Newbie Needs Advice ASAP

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lchcats

Member Since 2012
My 10 year old cat was diagnosed with diabetes yesterday. Her blood sugar was 463. The vet just called to tell me that the hospital gave FurBall "the smallest possible dose" of insulin last night -- I think the vet said it was 1 unit. They did not monitor FurBall overnight, and when they checked her this morning her temperature had dropped from 100 to 92 due to blood sugar dropping way too low. Now the vet has my beloved kitty on warming blankets and IV glucose. FurBall's sugar is now 99 and her temperature is 95. She (the vet) thinks FurBall's temperature will continue to come back up, but she tells me that the overall prognosis is looking much worse now and she has concerns that something more than diabetes is the matter (brain tumor was mentioned), and that I may not be able to regulate FurBall's sugar levels at home. I don't know what to do! The vet wants me to come there at 3:20 today. I don't want FurBall to suffer; she has lost weight and is not eating. Any information/advice is greatly appreciated. This is all new to me as I was just hit with this diagnosis yesterday. Please, please can someone help me?
 
I am so sorry this is happening to you and your Furball. It is hard to know how to help without knowing whether she is just diabetic or whether there are other issues. From what you describe, she didn't seem to get very good care from this vet. It sounds like too much insulin may have been given and then no monitoring done.

You can monitor and care for her diabetic needs at home, if it is only diabetes you are dealing with.

I think I might call this morning and find out if her glucose levels have come up into a safe range. If so, maybe take her in an ER facility or another vet in your area to be evaluated? We can teach you today how to test her blood levels and give her safe doses of insulin if needed.
 
Thank you Sue for your kind reply. Yes, clearly she should have been monitored. I expressed my concerns to the vet yesterday at her plans for my kitty, but she did not address them. When she called this morning, I told her I would NOT be leaving FurBall there overnight again. This time she agreed with me. FurrBall's bloodwork yesterday showed an enlarged kidney, but only ONE kidney was enlarged. Also a urinary infection, which is common in diabetes I think. I am perfectly willing to monitor the sugar at home and give injections if this will help FurBall. What do you think about the vet's claim that 1 unit was the smallest possible dosage? FurrBall only weighs a little over 5 pounds since she has lost weight due to the diabetes. The vet said she would never have expected this result from such a small dosage. The vet is basing her conclusion that something other than diabetes is going on due to FurrBall's response to the insulin dosage.
 
It is true that we usually suggest a starting dose of .5 to one unit of insulin. But we also suggest careful monitoring because you don't know how the cat will response, and small frequent meals to help her stay safe if she would drop low. In a vet setting, if she wasn't eating and she has an infection, that really complicates things.

Sometimes if they aren't eating well, and they have an infection, they can quickly develop a condition called DKA. It results from those first 2 factors and not enough insulin. Did your vet mention DKA? It is accompanied by high insulin numbers, not low, so it doesn't sound right for her condition.

What kind of insulin are they using? There are several harsh insulins that can cause sudden dangerous drops especially when combine with not enough food. (Humlin or NPH or N are some of the ones we do not recommend.)

If you think a second opinion might help, tell us your city and state. Maybe we have a member nearby who knows a good FD vet.
 
They tested her for DKA yesterday and said she didn't have it. The insulin is glargine (Lantus®). I live in Easton PA. The last time I know FurBall ate was 2 days ago when she was home with me. Yesterday she was at the vet's all day and I don't know if she ate anything. Today they are not giving food because they said her temperature is too low to digest it.
 
I hope someone else comes along with information about not feeding because the temperature is too low. It is not something I know about. It seems like they could put in a feeding tube; low numbers without food is not a good combination.

Is Easton near any larger city? I will see if I can find someone near you.
 
Yes, I am very concerned about the food situation, especially considering her extreme weight loss. I didn't realize that she had gotten so thin. She has long fur so it is not obvious from looking at her. And I have been preoccupied with my other cats and their illnesses. Toby has a liver tumor. The surgeon could not remove the complete tumor because it is wrapped around the cava vein and Toby could bleed to death. Stripe has severe IBD. She is emaciated and on subQ fluids. I am spending hours a day tempting her to eat and providing care, and agonizing over her vomiting and diarrhea and what to do to help her. And most recently Sybil, who is 15, had upper respiratory infection and conjunctivitis; she also is down 2 pounds. I am beating myself up for failing to notice FurrBall's weight loss.

The vet told me not to be concerned about eating since FurrBall is getting IV glucose!

Easton is right on the NJ border, so most places in NJ are within driving distance.
 
Oh, I am so sorry you are dealing with all these kitty issues. We don't do guilt here, :mrgreen:. The important thing is that you go her help and are trying to figure out how best to help her. The IV may be helping with the food issue. I just am not sure.

