Some relief for Cash

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cashy

cashy

Member Since 2017
Our 16ish year old black siamese(ish) cat started losing weight last fall. Normally he is about 13-14 pounds and we noticed he was thinner. Weighed in at 10 pounds and started to limp. Took him to the vet and he confirmed a diagnosis of diabetes. He did lab work and his blood glucose was 442. Ouch.
He started him on 3 units of Vetsulin BID. He was put on Science diet M/D dry food.

We brought him back in November and his blood sugar was 330. He said put him on 4 units. We are using the Relion glucometer mainly because of price. I think we paid $9 for it and 50 strips were $9. I started doing blood glucose curves after 8 hours Cash was usually over 480. We had trouble keeping his glucose under 400. Studied the Somogyi effect. We decided to put him on 3 units TID increasing to 4.5u TID after having glucometer readings of 500+.. By the first of the year we had him 4u TID, 12u daily He was doing clinically better. we used glucose urine strips and had clear testing every time. So he was not bonking and sugar was under 280ish. Our vet reassured us that we were on the right track and continue therapy.

A week ago he bonked and we gave him diluted honey in a plastic pipette. He was temporarily blind and walked in circles blood glucose and it was 40. We withheld his insulin for one cycle and started him on 3 units. He had a second episode which we caught and decreased his insulin to 2u BID.

Cash has been going close to a week on 4 units of Vetsulin per day. For us that is remission. We wonder what causes remission. The experts don't offer good explanations. I wonder if he has has a pancreatitis that is getting better. Like most cats Cash has been very healthy in the 9 years since we were gifted him.

Are we leary of how long he is going to maintain his health. I am a retired Optometrist and talked to a Veterinary Ophthalmologist friend of mine at Tufts University. He said that he doesn't see much proliferative diabetic retinopathy but does see a lot of hypertensive retinopathy. I have not done any retinal exams on him, frankly I didn't think he had much of a future. I am going dilate his pupils and look inside his eyes.

Has anyone seen any studies about hypertensive disease in diabetic cats?
 
Has his blood pressure been checked?
I get my cat's blood pressure checked whenever they have their annual physicals.
 
Pretty sure that his bp has not been checked. Never seen the vet do it. I know my cuff would be too wide. The Vet has a large animal practices, and the only vet within 30 miles. Never had any routine physicals for our pets. Dogs get a look at when they go in for shots or injuries. Cats stay indoors although they have had inoculations, we have 5.

We had a suspicion that Cash has acromegaly as he is long legged and he has a strong lower jaw with an underbite. When he had blood workup, growth factor was not checked. Seeing this reduction in insulin, makes us think that we were not correct on that assumption.

I have a feeling that since his insulin dropped so dramatically that he may go into remission.

Insulin has been relatively easy to administer not so with ear pricking for glucometry. Any suggestions. We started with the spring loaded lancets.With the spring loaded lancet it seemed like he quickly learned that when he could feel the pressure of the lancet he would spring into action. So we switched to standard lancets Now are using 16 gauge needles as they seem sharper than the lancets.

Thanks to those read this and found the time to reply.
 
With J.D. (avatar), he had thick black hair on the outside of his ears and white but much sparser white hair on the inside of his ears, so I always tested on the insides.
I was never able to use the lancing device. I always used 28 gauge lancets and did the tests freehand.

My regular vet at first said they do not do blood pressure tests.
So, I took my cat to the next vet 6 miles up the road who did. He always had high BP there as, I guess, he did not know that vet.
Eventually, my regular vet, then said they can do blood pressure tests and would drag all the equipment with all the wires into the exam room, and he and my other cats have always had fine BP at the regular vets that they are familiar with.
 
Hi Dyana
Cash sure hates the glucometry more than his insulin injection. Always takes two of us to perform glucometry.

For sure we will ask our vet about Cash's blood pressure and I am going to get a look in his eyes.

Just glad that we have given him some good quality of life. A couple of months ago I was ready to put him down.

Here is a picture of our black cat Cash and one of his stoned buddies.
2cats.JPG

Notice Cash's prominent lower lip.
 
He sure has a nice shiny and healthy looking coat.:cat:
My kitty got chin acne that looked kind of like that. It was from eating from plastic bowls.
 
I still think it might be easier to see the blood droplet on the inside of his ears where there is less hair to get in the way.
 
I would agree on the inside of the ear. I aim for the peripheral vein. Sometimes I have stuck it through his ear and into my finger below. No one is happy then. :)
He still has a good coat. Especially considering that he has been taking 12 units of vetsulin for 6 weeks. We wish his blond cousin had as nice of a coat.

