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Tricia Cinco(GA) & Harvey

Tricia Cinco(GA) & Harvey

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My husband and I have four very spoiled indoor cats. We do not have five because one of our kitties is violently opposed to having any more housemates. Last October I noticed that an orange tabby that had been around the neighborhood for years was spending a lot of time in our yard. In fact, he was there all the time. After about a week I finally offered him food and water. He inhaled both. This became a routine. As the weather cooled and rains started, we set up a shelter in the back yard (Cinco picked the location). My husband kept referring to him as "number five", so I named him Cinco. By January, he was letting me pet and brush him, so I started using Advantage Multi on him - although he didn't like it, he never took a swipe at me or tried to bite me. I noticed that he had a very good appetite and drank a lot of water. In June I decided it was time to get him checked out and vaccinated. My plan was, if he was healthy, to contact a rescue organization and try to find him a forever home. He deserved more than I could offer him. I took him to the vet on June 22nd. He tested negative for FIV and Feline Leukemia, but they called that night to say he had a lot of sugar in his urine and wanted me to bring him back for more blood tests. Everyone at the office commented on how mellow and cooperative he was. On the evening of the 23rd, the vet called and said he was diabetic, and his mellowness was probably due to severe dehydration. We took him in on the 25th to learn how to give him insulin, and he received subq fluids. We started him on 1.0 unit of Lantus, once a day. We moved him into the garage and began feeding him moist DM twice a day and dry DM, available all day. He was peeing all over the garage - sometimes in the litter box, sometimes not. Drank a LOT of water. On June 28 we took him back for a BG test, and it was still over 500. His dose was increased to 1.0 twice a day. He was still lethargic and his back legs were weak. Sometimes he would just lie where he was and pee all over himself. On July 1st he was tested again, and still over 500. Dose was increased to 1.5 units, twice a day. There were a couple of bare areas on his hind legs, which the vet said was due to urine scald. On the morning of the 6th I took him in again, and his BG was still immeasurable. He was hospitalized and put on IV fluids and insulin. They were also giving him 2 units, twice a day. When they bathed him, fur just came off his back legs in clumps. They sent him home on the 10th, with instruction to give him 3 units, twice a day. They had also started him on Chinese tea pills to help his bladder control. We were instructed to bathe him every day. The next day, the 11th, I took him in for another BG check, and he was still off the charts. He seemed no better at all. The vet suggested it might be time to consider euthanization. I took him home and fed him and gave him his insulin, and cried over him. Then we went out for five hours. When we came home, he was standing up in his cage and meowing! We decided to give him more time. Over the next couple of days, he continued to be more alert and seemed stronger. He stopped peeing on himself, although he didn't always use the litter box. I started feeding him smaller meals of the moist DM, and no dry food at all. On the 14th we went back for another check and he was still over 500. Vet was encouraged by his improved behavior and upped the dose to 3.3 units, twice a day. I got a home meter and on the 15th took my first reading - 365 five hours after his evening shot. The vet adjusted his dose to 3.5 (too hard to do 3.3). On the 16th we left him at the vet all day so they could do a curve. I don't have the numbers yet, will get them in the next day or two. On the 17th his BG ranged from 90 to 235. I noticed he wasn't drinking as much water, nor urinating as much. Still good appetite! The vet said we could reduce dose if we wanted. Decided to drop it to 3.0. On the 18th his levels ranged from 120 to 524 (First time over 500 since the 14th). Today (the 19th) his AMPS was 417, and he was at 259 +4, 426 + 9 and at 64 four hours after his evening shot! I feed him every time I do a BG test, as that's the only way he'll stay still. He's never shown symptoms of hypo since I started testing him at home. He's still moving fine, although his back legs are a little wobbly at times, and he's more alert than he's been since before he was diagnosed. I don't know what to do now - do we increase the dose, leave it alone for a while longer, or decrease it? Please, Help!
 
Good job on hometesting! Now please stop paying your vet to do it for you :lol: If you know how to do it, there is no reason to have the curve done by a vet. he's doing the same thing you are. But Cinco is probably stressed out at the vet's office which causes higher bg levels. This may cause the vet to increase his dose too much. The super high/super low numbers may be a result of too much insulin. When the body gets too low, it dumps out stored glucose to protect itself--resulting in high numbers. Without a little more info, though, it's hard to say for sure. You should probably try to get some ketostix from your pharmacy (dipsticks to test for ketones in urine). Ketones are the dangerous result of having too high bg, not enough food and water, and not enough insulin. they can build up and lead to ketoacidosis. With Cinco's high numbers you should try testing for them to be safe.

Also, there is no need to feed expensive rx food. We advocate a low-carb, high-protein diet. Most of uson a budget use Fancy Feast Classics, Friskies pates, and 9 lives pates. There are better brands out there, but those are widely available and inexpensive. Keep in mind, that a switch of food (especially doing away with the dry) may result in a lowered insulin need. That's why it's so important to test before every shot. If Cinco's bg is ever below 200 before a shot (pre-shot or "ps"), SKIP the shot! Once you know more of what's going on with him and how he reacts to the insulin you can start shooting on lower numbers, but for now you should consider 200 your no-shoot number. Here is a link to Janet and Binky's food list--try to stick to food below 10% carbs.http://binkyspage.tripod.com/canfood.html You may want to decrease the dose a bit during the changeover, but I'd like others to weigh in on that first.

You're doing great so far and you have a very kind heart to take in Cinco and take care of him. ((hugs)) Please ask any questions you have.
 
What a lucky cat, Cinco is to have found you.


What insulin are you using? Simba uses Lantus and is also very difficult to regulate, that's just the kind of guy he is, but with the Lantus and the numbers 90 to 235, I would have stayed with the 3.5 U for a while.
 
