Relapse?

[Tricia Cinco(GA) & Harvey]

I haven't posted for a long time. My kitty, Cinco, went into remission about a year ago and has been doing very well. At first, I tested him once a week, then once a month, and then I admit I slacked off. I hadn't tested him for almost six months when I noticed someone (I have five cats) was peeing an awful lot. So I got out the meter and checked Cinco, and he was at 379! I about had a heart attack. I admit, I've been a very bad mother - I've allowed him to have regular dry food several times a day. He seemed to be doing so well that I didn't think it would hurt, and now look what I've done!

My questions are: 1) Should I test him several more times before taking any action, to be sure this isn't a fluke?
And if his numbers continue to be high:
2) Obviously, he gets no more dry food from here on out, but should I go ahead and try just feeding him only the high protein moist he's been on since diagnosis for a few days and see if that gets him back to normal?
3) We still have some insulin (Lantus), but it's obviously over a year old. It's been refrigerated and is clear with no debris in it. If we decide he needs a shot, is it okay to use? If so, at what point should we decide he needs a shot, and how much should we start him at?

I will post again after the next test, which I plan to do in two hours.

Thanks in advance!

 

[Julia & Bandit (GA)]

Obviously, he gets no more dry food from here on out, but should I go ahead and try just feeding him only the high protein moist he's been on since diagnosis for a few days and see if that gets him back to normal?

If you've been feeding him dry food since remission, that's most likely why he's no longer in remission. A diabetic cat in remission is still diabetic (a better term for it is diet-controlled), and needs less than 10% carbs to stay in remission. So yes, the first step is to get rid of all the dry food permanently. He can't ever have dry food again. In fact, I would just get rid of the dry period and feed all your cats the same low carb, canned food. This will be easier for you to manage and will solve the problem of him finding and eating it. Also, it will prevent your other cats from getting sick from one of the many diseases dry food causes, like Cinco did. You can get low carb canned food in large 13 oz cans which makes it economical to feed all your cats.

I would test several times a day for a few days and see if that was enough to get him under control, but with a number like 379 it's likely he'll need insulin again. I would not wait more than 5-7 days to start him on insulin if his numbers are all or mostly above 200. But you also need to take him to the vet and get him checked out and some bloodwork done in case there is an infection or dental issues that are causing the high BG, as well as get a script for insulin.

We still have some insulin (Lantus), but it's obviously over a year old. It's been refrigerated and is clear with no debris in it. If we decide he needs a shot, is it okay to use? If so, at what point should we decide he needs a shot, and how much should we start him at?

If it's a used vial, than NO, you can't use it. Lantus at most lasts 6 months, but more commonly only 1-3 months. Get a script for the Lantus pens--they are more economical, and unopened they stay good for several years.

His starting dose should be .25u per kg of ideal weight. That comes out to be around 1u or less for most cats.

If you are able to get him back into remission (and that's likely if there's no secondary condition present ), make sure you're testing at least once a month. Many things can knock a diabetic cat out of remission--diet, illness, stress, etc., but the sooner you catch and treat the problem the easier and more likely it is to get the cat back into remission.

 

[Tricia Cinco(GA) & Harvey]

Thanks, Julia. After reading what you said, I think this was the perfect storm. We had our windows replaced last week, and Cinco was VERY stressed out by it all - so many strange men around all day. He hid in a cabinet the whole time. Add the dry food onto that, and I guess that's what brought this on. In my own defense, I must say that the dry was less than 25% of his diet, and at least half of it was the Hill's DM, but I see now that I shouldn't have let him have any at all. His second reading was still high, not surprisingly. I'll continue to test him over the next few days and hope that the lack of any more stress and cutting out all dry will get him back on the right track. If he's not down to the low 200s by Tuesday, I'll take him to the vet for a new prescription.

BTW, I told the vet about the FDMB at Cinco's last checkup, and she made a note of it and said she would start referring patients with diabetic cats to the site!

 

[Tricia Cinco(GA) & Harvey]

Cinco's numbers hadn't gone down by Tuesday, so I took him to the vet. He ran a complete blood panel and found no issues, but BG was at 399. He said he wanted me to bring him back next morning so they could give him a unit of insulin and do a curve. He was there from 8:00 am to 8:00 pm and they only gave him the one shot in the am. His BG dipped down to 61 at +6 and was up to 192 at +11. The vet wrote a script for Lantus, but told me to wait a week before filling it. He wants to give Cinco one more week to see if the correct diet can get his BG moving down. He said if at the end of the week it was still averaging over 300, I should fill the script and start at one half unit, twice a day. So far he's staying right around 300. His urine output is almost to normal, though, which I think is a good sign.