Newly diagnosed.

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Anitafrnhamer

Anitafrnhamer

Member Since 2013
Newly diagnosed, overwhelmed, and terrified.
My boy, Squeaker, 11 years old, is currently hospitalized and newly diagnosed with Diabetes. Please forgive me if this post is confusing or chaotic as I am not certain of what information is/is not helpful.

In Jan 2011 he was diagnosed hyperthyroid and put on a methimizole trial. He did not tolerate the methimizole, that medication was withdrawn and we had to wait until June 2011 do undergo I-133 treatment. He has not done well since the methimizole trial. Since that time he has had recurrent bouts with allergies for which he was given steroids. His last steroid injection was on May 24, 2013. On June 12, 2013 I insisted that a full blood work up be performed. His behavior was off-increased thirst/urination, increased appetite, everything about him was off.
On that date a glucose test was done and his level was perfectly normal( 149.0 mg/dL) but he was dehydrated. On July 5,2013 I took him to an emergency vet. He was lying in a heap on the floor and was too week to move. Another full blood work up was done and his glucose had shot up to 546 and he was dehydrated again. His blood work was all over the board very little was normal. He was given sub-q fluids again and sent home. The following day, July 6,2013, he again dehydrated and was lying on the floor unable to move. That afternoon he was hospitalized.
The chaos and confusion began.
He was anemic, kidneys painful/enlarged (possible infection/cancer), liver enlarged(possible hepatic lipidosis), pancreatitis, definitely diabetic, dehydrated, enlarged heart. He was not expected to survive.
The vet hit me with so much information on Sunday (7 July) that I am still reeling. He was talking a transfusion for the anemia and a feeding tube. By Monday (8 July) Squeakers condition had improved slightly but an echo cardiogram had been done and I was told that he also has restrictive cardiomyopathy. They were surprised that he had survived the night.
Today is Tuesday (9 July) and his condition is steadily improving. I went to the clinic today and had to take injectable insulin. Squeaker may be released tomorrow night or Thursday morning.
I am sorry I can't give a lot of information about labs or insulin dosage but when I bring him home, he is to have 2 injections daily. They are also pushing a prescription diet and I am so very uncertain as to what to do or what food to feed. I also have suggested that the glucose level on 12 June 2013 was skewed by the steroid injection of 24 May 2013 but that just seems to be unheard because this vet keeps saying "He hid the symptoms." I was just trying to get an answer as to how the glucose level could have been normal on the 12th but through the roof 3 weeks later on 5 July.
I am still learning, crash course, please bear with me.
I would greatly welcome any and all advice.

Anita and Squeaker.
 
Welcome to FDMB!

First step ... breathe! You've been through the wringer already.

Diet - prescription diets tend not to be diverse, nor even as nutritious as some over the counter foods. See Cat Info for some really great feline nutrition information. There's a printable food chart there too. If you're not in the US, there's a sticky post here.

Good insulins for cats include Lantus, Levemir, ProZinc, and in Europe, PZI.

We strongly advocate home blood glucose testing with a human glucometer, to keep your cat safe and to check the insulin's effectiveness.
 
Hey its ok, we can help with the diabetes and many of our members have experience with other issues too..

What country are you in? We can advise more on food etc if we know where you live?

The key to regulating or even remission in cats is 3 things. 84% of cats go into remission in 6 months with these things in place. Squeaker could well be one of them since, you are right, the steroid could have tipped him over the edge

Three keys to diabetes treatment in cats
1. Food. The food needs to be a low carb canned <10% calories from carbs. You do not need a prescription food for the diabetes - its expensive and other low carb canned foods work just as well ie Fancy feast classic pates if you are in North America. What were you feeding before?

2. Insulin - you want a good insulin that works well in cats. BJ already mentioned those - Lantus, Levemir or Prozinc.

3. Home testing - this is key to keep your cat safe and help adjust dose as they become regulated or go into remission. Don't change the food without home testing first as the food change can drop the blood glucose fast and then the insulin is too much.

