Newly Diagnosed, Losing My Mind

[spuds151]

It's been about 3 weeks since my tuxedo cat Boots was diagnosed. He's definitely doing better with this than I am. In the past few weeks when I've been doing research online, I regularly get directed to this website and everyone seems so helpful, so I hope it can bring me some peace of mind.

A little background first; I'll try not to make this too long. Boots was diagnosed at the vet. We took him in because we knew something was wrong - he was way hungrier than usual, drinking more, losing weight. Vet sent away for blood analysis and his glucose came back ~450. Glucose in urine, but no ketones. Vet put him on Lantus, 1u 2x/day. Ordered supplies, but since it was a weekend (and I tried to order the wrong kind of syringe), it took a few extra days to get them - almost a full week. Took a BG reading before the first dose, came back high 600s. After 3 or 4 days, tried taking BG again about 6 hours after the morning dose, still high 600s. Panicked, took him to the vet, verified that was the correct reading, dosage adjusted to 2u 2x/day. Did not change diet during this time, which was 1/4 of a 5.5oz can of Friskees pate in the AM and PM with Royal Canin SO dry food left out during the day (he previously had a lower UTI with blockage and had PU surgery to correct this, had not had any issues with this since).

I should add that I watched my father pass away from complications from diabetes. That was rough enough, and I DO NOT want to experience that again.

The day after the vet, readings were ~600 before AM shot, ~450 6 hours later, ~300 before PM shot! I was elated! After PM shot was low-400s, but I thought that might have been more because of stress because Boots was DONE with being poked. Next morning, back up to ~600. Fed wet food like normal but now took away dry food. Other cats (I have 4 total) were not pleased. BG down to low-500s 6 hours later. Mid-400s before PM shot.

The next AM, he's back up to ~600. Starting to get frustrated. Thinking maybe need to feed him more because they all got hungry earlier than usual the night before, probably because the dry food was gone (I wound up feeding them before bed too, so they all got 1/4 can 3x that day). Now giving him 1/2 of a 5.5oz can in the AM and PM. 6 hours later, down to low-500s. Back up to 600 before the PM shot (this was last night). But again, not sure how much of this is stress because we're having a heck of time getting him to stay still for BG tests.

Around now is when I broke down. It feels like this should be working, but it's not, and I can't figure out why. It's like his body wants to stay at 600 no matter what I do. Every time it feels like I'm on to something, his BG just shoots right back up.

Am I changing his feeding schedule too much, too quickly? Do I need to give more time for the insulin to do its thing? I'm obsessed and worried and can't stop thinking about what I might be doing wrong or what else I should be doing...

 

[Kris & Teasel]

Try to breathe and give yourself a pat on the back for testing him at home. This disease is overwhelming for the owner especially at the start. The learning curve is steep but you'll get there. Three weeks is very early days. Figuring out a workable dose and learning your kitty's responses can take months - sometimes longer.

Here are some things in play right now:

• erratic responses to insulin in a newly-diagnosed cat - very common
• possible impact on blood glucose of (likely) high carb dry food - many UTI prone cats do well with extra water added to their wet food but if the dry SO is essential you'll have to dose around it
• 100% increase in insulin dose after only a short time at the usual (recommended) starting dose of 1 unit of Lantus two times a day - we usually recommend keeping a dose for at least a week to 10 days to evaluate it at the start and then increase by only 0.25 unit at a time so you don't zoom past a good dose
• possible overreaction to a too high dose causing elevated blood glucose levels - we call this phenomenon "bouncing" and it's very common. A dose that's too high can drop the BG too fast or too low and the cat's body compensates by dumping more glucose (from a form stored in the liver) into the bloodstream.

This is just a start. I suggest you post on the Lantus forum where there are many very experienced people to help.

 

[spuds151]

Try to breathe and give yourself a pat on the back for testing him at home. This disease is overwhelming for the owner especially at the start. The learning curve is steep but you'll get there. Three weeks is very early days. Figuring out a workable dose and learning your kitty's responses can take months - sometimes longer.