When he goes hypoglycemic (from too much insulin) one of the first signs we see is that his pupils get sluggish and dilated. He can be still alert enough to eat.

He got like that today so after feeding him extra and giving him a diluted honey we cut his insulin to 1 unit.

I weigh every meal that he eats. He eats 3 oz of his science diet M/D dry food a day. Of course when he bonks I feed him as much as he will eat as well as injecting honey into his mouth.

For two months I didn't weigh his food and his diabetic control was terrible, control once and then 500 the next time. All of our cats just love the MD food. I feed Cash then inject him with insulin He gets his portion of his food allotment for the day. I keep the food broken up in small plastic tupperware type of dishes.

The packaging has the recommended amount of food for both diet and maintenance. For those first two months I was giving him food that was about the equivalent maintenance dose for a 16 pound cat. No wonder I couldn't get his glucose down.
 
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Here are Cash's lab tests from October 16.
This was a random blood test, not fasting.
cashlabs1of2.jpg


cashlabs2of2.jpg
 
@cashy This thread helped me with home testing: Testing and Shooting
Since you said you aim for a peripheral vein, I've read if you stick a vein it is more painful for kitty and maybe that scares Cash if he's associated the two. The sweet spot consists of the small blood vessels: capillaries. Hope BG testing gets down to 1 person :)
 
I don't have experience with vetsulin, so can't advise on dosing. He was on a pretty high dose, and then he had a symptomatic hypo episode where he was temporarily blind. You might want to post on the Vetsulin forum to see what the folks experienced with the insulin you are using have to say.
In the meantime, I can flag @Marje and Gracie to have a look at Cash's blood work.
 
Thanks
Yes dehydrated because of his blood sugar being 400+

Right now he is on 1u Vetsulin bid. From late November to the the first week of February he was between 8 and 15 units daily Was over the course of a few days at the end of that period he was going hypoglycemic as his remission started. Leading him toward just 2u daily. Who knows maybe he will go into complete remission.

I asked the vet a couple months ago. What is the highest dose of insulin that have ever prescribed to a cat. He said 14, a doc always remembers things like that. I knew that we were getting close to the end of our rope with him. When I was doing insulin curves I found it very non linear. The first few units (say when his bg was 4-500) would drop his sugar down 85-90 points per unit. As the BG got lower into the 250-300 range. The fraction went down to 50points/unit. Very unnerving. I am sure that many of the spikes we saw were do to glycogen release from the stress of doing the test. The science of the testing has a long way to go to make it truly useful.

Seems like he is almost our old Cash. He never knows a person he doesn't like. Before we got him, he was wandering around a neighborhood and being fed by several households. Seems like several homeowners knew him by sight and name.

Our vet had to knock him out to get a vein for the lab results. We are not going to put him through that again. At least that is what we saying now.

I think he enjoys life again as much as we enjoy having him
 
Boy his CBC doesn't make a lot of sense to me.

His HCT and HGB indicate dehydration as Larry said. But the MCHC is low which can occur when a cat has been anemic, doesn't have enough iron, has parasites, or an inflammatory condition. The MCV is high which can be after the cat has lost a lot of blood or has has anemia and the new blood cells are large. Other causes are hyperthyroidism, vitamin B 12 insufficiency, or clotting during the draw. The elevated lymphocytes indicate some infection.

I don't see anything indicating the sample was hemolyzed which could account for some values being skewed.

I'd talk to my vet and see what he thinks.
 
cashy said:
We had a suspicion that Cash has acromegaly as he is long legged and he has a strong lower jaw with an underbite. When he had blood workup, growth factor was not checked. Seeing this reduction in insulin, makes us think that we were not correct on that assumption.
Click to expand...
There is no feline growth hormone test available. What is tested is the IGF-1 (Insulin like Growth Factor), blood work is sent to MSU. The IGF-1 is a more reliable test than the growth hormone test. The acro tumour can wax and wane. A few acrocats have gone into remission. The latest research shows that one in four diabetic cats has aromegaly. Neko never had long legs or a strong lower jaw. The condition manifests differently in each cat.
 
Yes a month before was fairly asymptomatic Two weeks before the labs we had him in and had him treated for parasites. He is the only cat we have that wants to be outside so we have a cage on rollers and let him out 3 seasons a year. Parasites were a concern for us and the treatment was simple enough. The treatment didn't change anything clinical we saw and his weight loss continued.

