Questions about everything....

[Stewie’s mom]

I took my baby, Stewie, to the vet in early November because he was not eating as well as he had been. At that time he was 14 1/2 years old and had been very healthy up until then. The vet looked in his ear and said it was jaundice and said it was his liver. She examined him, took an X-ray, took some blood and said his liver enzymes were high. She also showed us the X-ray, which was very cloudy, and said he could have something else going on with his liver such as cancer but we would need an ultra sound to get further results. At that time, his blood sugar was normal. The vet gave me a prescription of prednisone (in pill form) to give him. She also gave him a shot of a 2-week antibiotic. I was able to give the pill to him when he was in the mood to eat because I would crush it and put it in his food. He caught on to that pretty quick and when I tried giving the pill to him orally, he would keep spitting it out or he would vomit. With some research online I found that I could get the prednisone in a gel which I could rub on the inside tip of his ear. That worked much better and I really don’t understand why the vet didn’t give that to me in the first place. I was treating him with the steroid until the end of December, when the vet told me his blood sugar was high. She had me stop the steroid, as she said the steroid could cause the high glucose numbers.

She had me bring Stewie back to re-check his blood after he was off the steroid for a few days and it was still high. That is when we began the prozinc. We started at one unit every 12 hours. She tested his blood 3 days later and his blood glucose was still in the 300s. This has gone on until recently. Over a course of time because his glucose was still in the 300s at each visit, the vet upped his insulin to 1.5 units every 12 hours, then 2 units every 12 hours and he is now at 2.5 units every 12 hours. During all this, he has had 2 UTIs. Last Thursday was when his last UTI occurred. They checked his blood glucose then and it was 199, which is the best it’s been since we started.

I have some questions, however. Stewie continues to drink a lot of water and pee a lot. Like every 1.5 to 2 hours. Is this normal? He eats pretty good, thank God. I took away all his dry food soon after he was diagnosed. I do give him baby food (chicken, beef and turkey). I also give him canned tuna and salmon in water. His primary food, however, is fancy feast classics, which he has eaten since he was a baby.

We live in a very small town, with only a couple vets, that I really don’t have a lot of faith in. Every time one of my cat passes away, I vow to never get another one because of our local vets. But I love kitties and currently have 3 . I also think that because of Stewie’s age, they think, oh well....

Sorry this is so long and drawn out. I did try to summarize, but there are just so many things going on. Have any of your diabetic kitties had UTIs? Also, towards the end of the 12 hour cycle and just after giving Stewie his insulin shot, he drinks a lot of water and pees a lot, sometimes every half hour. It usually takes a couple hours before the insulin takes effect, but he still goes every couple hours. Is this normal? Also, the vet schedules me 6 hours after his insulin injection to do the blood glucose. Is this normal?? Why 6 hours? I don’t do homes testing. The vet has never suggested that I do it. They take the blood from his paw not his ear. Poor baby.

Any answers you can provide would be appreciated. I love my Stewie soooo much and just don’t want him to ever hurt.

 

[Kris & Teasel]

Have any of your diabetic kitties had UTIs

The glucose in the urine makes an ideal breeding ground for bacteria so UTIs are very common in diabetic cats.

Also, towards the end of the 12 hour cycle and just after giving Stewie his insulin shot, he drinks a lot of water and pees a lot, sometimes every half hour. It usually takes a couple hours before the insulin takes effect, but he still goes every couple hours. Is this normal?

Yes, drinking a lot and peeing a lot are symptoms of unregulated diabetes. Both of those improve a lot when blood glucose is better controlled.

Also, the vet schedules me 6 hours after his insulin injection to do the blood glucose. Is this normal?? Why 6 hours?

Insulin is given every 12 hours and ideally it's at maximum effect half way through that 12 hour interval and blood glucose should be lowest then. That point of lowest BG is called the nadir. Problem is, that nadir point can move around a little or a lot - it isn't always 6 hours after a shot. Also, the vet is assuming that the insulin action is ideal every day - ie., BG starts high, lowers to nadir at 6 hours and then gradually rises back to a similar high. That doesn't always happen. The BG can stay high all day, not because the dose is too low but because it's too high and causes rebound hyperglycemia. If a dose is raised based on that it's like adding fuel to a fire.

