???Newbie seeking advice and guidance...

A

antheakay

Member Since 2018
Hello Everyone,
I'm not sure whether or not I'm posting to the right forum or not so please forgive me. My little guy, Mako (12 yo male siamese), was recently diagnosed with diabetes on Saturday and am feeling very overwhelmed. Diagnosis was largely through blood glucose which at the time was sitting at 30mmol/L. At the same time he was also diagnosed with very low B12 and relatively high Folate which are vet concluded was likely due to IBD. He tested negative for Pancreatitis.

Mako was kept in over night to generate a BG curve and it was decided that we would start him on Lantus (at .5) once daily, since his nightly reading on Saturday was very low (he received insulin Saturday mid day right after diagnosis). He got one more dose of Lantus the following morning (Sunday 10 am) as well as a shot of b12. I brought him home and began taking BG readings every other hour. His feeding schedule was switched from free-fed Royal Canin Urinary SO dry to Purina DM wet twice daily (half a can per feed - mako is 3.6 lb down from 4.4 lb normally). At about 1pm the following day Mako became Hypoglycemic (3mmol/L) the reading stabilized after giving him some of his previous kibble we had on hand but it was decided by our Vets that he was way too sensitive to the insulin and that we should keep monitoring BG before deciding whether to give more. We have not given him a dose of insulin since Sunday morning (it is now Wednesday) and BG readings are all below 6mmol/L. We have kept on our regular feeding schedule as best we can but he doesn't seem as ravenous as he did a few days ago (i.e. doesn't finish it all at once or beg for his meal) so it was okay'd by my vet to leave it out for him to graze on until he finish it. This morning however he seemed way less interested in his morning Purina DM - he took a few bites then went back to bed. BG reading before feeding was 6.7 mmol/L. I guess my question is does this all seem normal? I'm feeling very confused about how this is progressing and not sure if I should be worried. Thank you so much for your help!

Anthea
 
Welcome Anthea and Mako :) You are in the perfect place for answers and guidance to help Mako . If you haven’t already , I encourage you to read the yellow stickies that are full of info AND add a question mark icon to your thread title so it attracts more attention. One of the more experienced members will be along that can answer your questions . We have all been where you are and understand :bighug: Again, welcome to you and Mako .
 
Hello and welcome,


antheakay said:
(he received insulin Saturday mid day right after diagnosis)
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Do you know how much he got?

antheakay said:
Diagnosis was largely through blood glucose which at the time was sitting at 30mmol/L
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Did they run a fructosamine? Did they send the blood away? Or did they do this in house and you got the results same day of blood draw?
Did he have an infection at time of blood draw? Was he well? any symptoms of diabetes? (excessive drinking/peeing/etc)
antheakay said:
We have not given him a dose of insulin since Sunday morning (it is now Wednesday) and BG readings are all below 6mmol/L. We have kept on our regular feeding schedule as best we can but he doesn't seem as ravenous as he did a few days ago (i.e. doesn't finish it all at once or beg for his meal) so it was okay'd by my vet to leave it out for him to graze on until he finish it.
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I also can't see the SS, make sure you have shared it.
antheakay said:
I guess my question is does this all seem normal?
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We do see kitties go into remission when the swap from a high carb dry diet to a wet low carb diet, but from what you are saying this seemed to happen overnight for your kitty, that is unusual, as its not unusual for it to take a few days for the effect of the dry to work its way out of the system. I wouldn't be surprised if you see the numbers creep up.

antheakay said:
This morning however he seemed way less interested in his morning Purina DM -
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High blood sugar can make them ravenous, so when it comes back down into normal levels, appetite can return to normal. However, we have found kitties get 'bored' with the purina DM, there are many other LC better quality foods you could feed than the purina DM. Are you in Canada or the UK?
FWIW I find that with wet I need to rotate a few flavours with my kitties otherwise they get bored, whereas with dry they'll happily eat the same flavour.

Sorry about all the questions, once you get that ss shared we'll be able to tell you a little more.
 
Gill & George said:
Hello and welcome,

Thank you so much. Please let me know if it works now.

Do you know how much he got? He got .5 units


Did they run a fructosamine? Did they send the blood away? Or did they do this in house and you got the results same day of blood draw?

No fructosamine. On the spot blood test.

Did he have an infection at time of blood draw? Was he well? any symptoms of diabetes? (excessive drinking/peeing/etc)

Blood work showed not infection. I rushed him in because he was very lethargic and unmotivated. In hindsight does seem like he was drinking and using literbox more than usual. It was hard to track since he also has a brother.

