? Newish Member Needs Advice

Discussion in 'Feline Health - (Welcome & Main Forum)' started by csc228, Jul 17, 2021.

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  1. csc228

    csc228 Member

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    Jul 12, 2021
    Hi there, my sugar baby Kea has high numbers and I need advice. Here's the background.

    On September 18, 2020, Kea was diagnosed with diabetes via blood and urine tests and confirmed via a fructosamine test. My vet started Kea on Lantus, 1u BID. At the time of diagnosis, he was eating a combination of wet and dry food, but pretty high carb food (eg wet food with gravy). He preferred dry food to wet. Once he was diagnosed, (because of the FD Facebook page), I switched Kea to low carb food (FF) and PureBites snacks.

    On October 7, we took him in for his first glucose curve, and his readings were all normal (97, 90, 93, 100, 90). We reduced his insulin to 1u SID. We took him in for another glucose curve 2 weeks later, and his readings were 124, 108, 83, 99. At that time, we took him off insulin altogether, and when we took him in on October 30, his reading was an 83.

    My vet considered him "in remission" with instructions to watch him for clinical signs since we knew he was prone to diabetes. He put back any weight he'd lost prior to his original diagnosis and then some, so we reduced his food.

    Over the course of the next few months, we found him in his brofurs' and sister's food, which was the same high carb wet food. We'd stopped feeding all cats high carb dry food, but did put out a small amount of Dr. Elsey's low carb dry food, which Kea enjoyed. We thought he was eating his siblings' food only occasionally, but I guess it was enough to trigger his diabetes because I noticed that he started to lose weight in late March. On April 21, his diabetes was confirmed.

    We started him on 1u BID and here my notes because less precise, unfortunately...but we did increase his dosage in WHOLE units over the course of the next few months. I do know that on 6/25/2021 we increased his dosage to 5u BID, because he threw up a couple times that night, and then the next morning he threw up twice. I took him into my vet immediately, where they gave him supportive care - fluids and cerenia, and did blood and urine tests. We were able to rule out pancreatitis, but because we were worried there was still going on like IBD, Kea was put on budesonide.

    On July 8, a Freestyle Libre was put on Kea and thus the start of his spreadsheet. His dosage was increased the next day (July 9) to 6u BID. His appetite remains good - he's eating 3-4 cans of FF a day plus PureBites; I can't be sure he's eating all of that food because we've always done free feeding and his siblings have discovered his special feeding station. I haven't weighed him recently, but I think he's lost weight (over the past few months his weight has mainly remained the same).

    He was taken off budesonide on Monday (July 12) and we are now giving him Cerenia and fluids (100 mls) every other day.

    My vet is great but he's puzzled as to why his numbers aren't going down. He mentioned the other day that it seemed that every time we increased his dosage the numbers are going up rather than down; he's pondered whether we should test him for acromegaly and/or Cushings.

    I have purchased a ReliOn meter and have used it a couple times to check the Libre readings; the first time the readings were 100 off (Libre was 100 points higher) but the 2nd time the Libre was only 10 higher.

    Anyway, I'm turning to all of you for advice and suggestions. My poor baby. I feel terrible for him.

    Thanks in advance.
     
    Last edited: Jul 17, 2021
  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Welcome. I have a few observations. We find that QD dosing almost never works and we increase in much smaller increments? Do you have syringes with 1/2 unit markings? If not I would get some. It’s totally possible that increasing so fast has made it appear like he needs more insulin when he doesn’t or he could have acro or insulin resistance. I’m going to get some of our most experienced to have a look. I’m pretty experienced but let’s get more eyes on this. We can help you.
     
  3. csc228

    csc228 Member

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    Jul 12, 2021
    Thank you - I'll get some 1/2 unit syringes. The QD dosing was when we were decreasing back in the fall. Since April we've only increased doses and only in whole units.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Even our high dose cars are not increased by more than .50. Sometimes too much insulin can look like too little. You can also miss a good dose increasing too fast. I’m not saying he doesn’t have acro or insulin toxicity but it’s hard for me to say given the dosing.
     
  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Do you have any more data on 5 units, say back to that night he was throwing up? Are you testing regularly for ketones? You should be doing that when he's in such higher numbers.

    It's thought that 20-25% of diabetic cats have acromegaly, it wouldn't hurt to get that test done. Cushings is less common so I'd hold off on that for now. I would add a test for IAA (insulin autobodies). The blood goes to the place (MSU) as the one for acromegaly and is a cheap add on test. Some cats have both, like my Neko, some just one or the other.

    You say suspected IBD, was an ultrasound done? GI inflammation, actually any type of inflammation, can also contribute to insulin resistance. I wouldn't have put him on budesonide unless there was clearer evidence it was needed. For most cats it doesn't impact blood sugars (it didn't for my girl), but for some it does.

    Have you ever done blood testing at home with a meter (not Libre)? Just wondering what your thoughts are for testing once the Libre dies. Some people just keep putting on new ones, but it's a bit pricey.

    Sorry for the million questions, welcome by the way.
     
  6. csc228

    csc228 Member

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    Jul 12, 2021
    I don't have any more data on the day we increased to 5 units.
    We are not testing for ketones - I just ordered supplies.
    I'll tell my vet that I want the acro and IAA.

    No, an ultrasound wasn't done. He's now off budesonide and on cerenia and fluids every other day only.

    I've bought a meter for Kea (ReliOn) and have tested a few times. I'm fine with the Libre - Kea isn't bother by it at all, and it's way easier and more convenient than testing IMHO.

    Thank you!
     
    Last edited: Jul 18, 2021
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    I don't mean that particular day, but the days leading up to it or after.