Here is the reply from a message I sent to a member near you. She is dealing with family medical issues and can't come on the board and post.
I am about 45 minutes from Easton. I used to live closer years ago and have friends in the area. Two places I would reccomend would be:

1. Valley Central in Whitehall PA, not far off route 22 which goes thru Easton, Bethlehem and Allentown, the 3 major cities in this area.
210 Fullerton Avenue, Whitehall, Pa 18052, phone 610-435-5588
Valley Central would be my emergency vet if I had to go to one in off hours. All the vets I have gone to in this area use them as their emergency place but my understanding is they have a regular practice too. I know people who have taken cats here and were happy with the service.

2. Clinic for Cats
4090 West Tilghman St
Allentown, PA 18104
phone 610-398-3556
A dear friend with a few cats went to this place for years and liked them. And no barking dogs when you go there :)
 
Thank you so much Sue for your supportive responses. I am familiar with Valley Central and I think the daytime internist there is quite knowledgeable. The daytime and evening clinics are 2 separate entities though, and at least one of the doctors who is there at night is a nightmare. He is so bad that I drove there in the middle of the night and removed my dog from his care, "against medical advice." (There is another doctor who works nights and he is just wonderful. It is the luck of the draw which one will be on duty when you need help.) The internist there is an option for FurBall. But 1st I have to go to the vet for FurBall at 3:20 and hope that she is in condition to be released. And by that time the daytime doctor will have left. I really wanted to find a regular vet who could help. I have tried many vets in the area and have yet to find one who I would recommend (except for the internist and the surgeon at Valley Central).

Thank you for recommending Allentown Cat Clinic. I've never been there but I have heard good things about it too, but in my distress it did not occur to me to try them. I called Allentown Cat Clinic and explained the situation. I wanted to see if I could bring FurBall there tonight for a 2nd opinion. The person who answered the phone told me that they are down to 1 doctor now, and that that doctor is going away for a week. She said I can call back then if needed....

I just spoke to the current vet and they said FurBall is much improved and is alert and sitting up. They are going to call me as soon as they take her electrolytes and sugar levels.

I am on mental overload Sue! On Saturday I noticed a pregnant feral cat in my yard. I own a trap and was going to trap her and provide care, but this has been put on the back burner due to FurBall's crises. Meanwhile I am worrying that she is going to give birth out there in the heart of the city. I just love my furry companions so much and don't understand why they must suffer so.
 
Let me see if there are some Lantus people who can help. (I didn't use Lantus)

The vet is sounding more encouraging with your last call. When you pick her up, insist on a copy of her treatment record.
 
Yes, great suggestion! I am going to write out a list now of what to ask. My brain has been so frazzled from all this stress that I am making mistakes left and right. I also need to know how soon after injecting insulin she could crash. And how often, and how, to monitor her. And what to do if her sugar goes low. I read online to put honey on her gums? I was shocked at the cost of the Lantus - over $150! And also she is supposed to go on strict diet. I don't know how I am going to manage this because Stripe is on strict diet and has severe reaction if she even has a single morsel that is not on her diet. Stripe is eating Nature's Variety Instinct Grain-Free Turkey dry food and wet food, and Wysong Starch Free Epigen Venison dry food. I leave food down at all time since she is skeletal. I hope FurBall can eat this too. The vet said no carbohydrates for FurBall.
 
Keep checking back in for specific Lantus responses. Meanwhile, here is a page with lots of info on how to use Lantus in cats. (Below the thick grey line, all the starred topics) It is a lot of info but will give you a great beginning place for how to dose, care for the insulin, how and when to monitor, what to do with low numbers etc.

http://www.felinediabetes.com/FDMB/viewforum.php?f=9

The board is not terribly busy this morning so watch your thread for more responses during the day. I have to leave for a few hours but will check back on you later.

Some people think this is silly advice, but it has helped me so many times in tense situations: Breathe. Take deep breaths. You now have a support group that will help you and Furball. We will help you figure things out. Breathe. :-D
 
Welcome to FDMB.

Like Sue, I'm sorry you are having to go through this nightmare.

One unit is by no means the smallest dose of Lantus possible. If they are injecting directly from a Lantus pen, it may be the smallest dose but this would be unusual in a clinic -- they would be using a vial and a syringe. With a syringe, you can dose even a drop. We routinely see cats that are getting 0.25u or 0.5u. At a weight of 5 lbs., especially if your cat is underweight, the starting dose would be in the 0.5u range.

I would ask the vet hospital to simply xerox every single piece of paper they have -- every note. Every medication, the time it was administered, what FurBall ate, if she peed or pooped, everything. If they get nervous about why you want the records, tell them it's for your regular vet and you promised you would hand carry the information since the quality of a fax isn't always good. They may get nervous about releasing the records to you. If they make noises about you won't understand what's there, please gently inform them that since you are paying for your cat's care, the records are yours and you are entitled to them. The "right" of privilege is yours, not the vet's. I also suspect they are aware that they were in error by not monitoring FurBall 24/7.