I also can't see the SS, make sure you have shared it.

I hope this now works!

We do see kitties go into remission when the swap from a high carb dry diet to a wet low carb diet, but from what you are saying this seemed to happen overnight for your kitty, that is unusual, as its not unusual for it to take a few days for the effect of the dry to work its way out of the system. I wouldn't be surprised if you see the numbers creep up.

If this is the case do most still stop Insulin and keep monitoring?


High blood sugar can make them ravenous, so when it comes back down into normal levels, appetite can return to normal. However, we have found kitties get 'bored' with the purina DM, there are many other LC better quality foods you could feed than the purina DM. Are you in Canada or the UK?

We are Canadian. I have purchased some Fancy Feast in line with the nutritional profiles suggested in the diet spreadsheet. Is it okay to leave out and free feed what hasn't been used up. I'm hearing mixed things in therms of what is best for blood sugar regulati0n.

FWIW I find that with wet I need to rotate a few flavours with my kitties otherwise they get bored, whereas with dry they'll happily eat the same flavour.

Sorry about all the questions, once you get that ss shared we'll be able to tell you a little more.
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Thank you so so much for your help.
 
Perfect!The colors work but you need to get rid of the numbers on the US sheet and only put them on the World. It will convert for us. Does that make sense?
 
Maybe I am giving you the wrong info. The world is color code with numbers but now the US is blank. Sorry. That usually works. I’ll tag someone for help. @Gill & George Am I giving wrong advice?
 
tiffmaxee said:
Maybe I am giving you the wrong info. The world is color code with numbers but now the US is blank. Sorry. That usually works. I’ll tag someone for help. @Gill & George Am I giving wrong advice?
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Thanks! Its likely me! I've been a bit out of sorts the last few days. I have started from scratch and inserted US values into the US sheet. Hopefully that fixes the issue.
 
tiffmaxee said:
Maybe I am giving you the wrong info. The world is color code with numbers but now the US is blank. Sorry. That usually works. I’ll tag someone for help. @Gill & George Am I giving wrong advice?
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No you gave the right info, perhaps the formatting has got screwed up, there have been some issues with a bug following a big googGo update, but nothing like this.
antheakay said:
Thanks! Its likely me! I've been a bit out of sorts the last few days. I have started from scratch and inserted US values into the US sheet. Hopefully that fixes the issue.
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Thanks for doing that.

In my original post I asked you some questions do you think you could answer them a little more background would be helpful.
Thanks
 
Thanks so much! I did reply to your original questions - maybe there is an issue in how those responses are displayed as well?
 
One other though just crossed my mind, what syringes are you using? And how did you measure the 0.5u.

Just the other day someone was given incorrect syringes and they ended up giving there cat twice as much insulin, which resulted in very low numbers.
 
So far he’s running normal numbers without insulin. Interesting. It would be interesting to see how he tests three hours after eating. It seems his pancreas is working . :)
 
The number at the vets might have had some level of stress hyperglycaemia.
With the lethargy were they concerned about dka? Did they talk about ketones? Do you have the lab results? Could you put them into the ss ss there is a tab for that. Some folk here are very capable of interpreting those results, my experience with my original vet has been that she didn't highlight certain values because they were only slightly of, turned out George had early kidney disease and though doesn't need med, there's a lot one can do to slow down the condition. If it hadn't been for this board is have been none the wiser, as it is with changes I made to diet and water intake he is stable, and new vet says if anything there is an improvement.

It was the same for us with the benefit of hindsight the signs were there. It took a while for the penny to drop forusf.

With the diet change you have dramatically reduced his carb load and that in itself could be enough to bring him into normal range, some cats are lucky like that.

I'm more used to seeing numbers taken with a human meter, which would be lower. But overall he's looking quite good, I just don't like some of those higher blues you are getting. I'd like to see more green. I don't see any harm in monitoring over the next couple of weeks as you've been doing, if you see him trending up, then you might want to consider giving a micro dose it's possible to give a 0.1u or even a drop, sounds crazy, mists vets don't believe it, mine was speechless when I showed him.

If they were worried about dka, then I would have to rethink the above.

Btw excellent job on getting up and running with the testing.

I'm in spSpa, it's past midnight so I'm going to hit the sack.

Hopefully others will chime in.
 