    Good to hear Kea doesn't mind the Libre - cats really range in how they adapt to it.
     
  8. csc228

    csc228 Member

    Joined:
    Jul 12, 2021
    I don't recall anything special - clinically he's been acting fairly normal. He's def more active when his readings are below 450; above 450 and he's likely to be found lying around. But he follows me into the kitchen, jumps up on the counter (like he's not supposed to!)...that's why when he started vomiting it was unusual.
     
  9. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Rules? Cats have no rules....LOL
     
  10. csc228

    csc228 Member

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    Jul 12, 2021
    Am bringing Kea into the vet tomorrow to get the acromegaly and IAA tests done. Will update with results. Do we maintain status quo until then?

    Kea has not had any 500+ events since Friday. He was taken off budesonide starting Monday, so I think this makes sense.
     
  11. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I think you could go up to 6.5 but @Wendy&Neko may get online early enough to offer her opinion.
     
  12. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    I agree with Chris, I'd increase to 6.5 units. The Libre shows you aren't missing any lows, which you would eventually have seen if his dose was too high.

    The blood for the acro/IAA tests has to go to Michigan State University, who run the acro test starting Wednesdays. So it's likely not going to get there in time and will be part of next weeks test run and you should get results on the Friday/weekend. Same thing happened to me, it was a long wait. :nailbiting:
     
  13. csc228

    csc228 Member

    Joined:
    Jul 12, 2021
    Thought these might be helpful.

    upload_2021-7-21_14-56-36.jpeg upload_2021-7-21_14-56-43.jpeg upload_2021-7-21_14-57-26.jpeg upload_2021-7-21_14-57-33.jpeg upload_2021-7-21_14-57-42.jpeg upload_2021-7-21_14-57-47.jpeg upload_2021-7-21_14-57-53.jpeg upload_2021-7-21_14-58-0.jpeg upload_2021-7-21_14-58-5.jpeg upload_2021-7-21_14-58-11.jpeg
     
  14. csc228

    csc228 Member

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    Jul 12, 2021
    And more

    upload_2021-7-21_14-58-34.jpeg upload_2021-7-21_14-58-38.jpeg upload_2021-7-21_14-58-43.jpeg
     
  15. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    What time did you administer the insulin?
    Did you feed before shot? If not when did you feed?
     
  16. csc228

    csc228 Member

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    Jul 12, 2021
    He gets his shot every day at 6 am and 6 pm. He's on free feeding - always has been along with his 4 siblings. I will say that when I give the 6 am shot he's usually quite sleepy and likely no to have eaten too recently. In the PM it's a tossup.
     
  17. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    With free feeding it is harder to find best dose since free feeding results in different amount and time for eating. Based on the Libre curves I wouod increase by 1/2 unit. Usually we increase by only 1/4 units but since present dose i 6 units I would increase by 1/2 unit.
     
  18. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Is there a reason you didn't go up to 6.5 the other day when we suggested it? If he does have acro or IAA, it's even more important that you don't sit on a dose any longer than necessary if it's not getting the results you're looking for.
     
  19. csc228

    csc228 Member

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    Jul 12, 2021
    we increased to 6.5 starting last night. Our vet wanted us to go to 7. we have an appointment today to replace his Libre.
     
  20. csc228

    csc228 Member

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    Jul 12, 2021
    We don't have the 1/2 unit markings syringes. I'm also having to convince the hubby that advice from here is valuable. When vet told us to go to 7, hubby and I agreed to go to 6.5 but we are currently guestimating bc we don't have the syringes. They've been shipped and should be here soon.
     
  21. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    What's most important is consistency, not that it's exactly 6.5. You can take one of your used syringes and fill it with some colored fluid of some kind to where you decide 6.5 is. Then use that as a template when it's time to actually measure the insulin
     
  22. csc228

    csc228 Member

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    Jul 12, 2021
    His ketones via urinalysis are negative. (I received the Ketostix I ordered.)

    upload_2021-7-26_23-14-56.jpeg upload_2021-7-26_23-14-56.jpeg upload_2021-7-26_23-14-56.jpeg upload_2021-7-26_23-14-56.jpeg upload_2021-7-26_23-14-56.jpeg
     
  23. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    With the relatively high dose and BGs including the lowest in the cycle, I wouod say you can increase to 7 units
     
  24. csc228

    csc228 Member

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    Jul 12, 2021
    Okay, will do. Still waiting for results of acro test. IAA is negative, and first ketone test also negative.

    thank you!
     
  25. csc228

    csc228 Member

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    Jul 12, 2021
    My vet left a message - the acro test came back positive. I don't have any numbers - I'll try to catch him tomorrow night or Monday to get more information. He admitted that he knows very little about what to do next.

    Kea's ketone test via urinalysis yesterday was negative.
     
  26. csc228

    csc228 Member

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    Jul 12, 2021
  27. Larry and Kitties

    Larry and Kitties Well-Known Member

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    That helps explain the high BGs despite the relatively high dose of 6 units. Aero cats tend to use Levemir since Lantus is supposed to sting at high doses. My Snuffles is up to about 15 units twice daily. My MurrFee was up to 50 units twice a day. Once you have the test result values, please post in the Aero forum introducing yourself
    https://felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
     
  28. csc228

    csc228 Member

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    Jul 12, 2021
    Will do.

    My vet wants to increase to 8 units (He's currently on 7 - based on advice here we went to 6.5 on 7/21 and 7 on 7/29. Should I increase while we research options for the acro?
     
  29. csc228

    csc228 Member

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    Jul 12, 2021
    I've posted in Acro cats forum, but wanted to post here too. Kea's acro test was 288.
     
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