New user. Mable DX July. Intro and questions about spreadsheet dose increase and numbers.

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Courtney & Mable

Courtney & Mable

Member Since 2021
Hi Everyone,
I'm Courtney and my cat is Mable. My partner and I adopter her about 3 1/2 years ago. She is a grey and white suspected Norwegian forest cat.

Firstly I very much appreciate all of the helpers on here. In the first few weeks this was a great resource to know we were not alone. This is my first post but I've been lurking since the DX. I figured it would be best to share as much info as I can so everyone can get a better overall picture of what 's going on. Broken up into sections.

Background
Her health problems started in the Spring of 2021 with urination outside of her box, on our couches, and alarmingly with bloody urine. We took her in to the vet and they DXed her with struvite crystals, put her on Royal Canin Stox and hills Wet and I believe a stox purina crunchy. She like the royal canin, wouldn't really eat the hills, and then only wanted to eat the crunchies. The crystals dissolved. A few months later in June or July she started drinking from our running tub, so much that she had a couple of coughing fits from drinking too fast. So I bought her a fountain which she was at constantly but other wise ok. There were signs that I missed like her drinking constantly and peeing a lot- I thought it was just because it was summer.

Fast forward to this past July. She was DXed with diabetes July 24th after a couple of days being very sick. throwing up multiple times, lethargy, starting at her water and not eating etc I thought we were going to loose her. We took her to our local (regular) vet Thursday on Friday they called with partial results and again Saturday saying we had to urgently get her to the ER. She had DKA and a cyst on her pancreas. She was brought home on Tuesday. We immediately started insulin per the great emergency vet who said it needed to be treated aggressively. the first few shots I needed help with, after the 3rd day it was fine.
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Since DX
We were blind dosing for a few weeks at 2xday .5U lantus. Got a libre installed and tried to start ear poke testing. Libre consistently showing high numbers. About a week or so ago the vet called to have the dose raised to 1U. Mable went hypo at 50 the first day, nadir around 80 and 100 the following two days. So we brought it back down to .5 with recommendation to watch 5-7 days. The (coverage) vet originally thought mabe was going into remission, then smogoyi, but then i sent a journal someone had posted showing the bouncing effect and she agreed that may be happening.
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Current
Thursday she got a new libre. Starting this past Friday 9/3 we started with .75U and mixing in 1/4 canned friskies pate. Have since stopped the pate to only have 1 changing variable of the insulin dose. Mable's AMPS are 450-500+ with nadirs around ~200. She's having new face twitching/shaking a few hours after the shot. Not sure if because the nadirs are 1/2 AMPS her body thinks she's in hypo?
Last night my partner said to hold after dinner/shot food because she was past 500+ but I think that was a mistake. So today i've been giving her a small spoon of food every 2 hours and the drop seems to be less drastic.

We have a check up next Saturday and an ultrasound for the "cyst" in a few weeks. The vet at the hospital and our vet think she might not really be a true diabetic but this cyst might be making her body think she is. I might need an internal medicine vet.


Questions
- How do i set up a spreadsheet? Where is the template? Do i color code or is it a conditional formatting? I found it once and have another tab open with someone else's but i dont know if its the standard format.
- Vet only wants to treat with DM Purina. I think its too high glycemic but the vet says she doesnt need TR and it doesn't mattter. I would eventually like to switch to friskies. When is this safe to do? In a week after current dose regulates?
- Could the cyst be acromelagy or is that only in the brain?
- Does anyone else have a DKA/Pancreatitis/cyst cat?
 
Welcome to FDMB!!

You're going to need to post a photo of Mabel as your avatar. (Purely selfish on my part -- I have 2 Forest Cats. They are a wonderful breed!)

The information for getting your spreadsheet set up, along with the template that is formatted to automatically color codes, is in this post on helping us to help you.

We encourage caregivers to feed their cat a low carbohydrate (less than 10% carb) diet. Most members here feed their cats in the neighborhood of 5%. The canned DM is 7%. However, most cats get very tired of it and the ingredients are not ideal. A large number of people feed their cats either Fancy Feast or Friskies pate-style food. Lisa Pierson, DVM has a wonderful webpage on feline nutrition. She has also compiled a fairly comprehensive chart of the canned cat foods that are available in the US along with nutritional information -- including carbohydrates, phosphorus, etc. You have any number of options at a variety of price points. I'm not sure why your vet thinks TR and a low carb diet are synonymous. Cats are obligate carnivores -- they can't metabolize carbs. If you think about what a cat in the wild eats, that's a species appropriate diet. Fruits and berries, gluten of various sorts, and powdered cellulose are not appropriate for a cat.