We can help advise on these when you are ready

Wendy
 
Was a cardiologist used to do the echo on his heart? If not, I would strongly suggest you see a certified veterinary cardiologist and definitely confirm the RCM. He can not have steroids if he has RCM...worse thing for his heart. I would also learn to hometest ASAP because he may be a steroid induced diabetic and once it is completely out of his system, he may no longer need insulin. Also, my Hope had been on insulin for 4 1/2 yrs. when she suddenly stopped needing it. Got her in to an IM vet and also a cardiologist. She was dx'd with RCM but there is no evidence or studies done as to whether a heart problem can somehow make a cat stopped needing insulin. All I know is Hope has been dealing with her RCM for 5 1/2 yrs. and still off insulin and doing fine. I was lucky in the fact that we caught it early and that is only because I wanted to know why she didn't need insulin anymore. If she hadn't been diabetic, I don't know if she would still be with me. She showed no signs of a heart problem. I hope your Squeaker's will be home soon with you and improving.
 
What a warm and compassionate welcome. Thank you.

I live in Dayton, OH so the foods recommendations I saw when I skimmed the food information are easily available. Friskies Classic Pate has always been one of his favorites and he has always gotten that several times a week. For many years I had fed him Iams then 2.5 years ago I began feeding him Natural Balance LID. I couldn't figure out why cats needed all those fruits and veggies and grains so I was trying to put him on a better diet. Unfortunately for him I didn't understand that dry food was not a good thing nor were the carbs.

Just to clarify a few things.

The echo was performed by a cardiologist so I am fairly confident of that diagnosis.

Steroids. That information really shocked me and I don't find that to be any small coincidence that he had them on 24 May and by 12 June we began seeing issues. I can see where that could have been a big contributing factor. He isn't on steroids continually. About once every three months during the summer he would be given an injection of depomedrol for allergies.

I was relieved to see that the insulin prescribed, Lantus, was mentioned as a good one.

A question I do have though is: How do you know that the cat doesn't need insulin any more?

Guess I will be learning as I go along.

Again, thank you so much for the information and support you are showing us.

Anita and Squeaker
 
You home test the blood glucose for safety and to adjust the dose of insulin, that's how you determine it isn't needed anymore :smile:
 
Hi Anita and Welcome to the FDMB. We have a broad range of knowledge,not only about diabetes, but other cat issues and you found that out with Hope's response.

Please, ask all the questions you need to. Multiple times if necessary. There is a lot to learn and we will help you as much as we can along the way. You and your cat Squeaker have started on this new diabetic sugardance. With the steroid induced diabetes, there is a very good chance you can get him into remission.

Since you live in the US, a great meter to get for testing is the Relion Confirm, Micro or Prime,all from Walmart. They have inexpensive test strips which is where you major testing expense will be. It's still a great way to save money and make your cat safe with the home testing. My vet charges $100 for each "curve test" done at the clinic. It add's up quickly.

We have a great list of tips and tricks and videos to teach you to home test. home testing tips
 
Squeaker In Hospiatal Again

I brought Squeaker home from the hospital Thursday. He did well then and seemed even better on Friday. I gave all his meds and insulin faithfully. Today I noticed his water consumption was increasing again. I checked him and he was dehydrated so I took him to the emergency vet clinic. He was dehydrated so they put him on fluids and checked his glucose which had shot up to 600 just less than an hour after his second injection of the day. So now he is back in the hospital again.

Are scenarios like this common in the beginning?

Anita and Squeaker
 
Your experience is not common. However, Squeaker seems to have numerous medical problems which is compounding the treatment of diabetes.
One question is how bad was the anemia?
You also said "which had shot up to 600 just less than an hour after his second injection of the day." Do you have the BG reading before the shot? How many units of Lantus were given?
 
Larry,

I do not think Anita is home testing yet. Reading back through her posts, I only see numbers from the vet.

We have suggested home testing, but Anita had not started that yet. At least, she has not told us she has started home testing yet.
 
Anitafrnhamer said:
Newly diagnosed, overwhelmed, and terrified.
My boy, Squeaker, 11 years old, is currently hospitalized and newly diagnosed with Diabetes. Please forgive me if this post is confusing or chaotic as I am not certain of what information is/is not helpful.