I don’t do homes testing. The vet has never suggested that I do it. They take the blood from his paw not his ear. Poor baby.

Lots of vets don't recommend home testing for a variety of reasons. If you've done other reading here on FDMB you've seen that this is the basis for everything we do in getting our kitties better regulated. Almost all of us use the outer edge of the ear and learn very quickly that it's a lot easier than you think and is the best way to know what's going on with your kitty's BG.

You've said that you don't have a lot of faith in your vets. Learning to test Stewie's BG at home would give you a lot of peace of mind. We can help with tips and tricks to make it easier. Give it serious thought and ask all the questions you have.

 

[Stewie’s mom]

Thank you so much for all your answers. I wish you were my vet

Also, Stewie meows at times. Sometimes when he’s by his water bowl or sometimes just when he’s walking around. He’s always been a very quiet cat who very seldom meowed. Do you think it has anything to do with pain?

 

[Kris & Teasel]

Thank you so much for all your answers. I wish you were my vet

Also, Stewie meows at times. Sometimes when he’s by his water bowl or sometimes just when he’s walking around. He’s always been a very quiet cat who very seldom meowed. Do you think it has anything to do with pain?

Has Stewie ever been tested for hyperthyroidism? Sometimes hyperthyroid cats are more vocal. It could be pain but cats are very stoic and don’t usually meow from pain unless it’s sharp.

 

[Djamila]

Welcome @Stewie’s mom! Kris has given you some great info already. Most of us don't really use our vets in managing the diabetes because while they mean well, they just don't know enough about diabetes in cats to be helpful. I have a pretty good vet, but I still don't follow his advice about insulin dosing. On a recent visit my regular vet and another vet in the practice were both looking at my spreadsheet and the 2nd vet commented that she's never seen a diabetic cat look so healthy. There is a ton of information around here and we have lot of experience taking care of our kitties through home testing, diet, proper dosing, and lots of chin scratches. We are happy to help.

If you'd like to get started on home testing, we have videos and a zillion tips and tricks on how to make it work. Most of us use a human glucometer instead of the pet ones because the ones made for pets are crazy expensive. You can get a human one and test strips from any local pharmacy for much less money and it will work just fine. Most folks around here get theirs at WalMart, but if you don't have one near you, I can send you a link to the one I get online at ADW Diabetes.

Please let us know any questions you have and how we can help!

 

[Kris & Teasel]

I'll be proactive and give you my "new members info package". Lots of stuff here so take it slowly and ask a lot of questions. It outlines our basic approach in keeping out FD kitties safe.

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet (SS) like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

[Stewie’s mom]

Has Stewie ever been tested for hyperthyroidism? Sometimes hyperthyroid cats are more vocal. It could be pain but cats are very stoic and don’t usually meow from pain unless it’s sharp.

Has Stewie ever been tested for hyperthyroidism? Sometimes hyperthyroid cats are more vocal. It could be pain but cats are very stoic and don’t usually meow from pain unless it’s sharp.

Stewie has has blood tests. I don’t think they were specifically for hyperthyroidism, but would a regular blood test provide that information? My vet never mentioned anything regarding hyperthyroidism.

 

[Kris & Teasel]

Stewie has has blood tests. I don’t think they were specifically for hyperthyroidism, but would a regular blood test provide that information? My vet never mentioned anything regarding hyperthyroidism.

No, you'd have to ask specifically for a thyroid test. I only threw that out as a possible cause of increased vocalization. Your kitty isn't that old but some elderly cats will become more vocal if they're losing their hearing or are becoming "confused".

 

[Stewie’s mom]

Thank you all for your responses. I don’t know if I would be able to self test. I live alone and as beautiful as Stewie is, , he can be a meany. He puts his claws in my hand and will pull it away from him. He’s almost like a little human. Although I never thought I’d be able to give him an insulin shot and now I do ( however some days are challenging).

I do have several more questions. How often do your kitties, that are regulated, go potty per day generally? I’m sure some of you will think I’m crazybut I currently have a surveillance camera in my bathroom, set on Stewies litter box, to see how often he goes to the litter box while I’m at work.