Switching to low carb may involve a slow transition. If the carbs in your cat's food are keeping her BG elevated, you don't want to make an abrupt change since blood glucose numbers could drop as a result of fewer carbs. It's not so much as the dose needing to stabilize ad the what the effect of a diet change can be on the numbers.

I'm going to tag our resident expert on acromegaly - @Wendy&Neko. It's my understanding that acromegaly involves a pituitary tumor. I would want to know more about what the pancreatic cyst is all about. Has the vet suggested a biopsy or did they do an ultrasound? Did the vet say anything about an insulinoma? You may want to ask about these possibilities.

There are any number of cats who have had DKA and pancreatitis. Offhand, I don't recall any cats with a pancreatic cyst but that may be my memory. There may be other longer term members who will stop by and they may remember if there's been anyone else's cat with those issues. Many of our DKA/pancreatitis cats do well.

Please let us know how we can help.
 
Thanks for the welcome! Yes i have LC food as per Dr Lisa's chart. My vet actually suggested catinfo after several weeks back and forth asking about swapping the food because I had ingredient concern's as well. The vet tech lectured me the other day about not swapping her food too much. I just don't really want to spend $120 a month subpar food that doesn't really help her BG. Mable also has history of struvite crystals and they've told me the DM helps with both.

Does anyone know what ingredients in particular to avoid or to look for as wanted in a struvite controlling LC food? Are the FF classic pates still appropriate in this case?

The ER vet said mable has a cyst and to follow up in about 6-8 week with our regular vet. I have an ultrasound appointment on September 24 for a radiologist to examine the cyst and will have more info then.
 
Hi. A cyst on the pancreas has nothing to do with acro. That would be a tumor on the brain. I’m glad you have an ultrasound scheduled. I would want it done by a boarded radiologist. When Max was diagnosed with pancreatitis he had an ultrasound by a traveling vet who found all kinds of things except pancreatitis. I had gone to a felines only vet. It was recommended he have exploratory surgery. Went back to my original vet to see if he felt that was the case. He had another ultrasound done by a boarded radiologist less than a week later. Totally normal. He ran the test for pancreatitis at the same time which the other vet didn’t do because of the ultrasound. Diagnosis ONLY pancreatitis. Max never needed exploratory surgery. It was uncomplicated chronic pancreatitis which after a few years led to diabetes. I was able to get him tightly controlled but not into remission.

I am tagging Bhooma to get your spreadsheet visible. @Bandit's Mom
 
If you go back to the Catinfo.org site, there's an entire section on urinary tract issues. Her advice -- water. The prescription foods are generally not the answer. You may want to stick with foods that are lower in phosphorus -- this is highlighted in the link. Also, add water to your cat's food. It will help with crystals and is good for your cat's kidneys. Diabetes is hard on the kidneys so adding water is an extra layer of protection.
 
When I started here, my other cat with struvite crystals was on C/D, which helped him, but Neko was constantly stealing his food, so it didn't work for us. His vet suggested a raw diet would help both cats. After later reading catinfo, I found it was the low carb, with water added and lower phosphorus, that was what helped. It turns out both cats did really well on raw, and loved it, so that's what I fed for both conditions. Getting rid of dry food will have a significant impact on the size of insulin, so make any switch slowly.

Acromegaly is a condition/set of symptoms caused by a normally benign tumour on the pituitary gland, called hypersomatotropism. Cats with this type of pituitary tumour may or may not show symptoms of acromegaly initially. I don't think this is something you have to consider at this point in time.
 
Also above Sienna and gabby said "Switching to low carb may involve a slow transition. If the carbs in your cat's food are keeping her BG elevated, you don't want to make an abrupt change since blood glucose numbers could drop as a result of fewer carbs. It's not so much as the dose needing to stabilize ad the what the effect of a diet change can be on the numbers"

The reason that i asked about a slow transition to the FF classic was that I just changed mable's dose to .75 a few days ago. If the depot of lantus is 5-7 days we also should not change her food with the new increase because it could cause low/hypo numbers, right?

Our check up appointment is next saturday which would be 8-9 days, so i figured it would then be ok to start switching or doing a quarter or half and half purina and FF.
 
The depot of Lantus takes 5-7 days to build, when you first start insulin. After that you have a good idea what the dose can do by the end of the third day. You still have tonight to see if anything happens, then you can start the food transition. If you are only feeding canned DM ( and not the savoury selects which is higher carb ), there won't be much carb difference when you switch to Fancy Feast. So you could start it tomorrow.
 
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