointment for Black B, because today he was worse then I have ever seen him. I am not a religious person, but today Black B gave me a sign that he wants to go, that he doesnt want to live with his life the way it is. If I felt there was hope and a good quality of life in the future by pursuing different treatment I would be all over it. We are going to have a couple of good days together before his send off to kitty heaven. I wish I had come on to the forums sooner, there are a lot of things I wish I would have done. One thing I am confused about is why declined the way he did when we are treating him, why didnt catching his diabetes as soon as possible and getting treatment immediately save him?
 
If you are sure, then we are here to support you.

But I have to tell you, that cats who are newly diagnosed often look like pure hell, and they bounce back quite quickly.

it is totally your decision and we support you

Jen
 
He isnt newly diagnosed, We have been treating him since August 2010, he has been in the vets constantly, has been getting better medical care then I do. He has taken a very swift turn for the worst. This has been a very hard decision to make, but made a bit easier by the message he conveyed to me that he wants to go.
 
Good news.... the trip to kitty heaven has been postponed!

On Wednesday he had perked up a lot, and got an opportunity to talk to the vet. He thinks he is insulin resistant, and figured we should try switching him to a different type of insulin. I have picked up some Lantus pens, and I am hoping to notice change quickly! The vet is going to get me some 'confetti' that you put in the litter box, and that will help us monitor his blood sugar levels. He has also said I can use the glucometer from the vets office if I want to do home testing. I am going to switch him back to the no/low carb food as well, and try to see if I can convince him to like wet food.

So he has a bit of a new leash on life, wish us luck!

I need to do some research on the Lantus, the dosages, to see if I can get the next prescription cheaper, and replacement tips. I will search the forum and see what I can find
 
Erin, I am glad you are back and that your kitty is still with us!

Question...did you ever test blood glucose levels at home? What insulin are you using, what dose, etc.??? I ask because unless you started at 1 unit twice a day and moved up by 0.5 units at a time after testing at home, I doubt your cat is insulin resistant. I'm glad you are going with lantus, but unless you test at home, you're bound to repeat what happened ...testing at the clinic does not replicate home, and you need to treat your cat like human diabetics treat themselves...

Come on back with more info, ok?

Jen
 
I just re-read your last post

You do not monitor via urine glucose levels! That is the most imprecise way possible. Please, you need to let us help you learn to test BLOOD GLUCOSE levels

Jen
 
This is wonderful news. But please let us teach you how to test blood glucose levels at home. The urine test will tell you want is happening after the urine has made its way all through your cat's body. The blood glucose testing will tell you what it is happening right this minute. Which is what you need to know before giving insulin.
 
Erin,
I'm so glad your kitty is getting a new lease on life. And, I'm glad to hear that your vet is switching him to Lantus which is a good insulin for cats, and that he is open to home testing your cat, and seems to be helpful. You can do this, and we will help you.
:YMHUG:
 
Erin, you do not need your vet's permission to test blood glucose levels at home. You can buy a glucometer at a pharmacy and start testing right away. BTW, I tried the confetti stuff years ago and it really wasn't worth it.
 
I have a question/concern about the switch to Lantus. When he was on caninsulin, he was on 5 units, 2x a day. The vet said with the Lantus pen to start him at 5 units twice a day. I gave him his first shot last night, 5 units, then got on here and did some reading. I am freaking out looking at what the formula is supposed to be for administering the lantus. weight in Kgs x 0.5.... or weight in Kgs x 0.25. I would say his blood sugar is high and out of control based on the excessive drinking, urination and neuropathy. If I go by the first formula it would be 4 units twice a day, and if I go by the second its 2 units twice a day. I was on edge all night last night after giving him that 5 unit shot, and checked him all night. I didnt give him a shot this morning, I figure I will start tonight based on some recommendations.

I am in southern Alberta, Canada, and every vets office in the city uses Caninsulin as their insulin of choice for treating diabetic pets, I was calling around trying to get a second opinion.

I will be buying a glucometer to use at home, will check the forum later to see what one of the better rated, easy to use ones are. I also need tips for the lantus pen, and would like to get the best deal possible.

So far kitty seems a bit perkier, legs are still quite bad, I am trying mixing methylcobalamin in with some wet food rather then his water, see if that is absorbed a bit better.
 
I would not start at that high of a dose. We start low and go slow, because it is easier to raise the dose when needed than to get the insulin out of the cat once it is given. :mrgreen: I don't use your insulin but will see if I can get some Lantus users to comment on the dose.

You can use any glucometer that sips and takes a tiny sample. You can't get the ReliOn in Canada (which is the most popular on this site) But any one will work. The expense is not the meter but the strips. I used a PrecisionXtra which I loved. I got it free from the pharmacy. I bought the strips on ebay at less than half the usual price.

Here is a list of supplies you will need:


A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 25-26 gauge is good. Any brand will work.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

Very few of us got blood on our first try. But we all have tricks that helped us. For me, the rice sack was magic - it made such a difference in the amount of blood I could get. If you have trouble, take a deep breathe and come back on and tell us what is going wrong so we can help.

And I am SO GLAD you decided to give your kitty a second chance. We will do all we can to help you.
 
Did your vet start at 5 units of caninsulin?

Erin, 5 units is too much of any insulin to start with. It can cause the body to protect itself by dumping glucagon to prop up blood glucose levels and then eventually the body can't do this any more and the cat crashes. This is called the somogi effect and is a medical condition.