Can you copy your above post and start a thread on the Lantus forum? I think you will get a better response there. to copy and paste, you probably have to edit your post, copy the print, close out the edit, then go over to lantus, start a new thread then hit paste. that's a lot of retyping so this should work.
We were on lantus but just for about a month. Cedric is in remission and is "off the juice." Taking away the dry food is helping your 5! If I read your post correctly, you have been giving him 3.5 units twice a day since last Friday, dropping it to 3 at least one time? Since I haven't used the insulin long enough, I don't feel comfortable making a call, hence my advice to post in "Lantus land."

good luck and bless you for helping this cute stray!
 
Welcome and what a good job you've been doing with Cinco.

As others noted, diet is very important with managing diabetes. The canned DM is not terribly high in carbs but the dry food is higher in carbs than what a diabetic can easily process. As noted in a previous post, the majority of us feed low carb, canned food in the varieties mentioned. (Cats are obligate carnivores. A dry food diet is bad for them and adds to their being dehydrated, among other things.)

There is a great deal of information on the Lantus board. An outline of the info there, with links follows:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
I'd encourage you to look over the information on the Tight Regulation Protocol. This is our guide to dosing.

Please let us know how we can help.
 
Wow! Thank you all for your responses, info and encouragment. The friend that referred me to this site was right - you people are amazing.

First, in response to your comments/questions:
Doombuggy, thank you for the suggestion. I just copied my post (updated with today's info) to the Lantus board. We have been giving him 3 units, twice a day since the 18th.

Ann & Scatcats, I am using Lantus.

Charliemeow, how do I test for ketones if I'm never present when he urinates? Don't you have to hold the stick in the stream? What about the litter additive I've seen advertised? Does that work?

Sienne & Gabby: I feed my other cats FF Classic. I was told not to give a male diabetic cat the fish flavors. Is this correct? I have purchased some beef and chicken flavors and will start transitioning him to it from the DM. I read the Tight Regulation Protocol. If I understand correctly, they want you to start with a dose of .25 per kg of weight. Cinco weighs 9 pounds, so I think that means I should give him 1 unit twice a day. That is what the vet started him on originally. So do I go back to that, or try to merge into the protocol somehow? I'm more confused after reading all that!

Anyone: How do I add Cinco's picture to my posts? I tried uploading it as an attachment, but when I click on "Add the file" I get an error message.
Also, how do I make my spreadsheet available to anyone who wants to see it? confused_cat

Thanks again!
 
I was guilty of stalking Charlie till he peed. Some people put a layer of aquarium gravel in a clean, empty litterbox and then test in the urine since it won't get absorbed. I don't think I've heard of ketone-testing litter. That's a neat idea. Maybe someone else here has used it and can offer their opinion.
 
nemismom said:
I was told not to give a male diabetic cat the fish flavors. Is this correct? I have purchased some beef and chicken flavors and will start transitioning him to it from the DM.
Click to expand...

I hope that isn't correct. Bob has been eating nothing but FF classic for several weeks including the fish/seafood flavors. I know you shouldn't feed only seafood because of the risk of too much mercury in seafood. But Bob is thriving on all the flavors. Did you read that somewhere, or did somebody tell you that? I'm wondering "why not" I guess...

nemismom said:
Anyone: How do I add Cinco's picture to my posts? I tried uploading it as an attachment, but when I click on "Add the file" I get an error message.
Click to expand...

I just figured out how to do that last night. I'll send you a PM on how I got it to work. Actually easier than I'd thought.

Welcome to the board!
Carl in SC
 
Re: Now Do We Increase a Little?

Cinco is doing well. He acts like a normal cat again, moving around well, even has started grooming again. We've had him at 2.0 for almost five days and his readings have become fairly consistent, but there's still a 150-200 swing. I'm not sure if we should increas him by .25? Any thoughts, please?
confused_cat

Here's the link to his spreadsheet:
https://spreadsheets.google.com/spreads ... c&hl=en_US
 
The link to your spreadsheet is broken--you need to re-paste the link in your signature, but this time put it between the brackets. That will keep it from breaking every time you edit your signature.
 
The others in Lantus land might be able to give you better advice on the dosing, but I think you might need to give the current dose a little more time to see what it is doing.
 
Sorry, I'm really a rookie at this. Is this the right way?

[https://spreadsheets.google.com/spreadsheet/ccc?key=0Ap1XMeCgVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US]
 
no, that didn't work. I wish I could remember....There should be [url], and you want to paste to lin...ong! I'm one of the least tech savvy people!
 
You got the spreadsheet right!

Ok, it looks to me the dose is definitely too high, and I would decrease it. I'm sorry I didn't get back to give you advice last night (my computer crashed!), but I'm hoping you did not shoot 2u this morning. The high numbers you are getting are bounces from the super low numbers. It looks like your dose was raised too high too fast--dose increases should be made in .25u-.5u increments based off the nadir (the lowest number, usually around the +6), and held for at least 6 cycles. I see that Sienne posted it earlier, but following the dosing protocol is very important http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151.

I think you should start over at 1u. You didn't have enough data in the beginning to see how the insulin was really working on Cinco, but now you do! You can always raise the dose safely by .25u if 1u too low, but good amount of cats on a completely wet diet don't ever need much more than that. I'm going to cross post this thread over in the Lantus so you can get some more eyes and advice.

You might want to think about posting regularly in the Lantus forum for dosing advice--there's a lot a people there who know the insulin very well and give excellent dosing advice, which is incredibly valuable when you're first starting out. Advice can sometimes take a while to reach you in the Health forum because there aren't as many Lantus users here as in the Lantus forum.
 
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