What kind of "strict" diet are they suggesting? We recommend that a diabetic cat is on a low carbohydrate, canned food diet. This kind of diet is appropriate for any cat. Most of the Nature's Variety/Instinct canned foods are low carb. There are virtually no foods that are "no" carb. Even a raw diet has some carbs. We consider low carb to be nder 10% and most of us feed in the 5% range. We'll do our best to help you find a diet that can accommodate the needs of all if not most of your cats. You might want to take a look at this site on feline nutrition that was written by a vet, Lisa Pierson, DVM. There's a wealth of information about food and various medical issues.

There is a great deal of information about Lantus and it's use in the starred, sticky notes at the top of the Lantus TR board. I've linked them below.
  • 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 this 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.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

The amount of information as you start this journey is overwhelming. We've all been there and in a surprisingly short period of time, it will become second nature. Please let us know how we can help.
 
To help with the cost of purchasing lantus, here is a link to a $25 off coupon:

Lantus---http://www.lantus.com/solostar-insulin-pen/solostar-coupon.aspx

Expires 12/31/2012.

You will need a script and make sure they write solostar pens on it. Also, you will need to purchase insulin syringes - do not use the ones for the pens. Syringes are inexpensive and get the U100 with 1/2 unit markings - this will help you for microdosing.
 
OK now I am officially freaking out. I just got a call from the vet and they are cancelling my appointment to learn how to give insulin! They are giving up on this due to the poor (almost fatal) response FurBall had to just one shot of insulin. They said they are sending her home at 6:45 instead and going to manage her diabetes with diet!!! And the diet they are recommending is Hills MD. The first ingredient in this is chicken by products. Also it has corn and other grains that I know are not healthful for cats. I am at my wit's end as to how to proceed. It sounds to me like they are just giving up and sending her home to die. I will know more when I see what the vet has to say when I get there.

I see that I have some other responses from group members and I will look at them now. I just don't know what to do 1st. There is so much information on this board and it is all so vital and I don't know what to look at 1st. This is a crisis situation. They are sending home a cat who I brought to them yesterday morning who was limp and unresponsive -- clearly her blood sugar was soaring. Is there any chance the high levels could have been caused by the UTI? Maybe it's not diabetes? And now, after having treated her and made her worse, they are giving her back to me with no resolution other than prescribing a diet that I know is not good for her or for any cat!!!!!

Please forgive me if you have taken the time to respond and I haven't read it yet. I just wanted to put this latest development out there for you all to see. I know I am making poor decisions at this point.
 
Hillary thanks for the link to the coupon and other vital information for Lantus. If FurBall is put back on insulin I will definitely follow your advice in this regard. I will be making an appointment with another vet ASAP. I'm just not sure which vet would be my best option.
 
Sienne thank you so much for all of the good information. I've printed it out so I can better digest it. I just called the veterinary specialist in Allentown, trying to see if I can bring FurBall in tomorrow to see him. They said they are overbooked but they will call me back after they speak with him.

From what you say, and from my very limited understanding, a smaller dose of Lantus should be tried. It is so difficult to deal with vets when they give you inaccurate information! Why would she tell me that 1 unit is the smallest dose when that is clearly not the case???!!!

I think you are right that they are aware that it is their fault FurBall crashed last night. Especially when I told them beforehand that I did not want to leave her there unattended and I wanted to bring her home so I could monitor her. They told me that was not an option since she was on IV fluid. I expressed my concern that she would die during the night and they gave no credence to that concern. I am going to call them before the appointment tonight and ask for the records as you suggested. I appreciate all the detail you went into about this. Especially as I find myself intimidated by the attitude of the personnel at many offices.

Regarding nutrition I will look at the site you recommended next. It seems I will have to switch from the dry diet to canned. This will be a challenge since I am feeding so many cats -- I have to figure out the logistics of it since the large healthy cats seem to gobble up everything tasty right away, leaving the skeletal cats with nothing. That's why leaving out dry food works so well - it is not as tasty!

I had started to read some of the starred items previously. It is an overwhelming amount of material. And each sentence is invaluable. I really appreciate you taking the time to help guide me through this journey.
 
You have already gotten a ton of useful advice. I just wanted to mention a couple of things that don't sound quite right to me.

First off, I'll qualify this by saying I have no direct experience with Lantus insulin. I used PZI with Bob. That said, there's lots of "lower doses" than 1u, but 1u is definitely NOT a huge amount of insulin. What makes little sense to me is that your kitty crashed on her very first dose of insulin. The way that Lantus works (it is called a "depot type" insulin), that shouldn't have happened. Usually, a cat will need 3 days or more to "build the depot" before you start seeing really significant results. For Furball to have what sounds like a hypoglycemic episode just doesn't sound right to me. Unless she didn't need any insulin at all, and her blood glucose reading over 400 was due to "something else".