I know that vets here like caninsulin, but mine here in Calgary uses lantus and others use levemir...it just depends on whether the vet has done further education and reading on feline diabetes. Often people have to do their own education and work with or without their vet. Its a tough place to be.

Honestly? I would give maybe 2 units twice a day to start and monitor urine for ketones. I'd go to your nearest walmart or superstore and buy a meter, whether the bayer contour, one touch ultra, etc. Often the meters are free with the purchase of strips, and its the strips that are expensive, but well worth it.

We've lots of informational pages on how to test. We've information on the lantus insulin support group on how lantus works, how to dose, how to test, etc.

Please let us help. And if you'd like, I am available to talk via phone (remember, I'm in Calgary), but I will always make sure that whatever advice I give is also given online for peer review.
 
Hi Erin. Sue asked me to stop by since I tend to spend most of my time on the Lantus board.

Lantus is a great insulin. It is much, much gentler than Caninsulin and it has a wonderful track record of getting cats into either remission or tightly regulated. Even better, there is a dosing protocol that will allow you to better manage Black B's diabetes in a very straight forward way.

First, do NOT use the needles that come with the pens. You use syringes. There is a rubber gasket at the top of the pen that looks exactly like the gasket on a vial of insulin. You use the pen just like you would a mini-vial. You will need U100 syringes that are calibrated in half units. You cannot use your Caninsulin syringes -- they are U40 which is set up for an insulin that is a different concentration than Lantus. Please get the appropriate syringes. You may need to call around to find syringes that are in half unit increments.

As far as initial dose, this is more problematic. You don't have any test data to tell us whether 5u of Caninsulin was working. The formula for initial dose of Lantus is 0.25 x ideal weight in kilograms. However, when a cat is switching from another insulin, we take the dose of the previous insulin into consideration. Personally, I'm not comfortable suggesting that you give 5u of Lantus without being able to home test. I would sooner see you get started on a lower dose so we know that Black B is safe. That said, I will give you a head's up that it takes at least 5 - 7 days for Lantus to establish a depot (this is a reservoir under the skin and it is responsible for the gentle and long-acting nature of this kind of insulin). It also means you will not see immediate results. Using Lantus requires patience. From the doses you noted, Black B weighs 17.5 lbs (8 kg)? If this is correct, I'd suggest that you start with 2.0u, and even this is relatively high starting dose.

Please start home testing. You need to get a test before you give a shot. Because Lantus dosing is based on the lowest point of the cycle, you also need to get spot checks at various times. Home testing and having a dosing protocol to follow will allow you to have much greater control of Black B's diabetes and you will not need to rely on a vet who's management of feline diabetes is obviously somewhat dated.

There are a series of starred, sticky notes at the top of the Lantus board that I've linked. These will help you to understand the use of Lantus.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about the Lantus forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
 
I am in BC, and got my metre (One Touch Ultra) at Shoppers Drug Mart for free when I bought 100 strips. The strips cost about $85. I now buy my strips at Costco for $70. I don't know if they have the same deal for a free metre with strips, but worth checking. Also, insulin seems to be a lot cheaper at Costco as well.

I can only agree with others who have encouraged you to test at home. It seems like a big deal at first, but very quickly becomes quite routine. You'll do fine and you'll give your kitty the best chance of becoming regulated and feeling better.
 
Why cant you use the Lantus pen with the needle tips? It honestly seems like an easier way to give him his shot. My company is sending me out of town for several days next month, and I am going to have to rely on other people to come and give the shots for me, and the pen seems like it would be easy for them. I am really limited on who I can get to come and do this while I'm gone.

When we started the Caninsulin we started at 1 unit 2x a day and progressively moved up over a period of 7 months. The vet figured for the Lantus we would be starting at 5 units twice a day and moving up from there. I think I will start at 2 units and see how it goes.

And yes, I will get all of the other supplies, but it will take time. I made the decision that the cat got medical care over myself, so finding the supplies for a price that wont break the bank would be fantastic. $120 for the Lantus yesterday *sigh*
 
erin_mc said:
Why cant you use the Lantus pen with the needle tips? It honestly seems like an easier way to give him his shot.
Click to expand...


Because if you use the pen the way a Human diabetic would, the pen only doses in whole unit increments. Some cats need half unit, even quarter unit doses. By using insulin syringes with the pen, you can easily measure whatever dose your cat needs. You just stick the insulin syringe needle into the rubber stopper:

images


How%20to%20use%20an%20%20insulin%20pen%20for%20cats.jpg


erin_mc said:
And yes, I will get all of the other supplies, but it will take time. I made the decision that the cat got medical care over myself, so finding the supplies for a price that wont break the bank would be fantastic. $120 for the Lantus yesterday *sigh*
Click to expand...

Here are tips on how to save money on diabetic costs: http://binkyspage.tripod.com/frugal.html Costs do go down after the initial purchase of all the supplies you need.
 
I have already contacted her, would like to get a deal on a tried and tested glucometer, strips and some needles. Okay, I did notice that the pen has the same rubber stopper/seal that the caninsulin had, so I do understand how needles can be used. I guess we will start at 2 units 2x a day and see how he reacts, I hope after a week we will see some noticable difference.

Black B really is the nicest cat ever, like a cross between a bear and a loion and doesnt have a mean bone in his body... I would sure like to keep him around for a few more years!

I will update on how Black B seems to be doing with the insulin change in the next few days ;-)
 
We'll be waiting for an update. Hope we see some good news soon!

Let us know how we can help with testing. And be sure to get some ketone strips to test the urine.
 
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