Thanks so much. No, no DKA. I have attached the labs to this message. Our vet wants us to test twice daily for the next week (before his meals morning and night). I'm worried that might not be enough especially since we are leaving his meals out for him to complete/graze on throughout the day?
 

Attachments

I think it's reasonable to test twice daily before his main morning and PM meal (the times you would shoot if you did have to go on insulin).
I might also test at +3, if his pancreas is working the +3 is often lower. If you do that you should catch any anomalies. I would hold of insulin for now, see what happens. Overall he seems to be in a good range.


I'm just going to tag @Marje and Gracie , could you please take a look at the labs. GGT is out of range, I don't know what this means other than it is indicative of liver issues, though other liver values are normal, so don't know what that might mean, perhaps the recent weight loss is something to do with it. the T4 although in range is a little on the low side so you might want to keep on top of that, just in case its a sign of early hypothyroid.



Is Mako having any tummy problems? diarrhea or vomiting?
What sort of condition is he in? has his fur changed
Is he still lethargic?
 
Any other symptoms because low B12? Vomiting? Diarrhea or constipation? From the labs I don’t see anything alarming except GGT is slightly high which could be normal next time. Why was he on Urinary SO? Did he block or have crystals? Wondering why IBD diagnosed.
 
I can't thank you guys enough for your support - it has been such a life line during this time.

Urinary SO was because his brother had once had crystals in his urine and because both are siamese and are more prone it was advised they both be on. IBD diagnosis was purely based on malabsorption of Vitamin B12. Is it too late to have a fructosamine test now to see how long those sugar levels were high.

In hindsight mako was having some vomitting but not more or less than in the past which we had chocked up to just hairballs. No diarrhea but we did notice more urination out of box. He is no lethargic as he was when i first rushed him in on Saturday - at that point he wasn't even wanting to get up and walk around.
 
I’m not sure putting a cat on SO without crystals is such a good idea. Max blocked once and I nearly lost him so I understand wanting to avoid that. He went on CD after that for way long nger tgan needed now that I know more. Feeding a species appropriate food seems a better way to go. I’d check out felineinfo.org Lots of great ideas there.

It’s not too late for a fructosamine. It will give you an average of his bg over last few weeks. You will need a new blood sample. I think I’d wait a little longer without insulin but not sure about that.

I’d love to see a picture. One if the two I got after losing Max two years ago looks mostly Siamese but her sister looks tabby.
 
antheakay said:
it too late to have a fructosamine test now to see how long those sugar levels were high.
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The fructosamine will tell you the level of glycaemic control the previous 2 to 3 weeks, I'm not sure that will be real helpful to you and you would need to do another blood draw, it's almost a week since you took him in.
As you now have the tools to monitor his BG going forwards, that will actually be more useful to you than the fructosamine going forwards.

The site Elise mentioned has a very interesting section on urinary tract disease, and Opie's story
https://catinfo.org/feline-urinary-tract-diseases/
 
Gill & George said:
I think it's reasonable to test twice daily before his main morning and PM meal (the times you would shoot if you did have to go on insulin).
I might also test at +3, if his pancreas is working the +3 is often lower. If you do that you should catch any anomalies. I would hold of insulin for now, see what happens. Overall he seems to be in a good range.


I'm just going to tag @Marje and Gracie , could you please take a look at the labs. GGT is out of range, I don't know what this means other than it is indicative of liver issues, though other liver values are normal, so don't know what that might mean, perhaps the recent weight loss is something to do with it. the T4 although in range is a little on the low side so you might want to keep on top of that, just in case its a sign of early hypothyroid.



Is Mako having any tummy problems? diarrhea or vomiting?
What sort of condition is he in? has his fur changed
Is he still lethargic?
Click to expand...
GGT can be high due to pancreatitis, bile duct inflammation, cholangiohepatitis, liver damage, etc. I agree with Elise that I’d keep an eye on it and watch for symptoms such as continued vomiting, weight loss, etc. Each test is just a snapshot in time and so it can be slightly elevated now but normal on the next test especially because none of his other liver enzymes are elevated. Typically, if there is an issue with the liver or cholangiohepatitis, you would expect to see other liver enzymes elevated.

Obviously, if he starts to turn yellow or his urine becomes bright gold, get him in right away.

Cats are not typically hypothyroid unless they were hyperthyroid and the I131 treatment was a little too effective. However, when there are other illnesses going on, we sometimes see the tT4 levels on the low side. This is called euthyroid sick syndrome. Again, you just need to keep an eye on it and see if it comes back up as he does better.
 
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