In Jan 2011 he was diagnosed hyperthyroid and put on a methimizole trial. He did not tolerate the methimizole, that medication was withdrawn and we had to wait until June 2011 do undergo I-133 treatment. He has not done well since the methimizole trial. Since that time he has had recurrent bouts with allergies for which he was given steroids. His last steroid injection was on May 24, 2013. On June 12, 2013 I insisted that a full blood work up be performed. His behavior was off-increased thirst/urination, increased appetite, everything about him was off.
On that date a glucose test was done and his level was perfectly normal( 149.0 mg/dL) but he was dehydrated. On July 5,2013 I took him to an emergency vet. He was lying in a heap on the floor and was too week to move. Another full blood work up was done and his glucose had shot up to 546 and he was dehydrated again. His blood work was all over the board very little was normal. He was given sub-q fluids again and sent home. The following day, July 6,2013, he again dehydrated and was lying on the floor unable to move. That afternoon he was hospitalized.
The chaos and confusion began.
He was anemic, kidneys painful/enlarged (possible infection/cancer), liver enlarged(possible hepatic lipidosis), pancreatitis, definitely diabetic, dehydrated, enlarged heart. He was not expected to survive.
The vet hit me with so much information on Sunday (7 July) that I am still reeling. He was talking a transfusion for the anemia and a feeding tube. By Monday (8 July) Squeakers condition had improved slightly but an echo cardiogram had been done and I was told that he also has restrictive cardiomyopathy. They were surprised that he had survived the night.
Today is Tuesday (9 July) and his condition is steadily improving. I went to the clinic today and had to take injectable insulin. Squeaker may be released tomorrow night or Thursday morning.
I am sorry I can't give a lot of information about labs or insulin dosage but when I bring him home, he is to have 2 injections daily. They are also pushing a prescription diet and I am so very uncertain as to what to do or what food to feed. I also have suggested that the glucose level on 12 June 2013 was skewed by the steroid injection of 24 May 2013 but that just seems to be unheard because this vet keeps saying "He hid the symptoms." I was just trying to get an answer as to how the glucose level could have been normal on the 12th but through the roof 3 weeks later on 5 July.
I am still learning, crash course, please bear with me.
I would greatly welcome any and all advice.

Anita and Squeaker.
Click to expand...

Anita,
I hope it will help you to take each item separately.
1. HyperT - had I-133 in July 2011, and all is good there? Were you told that the treatment was successful, and what do you mean about not well since the methiz trial....

2. Allergies - he had them before but just started with the steroid shots for them? Do they seem to help - how was he before shots and then after, and how long before another shot was needed.

3. Blood glucose - Are the numbers you mention just simple glucose numbers on blood panel results, or has the vet ever done a fructosamine test which lets you know how the average of his numbers over the last few weeks. I hope you can start home testing soon, if you have not already started; you need to know how he's doing, and it's the only way you will know if his numbers improve to the point of no longer needing insulin.

4. Anemia - do you have some numbers and what is the vet doing for the condition? What were you told about his issue?

5. Heart - In case you have not been given any info on RCM, you can start on this site, it's a good one... http://www.fabcats.org/owners/heart/cardiomyopathy.html

6. Fluids - you can give fluids at home and it would be much easier on him and less of an expense for you. A great many people give their cats fluids at home for all sorts of conditions, and I am sure he will appreciate getting fluids in the comfort of his own home. Find out from the vet how much they have been giving in each single sitting, and how much you can give at home. You can purchase a kit from your vet office, and if they are needed indefinitely, you can find out about purchasing the lines and fluids from other cheaper sources. You can order them online, and have a full box of fluids on hand to use as needed. Just be careful with too much at a time as it's a strain on the heart, so if you need to give 100ml a day, split it into 2 sittings of 50ml in a day.

7. Diabetes - the home testing will show you how well the dose of Lantus is working, and if you need to give more or less. There is a good protocol that many follow on this board and people can help you get set up and settled. People usually record their test results in a google spreadsheet as you can make it shared so that multiple people can look at the numbers at the same time.... it comes in handy when someone is explaining to you what the numbers you are getting really mean and how you should proceed with dosing. It's helpful to have others guide you along until you are able to 'see' his patterns in the numbers. And finally, you can email the link to your vet to see how you two are doing.

