Newly diagnosed

[Georgiana & Perlutz]

Hi All,

My “little” boy Perlutz has been diagnosed with diabetes 3 weeks ago and we haven’t made any progress yet, on the contrary...he seems unwell
Short introduction - he is 11yo (12 in April) and he has been overweight for years (currently 6.8kg/14.9 pounds). Previously, he was on Hills Metabolic dry food (vet recommended) and a daily can of wet food from different brands. He was licking his bowl clean of pretty much any can of wet food out there.

On the day of the diagnosis, his blood level at the vet was 33.3 and he was prescribed 2 units of Caninsulin, twice a day and the vet sold us Hills w/d wet and dry to get him adjusted on gradually. Luckily, he was amazing with the insulin shots but he refused the w/d food So we’ve kept him on his old Purina Gourmet cans, without any dry food. The first week, he was eating 1 can before insulin, twice a day but then he slowly started eating less and less, regardless of the brand or flavour I sometimes offered him 4-5 different flavours, just to get him to eat

We’ve been told by the vet not to home test the first 2 weeks, go back and see her. Which we did 1.5 weeks later and she did a fructosamine test (669 was the result of that) and BG on the day was 23.3 and sent us home to continue exactly as before.
In the meantime, our BG meter arrived, we went for the AlphaTrak 2 ( should I have not rushed the purchase, I might have gone for something else) but we had trouble testing as there was not enlugh blood coming out so we were left with a cat with no appetite and stressed to the max I’ll spare the details, but we weren’t happy with the vet so we went for a second opinion at his old vet (only reason we didn’t go to him at the first signs of DM is because he was fully booked for quite few days). He handled Perlutz much better and agreed with my fears, that the fructosamine test was a useless stress for him and my pocket as it was done 1.5 weeks after starting insuline when results are not accurate and he would have advised on ProZinc rather than Caninsulin... His BG at this vet visit (2 weeks after diagnosis) was 18.1. He advised to stick with what we’re doing and the Caninsulin at least until we do a glucose curve, which we werw hopingbto do last Sunday.

But Perlutz has been incredibly stressed ever since He is not playing, doesn’t want to be with us, avoided and even hid from us sometimes, hardly eats anything, he’s not chilled about his insulin shot anymore... all he does is lay in his bed Yesterday morning 1h after mean he vomitted a little bit and this morning, before food, he vomitted a little gastric juice and had a softer poop

This morning we finally managed to test his BG at home and he tested a whooping 34.8 on the AlphaTrak We’re hoping for a glucose curve this Sunday but until then, I am hoping some of you wonderful people and fur babies could give us some advice pleaseeee Also, we’re in the UK (Berkshire).

Thank you all and please excuse the very long post!

Georgiana & Perlutz

 

[Nan & Amber (GA)]

Oh, I'm so sorry you guys are having such a rough time! Poor Perlutz, he sounds like a trouper.

It sounds like you are on the right track in terms of following up with your vet(s) and trying to make the recommendations (food, testing, etc) work for you. In the long run, this will serve you well, but I'm very concerned about the current situation, with Perlutz clearly feeling unwell. Couple of possibilities:

1) the two units of Caninsulin is a high-ish starting dose for a cat, and it may be too much for him. The one 34.8 doesn't tell you one way or another, because one of the things that can happen on a too-high dose is a lot of bouncing up and down; the insulin brings them (way) down, then their bodies react by dumping extra sugar into the blood and you get a sky-high number. When (relative to shot time) did you get that 34.8?

2) He could just be feeling yucky from the high numbers, but some of the things you mention (vomiting, soft poop) suggest that there may be something else going on. Has he been tested for pancreatitis? Does he seem like he's in pain at all, spending time in "meatloaf" position? Pancreatitis can be really painful and definitely get them off their feed. No cure per se, but they can feel a lot better with symptom management (pain meds, sub-cutaneous fluids, anti-nausea meds).