Here are some things in play right now:

• erratic responses to insulin in a newly-diagnosed cat - very common
• possible impact on blood glucose of (likely) high carb dry food - many UTI prone cats do well with extra water added to their wet food but if the dry SO is essential you'll have to dose around it
• 100% increase in insulin dose after only a short time at the usual (recommended) starting dose of 1 unit of Lantus two times a day - we usually recommend keeping a dose for at least a week to 10 days to evaluate it at the start and then increase by only 0.25 unit at a time so you don't zoom past a good dose
• possible overreaction to a too high dose causing elevated blood glucose levels - we call this phenomenon "bouncing" and it's very common. A dose that's too high can drop the BG too fast or too low and the cat's body compensates by dumping more glucose (from a form stored in the liver) into the bloodstream.

This is just a start. I suggest you post on the Lantus forum where there are many very experienced people to help.

Thanks for this, truly. I'll cross-post on the Lantus forum about dosage. I guess it's more that I need to stop expecting to see immediate (consistent) results. I'm so afraid that him having BG so high for an extended period of time will do irreparable damage.

 

[Kris & Teasel]

Thanks for this, truly. I'll cross-post on the Lantus forum about dosage. I guess it's more that I need to stop expecting to see immediate (consistent) results. I'm so afraid that him having BG so high for an extended period of time will do irreparable damage.

Cats can tolerate high BGs for quite a while before suffering the effects. The opposite - too low a BG - is more immediately life threatening.

 

[MrPawsKitten]

Hi Spuds! I'm completely new to this too (Paws was diagnosed one week ago today), but from my experience here so far, we're all in amazing hands - such an awesome support group.

I'm assuming the vet tested for a UTI? With glucose in the urine, they're at a higher risk... We were fortunate that Paws hadn't developed one yet.

I'll be watching for your posts too, since we're at the same stage of being overwhelmed and scared by all of this!

 

[spuds151]

Hi Spuds! I'm completely new to this too (Paws was diagnosed one week ago today), but from my experience here so far, we're all in amazing hands - such an awesome support group.

I'm assuming the vet tested for a UTI? With glucose in the urine, they're at a higher risk... We were fortunate that Paws hadn't developed one yet.

I'll be watching for your posts too, since we're at the same stage of being overwhelmed and scared by all of this!

Hi, and thanks for sharing your confidence, I definitely need it. The vet did check for crystals in Boots' urine and didn't find any. He hasn't had any issue at all since the PU surgery, and I do make sure he doesn't have issues using the litterbox and I feel for his bladder from time to time. I'm worried about pulling him off of the SO dry, but I'm hoping that the increase in wet food will work in our favor. I'm not entirely sure he ate the dry food all that much anyway.

 

[MrPawsKitten]

A UTI is different from crystals - both are an issue, but with completely different reasons and resolutions. A UTI is an infection and may need antibiotics.
What's the reason for the SO dry food? Because of the PU surgery? Or does one of the other kitties have CKD?

Every time it feels like I'm on to something, his BG just shoots right back up.

Check out Paws's spreadsheet (linked in my signature) if you want to see BG really shooting back up - Paws bottomed out at 55 last night and then hit 524 this morning. Not sure if that is the "Lantus Bounce" that is described in the Lantus forum, or that I gave him some high carb dry food when I freaked out he was so low, some of both, or just the complete unpredictability of things!

Stick with it, we're all here for you!

 

[MrPawsKitten]

Oh, and to emphasize what Kris & Teasel said above - extremely low numbers are much much more of an issue than high numbers -- so as long as he's happy, don't worry about it too much - we'll get it under control.

And last, keep in mind that Lantus is a long-acting insulin... we shouldn't expect to see immediate results, and we can't make quick adjustments - it takes time for it to build up (make sure you read about the "Lantus depot," also in the stickies over in the Lantus forum).

 

[spuds151]

A UTI is different from crystals - both are an issue, but with completely different reasons and resolutions. A UTI is an infection and may need antibiotics.
What's the reason for the SO dry food? Because of the PU surgery? Or does one of the other kitties have CKD?