My other question is regarding Stewies UTIs. When I brought him to the vet, like I said, she gave him a shot of a 2 week antibiotic (convenia) and also gave him an oral dose of Metacam. She gave me four more syringes of Metacam for me to give him, orally, for the next four days. When I got home, I read up on Metacam and it wasn’t very good. The things I read said that Metacam came with a black label warning on the box, etc. I never received a box, only the filled syringes. My vet never informed me of any risks. Why would she prescribe something that may cause renal failure to a cat with these types of issues already? Have any of you been prescribed Metacam for a UTI? I ended up not giving any more of it to Stewie.

 

[Rachel]

Haha, trust me, we won't think you're crazy! Just wait...you'll see some of the nutty conversations we have here about following our cats to the bathroom and the exact size and consistency of poop. We're a fun group!

I never thought I'd be able to home test either! If you're interested in possibly starting, you could try just desensitizing first. Pick a place to test (mine was on a towel on the floor by the fridge) and carry Stewie there several times a day. Pet him and make a huge fuss over him (especially messing with his ears a bit) and then give him a treat. He'll come to associate that spot with treats and love and might take the testing easier once you get to that!

Metacam has been known to cause renal failure, but I think a lot of vets either don't believe that or don't know it. My old vet mentioned it to me once, but she chose not to give it to us. My poor kitty was going through so many issues and she told me that she'd heard it could cause renal failure and though she had prescribed it plenty of times and NEVER seen that...I would be the one person whose cat would get it from the Metacam. I wouldn't give it honestly. It's an anit-inflammatory used for pain relief and there are better options like buprenex. Many of us have NO METACAM written on our cats records. If this comes up again, I'd tell the vet you're not interested in the risks and ask for buprenex.

Side note, Convenia isn't usually a good antibiotic for UTIs. It's supposed to be used for skin issues mostly. I've had it work on mine before, but it's really not a good option if he gets another one.

 

[JanetNJ]

Thank you all for your responses. I don’t know if I would be able to self test. I live alone and as beautiful as Stewie is, , he can be a meany. He puts his claws in my hand and will pull it away from him. He’s almost like a little human. Although I never thought I’d be able to give him an insulin shot and now I do ( however some days are challenging).

I do have several more questions. How often do your kitties, that are regulated, go potty per day generally? I’m sure some of you will think I’m crazybut I currently have a surveillance camera in my bathroom, set on Stewies litter box, to see how often he goes to the litter box while I’m at work.

My other question is regarding Stewies UTIs. When I brought him to the vet, like I said, she gave him a shot of a 2 week antibiotic (convenia) and also gave him an oral dose of Metacam. She gave me four more syringes of Metacam for me to give him, orally, for the next four days. When I got home, I read up on Metacam and it wasn’t very good. The things I read said that Metacam came with a black label warning on the box, etc. I never received a box, only the filled syringes. My vet never informed me of any risks. Why would she prescribe something that may cause renal failure to a cat with these types of issues already? Have any of you been prescribed Metacam for a UTI? I ended up not giving any more of it to Stewie.

If you can get him to associate having his ears fiddled with with a treat it may help make him more relaxed about testing. A few times a day just rub and touch his ears, then give allow carb treat. Once he's ok with that you can attempt testing. I have a video in my signature showing how I test my cat CC at home.

 

[Djamila]

I promise you can test him! When my kitty diagnosed he was barely tame from being a feral for the first two years of his life. He would only rarely let me touch him at all when he was first diagnosed, and I live alone too, so having someone hold him down wasn't an option - besides, no one wants to torture their cat! I knew I couldn't make him go through this if it was going to make him horribly miserable. Fast forward a few weeks and while I wouldn't say he likes the tests even today, after the first couple of weeks he became a willing partner in them - even reminding me if I was running late.

And as you said, you've already got over the fear around the shots.

Watch a few of the videos - Janet mentioned the one in her signature, and here are a few others:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

And ask as many questions as you have. We have soooooooo many tips and tricks to overcome just about any testing trouble. When you're ready to give it a try, we're here for you!

As for the peeing question - the number of pees/day really depends - of course they pee a ton when they aren't regulated, but then they also pee a lot when they are eating wet food only since most of us add quite a bit of water to their food to keep them properly hydrated and avoid kidney issues, UTI's, etc. So it went from a lot of bad peeing to a lot of good peeing. The size of the pee is probably the bigger thing that I noticed changed. Sam used to make gigantic pee clumps before he was regulated, and much smaller ones now. The frequency is probably not that much different though, at least in his case.