Keep an eye on his eating-- if that doesn't improve soon, I'd take him in to the vet for another assessment and maybe treatment. I'd also do a few more practice BG tests now that you have the meter in hand. Not only will it make the curve go easier if you have more practice, but getting more data will help folks here assess the situation. We also recommend always testing before a shot (especially a fast-acting insulin like Caninsulin) to make sure it's safe.

Hoping some of the UK folks and those with specific Caninsulin experience will be able to offer some more specific suggestions.

Hang in there, I hope Perlutz is feeling better very soon!

 

[flyingduster]

Oh man, it’s a roller coaster right!!!

Has the vet tested him for ketones? With the high levels and the lethargy and not eating well, my worry is DKA.... I am new here so I’m sure others will help, but my girl when in to DKA and that’s what she was like...

 

[Georgiana & Perlutz]

Hi Nan,

Thank you for your reply

Compared to the last 4 days, he has improved slightly today since writing this in the morning. He has looked a bit more lively, ate a bit more and seemed to enjoy eating. He’s still not his usual self, but any improvement is welcome!

I didn’t find anything (yet) on what a normal/usual dose of insulin would be, but we had some suspicion it might be a bit too much just like you said... During his first week, he had no dinner once and we skipped the dose (we called the vet and they advised skipping) and within few hours, we got our cat back! He was lively again, coming for cuddles, coming to bed at night etc. This has happened a couple of times now, but as the 2nd vet did not challenge the dose, we just followed the initial advice...

The 34.8 reading this morning was taken just before his meal and 20-30 min before insulin. However, he did get a reduced dose last night as he hardly ate anything. This is one thing we’re still struggling with, whether to give full dose or not if he is not eating? I’m hoping it will make more sense when we will monitor his BG constantly. After reading a lot on FDMB, I umderstand it’s crucial to monitor.

As for pancreatitis, I was also fearing that... He has not had any tests specifically for it, that I know of... The first vet we saw wasn’t really sharing a lot, hasn’t even explained the blood test results to us... Perlutz hasn’t done the meatloaf pose really, he’s mostly on his side (changing sides, positions) in his round basket or stretched on his mat in the other room. He doesn’t seem to hurt when I pet him, but he does sometimes meow when I pick him up to give him a cuddle. But not sure if this is not just due to him being stressed and a bit upset with us for taking him to the vet 3 times in 2 weeks, shooting his insulin daily and few previous BG testing fails...

We currently have an appointment on Wednesday next week. I’ve booked it to discuss the curve results (hoping to do it Sunday) and see what the vet thinks should be the next steps. But I will definitely take him to be seen earlier if there are any changes or he vomits again.

Can insulins be changed just like that overnight? I’ve read that the general advice is to never put a newly diagnosed on Caninsulin and that others are so much better. I cannot understand why we were put on this, it was given to us straight after diagnosis with no mention of other brands/types.

Thank you so much for taking time to reply, it really means a lot in these moments of desperation!

Georgiana

 

[Georgiana & Perlutz]

Oh man, it’s a roller coaster right!!!

Has the vet tested him for ketones? With the high levels and the lethargy and not eating well, my worry is DKA.... I am new here so I’m sure others will help, but my girl when in to DKA and that’s what she was like...

Hiya,

The 1st vet did comprehensive blood tests but never explained them to us
The results were as it follows (no reference numbers have been given), maybe someone understands these better:
WBC: 4.9 L
LYM: 0.6
MONO: 0.2
NEUT: 3.9
EOS: 0.2
HGB: 15.0
HCT: 43.3
RBC: 8.15
MCV: 53.0
PLT: 421

TP: 83- H
ALB: 44 H
ALP: 116 H
GLU: 33.3 H
TBIL: 2
IP: 1.2
TCHO: 7.99 H
GGT: 2
GPT: 57
Ca: 2.74
CRE: 94
BUN: 11.78
Na: 148
K: 4.0
CI: 106 L

There are just 2 notes the vet made to these, high liver enzymes and cholesterol.

