? #s still high, how much to increase?

[William's Mom]

William has been back on ProZinc for a couple of weeks and his numbers are a tiny bit better than before, but we haven't seen many pretty drops. I want to increase and don't know if I should go up .25u or .5u? I feel like .5u is the way to go, but I get so nervous! I can't tell if I'm being impatient or being proactive. Also, I'm around to watch him.

 

[Sue and Oliver (GA)]

I think increasing by .5 would be fine. When upping the dose, it's always a good idea to get a +2 to see if he is dropping faster tHan you want, and a +6 to see how low the dose took him. We usually think with higher ranges that you hold a dose 3 days and then increase. Are you testing for ketones too?

Also knowing how to handle lower numbers will make you feel easier about increasing. Do you know what to do?

 

[William's Mom]

I was hoping you'd be around! I haven't given his AM dose yet, so I'll do the .5 increase for his AM dose. I have gravy food and he actually loves honey, so those are both there in case of scary moments. No, I'm not checking for ketones. Bad mom. I can go get the strips today. Thank you so much for your quick response!

 

[Buffy-&-Cindee]

Hi...I'm certainly no expert in diabetes or a vet but after reading your notes, I have a few questions:

1. Why are you giving him fluids, because of the constipation?
2. What is his BUN and Creatinine?
   
3. Why valium?

The reason I'm asking is because, while clearly he is diabetic, all of his symptoms sound like CRF (chronic renal failure). That sounds worse than it is so don't panic. I'm just about an expert in that disease. The bad coat, the constipation, the diarrhea are signs of CRF. I'm also concerned that he's ingesting so many different products, from different antibiotics (but no mention of a real infection) to all the other things you mention. The antibiotics alone can cause constipation in some cats. Carafate will sooth the digestive track but too much can also add to a constipation problem. Miralax is a miracle drug for constipated cats and don't be afraid to increase the dose. 1/8 tsp may not be enough. Try 1/4 tsp. If his poop gets too soft, back off the amount.

To me it sounds like your cat's digestive system is being over loaded and you need to unload it. The first culprit I'd suspect would be his food. I'd cut out the dry completely. In lieu of dry treats, you might want to try "Pure Bites" soaked in water. Zero carbs. I'd also suggest trying raw food. My personal favorite is Rad Cat. It's fairly expensive but so are vet visits. At least give it a try for a week and see how William responds to it. You may need to sprinkle a little bit of Forti Flora on it at first if he' doesn't take to it right away. All but one of my cats dove right in but even she did with a little Forti Flora on it.

Here's why I suggest raw food...

I had a cat who had a reaction to a Rabies vaccine and had horrible diarrhea for weeks. Nothing the vet or I tried helped and he was losing weight rapidly. I combed the Internet looking for a solution and kept coming across articles about raw food. I was desperate, so even though I was scared to death to give him "raw" food, I did it. Within 24 hours the diarrhea stopped. My vet who was totally against the idea at the time, is now a proponent of raw food diets.

My CRF cat had less than 10% of her kidneys functioning and thanks to Miralax and raw food, she had 3 wonderful years without supplementing with sub-q fluids. Basically both she and I had a stress free life. She wound up with CRF because of an emergency vet who gave her not one but two drugs that he never should have given a cat. HE put her into acute renal failure.

I'll get off my soap box now about raw food...I'm in favor of canned food as well.

As for your original question, have you read the "Start Low, Go Slow" approach. It will guide you through the decision to increase or decrease the insulin. It's incredibly helpful. The one thing I try to keep in mind is that while we all want that perfect number, too high is better than too low. If you'll look at my cat's SS, you'll see her numbers are high. While I am concerned and doing what I can to get them down, I also have learned not to become obsessive about it either because that's not good for you or your cat.

Lastly, for his skin wound, have your tried Vetericyn? It's a wonderful product and easier on the skin than Chlorhexidine.

I hope this info helps.

 

[William's Mom]

Hi @Buffy-&-Cindee

He had a full blood panel a few months ago that showed normal liver and kidney function and it was seen by quite a few vets. My regular vet was out of town so I had a LOT of cooks in the kitchen for a sec- it was terrible and it was the start of a chain of events that put him in a bad spot for a few weeks.

The rub of cat illness is that so many disorders and diseases present with the same symptoms that they can all look alike and then you have others who are pretty ill and don't show many symptoms at all.

He has been suffering from constipation from around the time his diabetes began to develop and he has had two spec fPLs that were done a couple months apart showing increased crappiness of the pancreas. He did have severe pancreatitis as little one, and that often sets chronic pancreatitis in motion, but he really doesn't have most of the clinical symptoms. So that and the IBD that is possible as either a trigger for or just a complication of pancreatitis, not to mention the dehydration that hyperglycemia creates are the reason for the fluids. That is the principle part of the supportive care for pancreatitis. Both of those conditions are often treated with steroids which everyone wants to avoid, so fluids are the most gentle and crucial and effective means of flushing and hydrating the system and hopefully easing the cycle of inflammation. I also learned that the dehydration that results from hyperglycemia can hinder the response to insulin. The vicious cycles! He was also given pancreatic enzymes which I noted that I started him on on his SS, but what I didn't say is that I did that for two days, didn't feel good about it for some reason and discontinued. He also did have evidence of a slight infection in his urine so that was the reason for the antibiotic this last time. Before they were started preemptively and discontinued when we found no infection. Right now he has nothing extra in his regimen, but a little miralax (i'm going to increase that), occasional pepcid (for pancreatitis) and the fluids, and of course insulin.

The skin stuff is most likely a form of diabetic dermatitis. It doesn't happen to all diabetics, but it can look like allergic reactions, lesions, delicate skin, and dandruff from lack of grooming or just the poor health associated with uncontrolled diabetes. His initial wounds and skin problems, however, occurred at the vet where a tech nicked him and he licked it raw and then we had a spiral where he acquired another raw spot from the bandage they did and on and on which he's mostly recovered from. So he basically has some gnarly dry skin going on and it's taking the hair off with it, but it actually seems to be improving.

Also! I totally understand raw in theory, but I'm a little scared (like a lot of people seem to be) and it's really not budget friendly (but nothing healthy is) and, for the moment, I'm trying to figure out everything I can do to maintain all the treatments and food and test strips, blah blah and balance that with my own needs outside of my adorable William. Plus, I've got my other guy Sam who will be jealous and break my heart, so I'll have to give him raw, too It's something I'm getting closer to experimenting with, though. I can start with the treats.

It's all just a lot to think about! Not 5 months ago I would just cuddle them and put food in the bowl and that was all.

I appreciate your detailed response. The more I know, the better. I've got some more homework to do!

Thanks so much. It's great to have support!