8. Food - you don't need any fancy, expensive vet food; you will be just fine with Fancy Feast or Friskies pates. Pretty much pates are the way to go, and add water into the food so it adds to his fluids intake for the day. Take a good look at Dr. Lisa's list of foods and stick to foods under 10% carbs. If you don't see a food on the list, treat it as an unknown, and stick to the foods in her list because you know the numbers for them. .... catinfo.org/docs/FoodChartPublic9-22-12.pdf

9. Medications - Can you list the meds, including the Lantus dose, that you are giving him at the moment? It is helpful to know all that you are giving, just to confirm there no bad interactions... you can check yourself if you like .... http://www.drugs.com/drug_interactions.html

10. Pancreatitis - was this condition just mentioned or did the vet do a test for it? The fPLI test would give a result number that would tell if negative- under 3.5, grey area- 3.5-5.0, or positive- over 5.0. Treatment is something for upset stomach like Pepcid AC, fluids every day for a few days, and definitely pain medication - buprenex is the best for pancreatitis.

11. Can you get a list of all the things done at the vet office, and a listing of what meds, amounts, and times given while at the vet office? It's important to know what they do there because maybe you need to continue at home.

Trips to, and stays at, the vet office are extremely stressful on the animal, so most people try to do as much as then can in their homes .... you will find he's better at home for most things.

Gayle
 
What are you feeding right now? Dry is too high in carbs as you are aware. Also the natural balance is too high (over 14% calories from carbs). The friskies pates are better, or fancy feast classic pates if you think he would like those.
 
1. HyperT At the 1 and 3 month post treatment check-ups his T4 and Free T 4 had been reduced to the normal range (was not given the exact numbers) but I was told that the treatment had been a success. After he had the reaction to the methimizole (self-mutilation, periodic vomiting, hiding, depression) the self mutilation continued for about a year and that is when the steroid injections began, he also began to have sinus allergies (running eyes and ear discharge). The depo injections occurred on Feb 2012, Mar 2012, Nov 2012, Feb 2013, and May 2013. There was no real pattern to the allergy events and despite the vet’s advice I did not get one monthly. Prior to the methimizole trial he was a very affectionate cat, after that he no longer purred (Feb 2011-present) he did not seek nor would he tolerate affection/petting, he stopped sleeping on the bed at night with the exception of heat seeking behavior during the winter (for the first time in 10 years he would get under the blankets and snuggle like he was cold).

3. Blood glucose This whole condition with the high glucose and dehydration began around the 4th of July. By the 6th he was hospitalized and was not released until the 11th. On the 13th he had to be hospitalized again. All of the numbers and data I have are from the tests done by the internist at the vet clinic over the course of the past week. I had only been dealing with this at home for 2 days when I had to take him back to the clinic so I had very little time or experience with this condition. Before I picked him up from the clinic on the 15th I did purchase a ReliOn Confirm and testing supplies.

4. Anemia On 12 June when the first bloodwork was done he was 22%. The vet I was taking him to at that time did not tell me that he was anemic. Treatment for the anemia began on 7 July (still 22%). He is being given a vitamin/iron supplement (Amino B-Plex) twice daily. On 8 July the anemia was 27% and have not been given any additional information since then. There was no information given as to the possible cause of the anemia.

9. Medications Clavamox 62.5mg tabs 1 tablet 2x daily 6 am and 6 pm
Marbofloxacin 25 mg tabs ½ tablet 1x daily 6 am
Famotidine 10 mg tablets ½ tablet 1x daily 9 pm
Tumil-K gel 2.5ml 2x daily 6 am and 6 pm
Amino B-Plex 1ml 2x daily 6 am and 6 pm
Lantus was 2 units every 12 hours Now 3 units every 12 hours 9 am and 9 pm
Sub-q fluids 100 ml every 24 hours starting today, 16 July 2013

10. Pancreatitis A sonogram is what was used as far as I was told. As far as other testing, I had asked for test results, etc and they were not provided.
 
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