I did buy keto-stix and diastix the other day. With Perlutz so stressed already, I haven’t collected a urine sample yet, leaving that for tomorrow when I can watch his toilet usage I did put one of the sticks on the bottom of the litter box, where the litter was soaked in urine, and it was clear for ketones and high for glucose. However, I know this is not proper testing so will have to wait for the clingfilm method tomorrow. Also considering buying a ketone blood meter.

How is your little girl now?

 

[Nan & Amber (GA)]

Oh, so glad to hear that he's eating a bit better! That really is crucial-- as flyingduster pointed out, at the end of that road is DKA, and you do not want to go there. So, eating is good!

I think that there are some kind of regulations in the UK (someone who knows better can correct me on this) that state that vets have to start with Caninsulin, and only afterwards move to other insulins. If you can change to ProZinc or something else, it should be no problem to just do the switch, as Caninsulin is an in-and-out type of insulin.

Acting more himself after a skipped shot is intriguing... could be that the dose is wrong, or it could just be that this insulin type doesn't agree with him for some reason or another (it can happen). Getting some more BG tests might help sort it out, but I'm also glad you're going back to the vet next week to discuss the situation. It sounds like your regular vet has some experience with FD, which helps tremendously!

 

[flyingduster]

It’s stressful right!?! But keep going. Keep reading. Keep learning. It begins to make more sense as time goes on.

I’m about two weeks in now and I still feel utterly disheartened and worried, but not nearly as overwhelmed.

But it is a marathon, not a sprint. We will get there.

 

[Georgiana & Perlutz]

Oh, so glad to hear that he's eating a bit better! That really is crucial-- as flyingduster pointed out, at the end of that road is DKA, and you do not want to go there. So, eating is good!

I think that there are some kind of regulations in the UK (someone who knows better can correct me on this) that state that vets have to start with Caninsulin, and only afterwards move to other insulins. If you can change to ProZinc or something else, it should be no problem to just do the switch, as Caninsulin is an in-and-out type of insulin.

Acting more himself after a skipped shot is intriguing... could be that the dose is wrong, or it could just be that this insulin type doesn't agree with him for some reason or another (it can happen). Getting some more BG tests might help sort it out, but I'm also glad you're going back to the vet next week to discuss the situation. It sounds like your regular vet has some experience with FD, which helps tremendously!

To be honest, I had higher expectations from the first vet as she is a diabetic herself. I know it’s not exactly the same, but you’d think one would know more and be more empathetic...Unfortunately, we felt it was money before anything else as we went there twice and on top of blood work, insulin etc we were charged just under £50 each time for a “check up” that wasn’t done at all, instead a note was put in the system that said check up could not be performed because he is aggressive He is not an aggressive cat, buy they’ve refused to allow me to be with him and instead took him in a back room, wrapped him in a towel, shaved his neck etc. His other vet is much more confident in handling him, no towels involved, spoke to us so much more and we will stick with him.

As for the insulin, I’ve read somewhere on the forum that the Royal Veterinary College never recommends Caninsulin for newly diagnosed cats as there are better options available. We have a brand new Caninsulin bottle as we stuck to the vets advice not to change before doing a curve so will stick to this for few more days but I do have a feeling it’s not really agreeing with him...

 

[Georgiana & Perlutz]

It’s stressful right!?! But keep going. Keep reading. Keep learning. It begins to make more sense as time goes on.

I’m about two weeks in now and I still feel utterly disheartened and worried, but not nearly as overwhelmed.

But it is a marathon, not a sprint. We will get there.

I feel exactly the same! I’ve had a couple of break downs already I have syringe needles, injections and blood phobias so it hasn’t been easy but I’m so lucky that my bf has been amazing and doing all shots etc, I am there for moral support for the cat