After seeing the labs we started Cash on methylcobamaine, He had a perfectly normal tt4. His teeth are not infected. The answer that we got was that being a diabetic threw off the numbers. I bet if we were to retest him now 4 months later most findings if not all would be back to normal. He used up one of his 9 lives.

Funny what throws labs off. We had another 16 year old feline that was in similar straights, her labs showed liver damage, kidneys in trouble. The old vet we had said that she needed a tooth extracted but didn't feel like she was in good enough shape for him to do it. I had my dentist buddy over to the house one night and the cat issue came up. Ended up we took the cat to the dental office that evening and he extracted it. Within weeks the cat was putting on weight and shine came back to her fur. Later had the vet run another series of labs and they were perfectly normal. Kitty lived two or 3 more years.
 
Wendy&Neko said:
There is no feline growth hormone test available. What is tested is the IGF-1 (Insulin like Growth Factor), blood work is sent to MSU. The IGF-1 is a more reliable test than the growth hormone test. The acro tumour can wax and wane. A few acrocats have gone into remission. The latest research shows that one in four diabetic cats has aromegaly. Neko never had long legs or a strong lower jaw. The condition manifests differently in each cat.
Click to expand...
Thanks Wendy and Neko Somehow I missed your post from last night. Had started the reply you see above but didn't send it till this morning.

Didn't know where such a test was available. I can see why the growth hormone surrogate (IGF-1) test was not done for the initial consultation.
My wife first read about the connection between of high levels of growth hormone in diabetic cats It got our wheels turning. This is our first diabetic cat a lot to learn. We noticed that Cash has a strong jaw where as our other cats have a slight overbite. So much so that his lower lip is fairly prominent.

He has been on 1u BID for a couple of days and today we checked is bg and it was 288. A bit high. I gave him a unit about 7hrs post the previous dose and will give him a 3rd dose in another 7-8 hrs. Tomorrow we are going to go to 1.5u BID. That has to be close at least till something else changes.
 
With Lantus, it's really best if you stick to 12 hour dosing. The most we'd recommend people shoot an hour early is if their kitty is much higher than 288. And at small size doses and seeing yellow, it's best to increase by .25 units, up to 1.25 U as the new dose.
 
Thanks for your concern. We were dosing TID after Cash was bottoming out between doses and over 500 by 12 hours. What would your approach be? Since he started to go into remission we are hopeful that he can handle BID dosing.

Our vetsulin is clear, well slightly milky. Our insulin syringes are graduated in 1u markings. Half units I am comfortable with.
 
We determine the Lantus dose by how low it takes kitty. Depending on whether you are using the Tight Regulation Protocol or Start Low Go Slow method, you would reduce the dose if kitty got lower than either 50 or 90. Depending on what you mean by "bottoming out", it could mean the dose is too high. The other possibility is that kitty is bouncing. From the New to the Group Sticky note:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Bounces are a temporary condition that a lot of cats do and we don't change the dose if kitty is just bouncing due to see a number lower than it is used to.
 
Sorry Doctor.
The only way we were to get his glucose down for the majority of the day was TID dosing. It is a real pain on us the owners. 6AM 2PM and 10PM every day.
Bonking We would see clinically on our cat, usually in stages starting with pupil dilation, agitation then confusion/blindness. Pretty much in that order. Had a lot of times with BID dosing, using 3 units would give us a nadir of 300 and >600. 3.5u gave a low of 280 and high of >500. 4u gave us a low of 50 or clinical symptoms of bonk. and a high of 500.
We would try each for several days. In the mean time his hind quarters were getting weaker from neuropathy.
With in the first month he had lost all ability to climb and could only walk a few steps. This went of for a couple 3 months. Now he can run and go up stairs.
 
A note about obtaining blood for glucometry that I have observed after testing my cat for the past 3 months.

I have decided to only take the blood from the back face of the ear near the margin at the larger peripheral vein. I looked close at the underside of the ear where there is only sparse hair but the vessel is on the other side of the cartilage plate in the ear. I am also only using a hypodermic needle. The needle is long enough that I can prick near or in the vein at a very shallow angle. Just takes a bit of pressure to get a big enough wound for modern glucometers.

I remember in the early 80's, we were doing glucometry in the office. The paper strip had treated area. Had wet the end of the strip with blood then blot the blood off. Took a lot more blood and had maybe 10x the biohazard.

We also found that Cashy has taste for dog food. I think the behavior has just started. Really has messed up blood glucose the past few days.
 
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