The SO was basically to make sure he didn't develop any more crystals. I assumed that was an indication of UTI, but I guess not. I would hope that the vet checked for UTI, but I think we would've noticed something if he had one? Like pain and having trouble urinating.

 

[MrPawsKitten]

Crystals are more like kidney stones but in the bladder... caused by buildup of various ingredients in many over-the-counter dry cat foods. And the crystals can cause urinary blockage, which would've resulted in the need for the PU surgery. The SO food is formulated to not have those ingredients. (or at least it should be, I don't know for certain). My sister's cat had crystals too, and had to have them surgically removed before they got stuck.

My understanding is that most wet foods don't have those ingredients anyway... but I'd see if we could have a more regular contributor here weigh in, since I'm so new to the forum as well.

A UTI is either a yeast or bacterial infection in the urinary tract. Since the urine of an uncontrolled diabetic cat contains a lot of sugar, it's a prime environment for development of urinary tract infections. First thing my vet did after diagnosing diabetes was to take a urine culture and send it off. I'd guess your vet did too, but it certainly couldn't hurt to ask. Symptoms of a UTI are struggling to urinate, blood in the urine, urinating outside the litter box... so as frequently as a diabetic cat "goes" you'd probably notice pretty quickly.

 

[Veronica & Babu-chiri]

First of all welcome!!!

You've arrived at the best place you've never wanted to be.

Diabetes in cats requires patience a lot of it!!

It will take some time before you see his numbers regulated (could be months)

You are already at a great start by testing at home, like in humans diet is important, so you may want to consider if possible (unless he can't change for medical reasons) to change his diet to wet low carb food (most of the dry food is high carb ) that alone will help his numbers, this is the link to a great list of food, you should look for one that has 10% or less carbs that suits you and that he likes since is important that he eats because you don't want him loosing too much weight http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Getting him checked for infection is also important since an infection will also raise his numbers, infection can be present with or without the crystals infection would show in an urine culture and could also appear some signs of it in his blood work

 

[spuds151]

First of all welcome!!!

You've arrived at the best place you've never wanted to be.

Diabetes in cats requires patience a lot of it!!

It will take some time before you see his numbers regulated (could be months)

You are already at a great start by testing at home, like in humans diet is important, so you may want to consider if possible (unless he can't change for medical reasons) to change his diet to wet low carb food (most of the dry food is high carb ) that alone will help his numbers, this is the link to a great list of food, you should look for one that has 10% or less carbs that suits you and that he likes since is important that he eats because you don't want him loosing too much weight http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Getting him checked for infection is also important since an infection will also raise his numbers, infection can be present with or without the crystals infection would show in an urine culture and could also appear some signs of it in his blood work

Thank you, and thanks for the link to the chart. I did stumble across that last week, and it has been absolutely invaluable. The good news is I've been feeding him the Friskies pates already, so I didn't have to change his food since the varieties he eats are at 5% and below in carbs. I'm 99% sure the vet did send blood and urine out for a full workup when Boots was first diagnosed, so I think we're clear there (for now). I feel confident in taking him off of the SO, so he gets no more dry food. I'm hoping to see a good change in his BG next week.

 

[Kris & Teasel]

Thank you, and thanks for the link to the chart. I did stumble across that last week, and it has been absolutely invaluable. The good news is I've been feeding him the Friskies pates already, so I didn't have to change his food since the varieties he eats are at 5% and below in carbs. I'm 99% sure the vet did send blood and urine out for a full workup when Boots was first diagnosed, so I think we're clear there (for now). I feel confident in taking him off of the SO, so he gets no more dry food. I'm hoping to see a good change in his BG next week.

We almost always suggest adding extra water to all wet food meals. It helps with hydration, cysititis, washing out of ketones should they develop, etc.

 

[tiffmaxee]

Welcome. You have gotten a lot of good advice already. I just want to make one suggestion. Ask for copies of all blood and urine tests for your records. That way you can keep track of everything. I learned the hard way how that can help. One of mine was anemic and I wasn’t told. Her kidneys were deteriorating and the oncologist never told me. With Max my vet would call with results and automatically email them to me. It helps should you end up at the ER or on the weekend with a vet who doesn’t know your cat.