I don't think suspending insulin immediately is really a bad thing. One day without insulin isn't going to be life threatening. Apparently one day with it might have been. Another vet sounds like your immediate need, because this just isn't making any sense to me.

Hills M/D - I would feed my cat Cap'n Crunch before I would feed Hills M/D dry food (or canned food for that matter). It's absolutely garbage food for any cat, and if Furball is diabetic, it's the worst prescription food they could prescribe. Someone has already linked you to the food charts, but I'll make it simple. Short term, go to the grocery store and pick up a half dozen flavors of Friskees Pates and Fancy Feast "Classics". Much better than any Hills food, and appropriate for a diabetic cat. If she will eat those, that'll cover you for the next few days. Then you can research the list if you want to feed a more "top-end" low carb canned food. But Friskees and Fancy Feast are perfectly fine for now.

As far as a lower dose goes, I would wait for a 2nd vet to conclude that Furball has diabetes before worrying about the dose.
And like Sienne, I think, said..... get a copy of every single record they have that documents what they have done to Furball since you brought her in.

Carl

edited to insert "NOT" a huge dose of insulin...
 
First, breathe.

A vet cannot ethically abandon care. If that's what this (ahem) veterinary "professional" is doing, I would have a cell phone that records, or a tape recorder in my hand, or walk in with a written note for the vet to sign that says he's abandoning care. He could lose his license for doing this especially given what happened last night. I suspect that if you stand your ground, you'll get what you need especially if you seem knowledgeable. (I suppose the vet would be rather taken aback if you pointed out that he's refusing treatment because he overdosed your cat and wasn't monitoring in an acceptable manner for a cat that was hospitalized under his care.)

If you are bringing FurBall home tonight, you will need some supplies. I would ask the vet to GIVE you the vial of Lantus they no doubt started for your cat. I wouldn't be surprised if you were charged for it so it's yours. If they refuse, get a prescription for Lantus. You will need to pick up:
  • U100, 3/10cc syringes that are in half unit increments and are 30 or 31 gauge needles - you will need a prescription for the syringes
  • lancets for getting a blood test. For now, get a thicker lancet (28 or 29 gauge)
  • a glucometer - human is fine, it's what we all use
  • ketostix for doing urinary ketone testing
  • treats -- chocolate for you and things like freeze dried chicken, cooked chicken, jerky style treats (e.g., Wellness makes a jerky cat treat) for FurBall
You can get all all of these supplies at Walmart. The Walmart store brand, Relion, is absolutely fine for a glucose meter and syringes. Some stores may now be using Arkray meters -- this was the company that actually made the Relion meter and Walmart re-packaged it. The strips are the least expensive around.

Home testing is not difficult. I learned by watching videos on YouTube. The same with giving an insulin shot. When I picked my cat up after she was hospitalized, because I can do medicalspeak, the ER vet assumed I knew what I was doing and I was so flustered with Gabby having been hospitalized, I forgot to ask for a demonstration. It took me about an hour of watching videos to figure it out. The key is to be confident with FurBall and to give treats.

Once all of this settles down, you may want to take a look at this website. A former member here ran into a similar situation with poor overnight care for her cat and started the Toonces Project.
 
Hi Furball's Mom- I'm casey and new to the board but not to diabetes in cats. And, I've been giving Lantus (insulin glargine) to one of my cats for 7 years. Lantus is a very slow acting insulin, the nadir (peak time) is usually 8 hours or longer, so my question to the vet internist (because you are a very smart mom to want your baby out of that hospital) is it possible that she could have an insulinoma- these are tumors that are usually seen in dogs, so I'm not sure if they can happen in cats, but they do produce these extreme highs and lows. Also, depending on who dosed Furball, and what type of insulin syringe was used will tell you a lot. For example, all human insulin is formulated for a U-100 syringe and Lantus is a human insulin. However, animal insulins are formulate for a U-40 syringe (PZI and Vetsulin) In humans the U-100 syringe can be 1ml total (100U = 1ml) ir 3/10 ml (30 U total). If whoever dosed Furball wasn't paying close attention, they could have accidentally given her more than 1 unit. If she were my kitty, I'd take her to the emergency clinic where the internist is. I'd also put in a call to the internist ahead of time (if possible) and ask that he/she write up a plan for her overnight care until the internist gets there in the morning. I know you don't like one of the overnight vets there, but in all honesty, they will take care of her and there will be someone there to keep an eye on her. I worked graveyard as a tech for 3+ years at an emergency hospital. Best of luck for you!
 
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