Things are going pretty bad with Tango

[Link]

Hey everyone,

I'm still pretty new here I guess, but I had a long thread going with Tango a few weeks ago when he'd just been diagnosed and we were trying to work out a new direction, but things are going pretty wrong right now, we're all a bit streched and it's not looking good...

The Methyl B12 seems to be staving off the neuropathy a bit, but the rest of it isn't so great.

The 28G SoftClix I ordered hasn't arrived yet and doesn't look like it will be here for a while, so I still can't home test (the fastclix has been utterly useless so far), and there's been no success trying to persuade the vet to prescribe Glargine (they all go by a "Cascade system" where they legally have to use the closest animal insulin type until treatment proves ineffective before trying something else and they're adamant that Caninsulin does the job perfectly well), and they'll be increasing his dosage to 4u of Caninsulin twice a day now.
Blood tests have just come back indicating suspected kidney infection as well, which isn't helping at all, and I'll have to go and pick up antibiotics later today.

Worst yet is about two days ago, I let him outside at about 3 and there was no sign of him for hours in the freezing cold and pouring rain. We went out to look for him shouting his name etc and he didn't appear until about 7:30, 2 hours after he should have eaten, and he was soaking and seemed dazed, wide-eyed and very quiet. He ate 2 sachets of food and curled up in the corner of the living room out of the way and rested/slept. He did the same for all of the next day and didn't even consider going outside again, so we had to get out his litter tray.

This morning he was much perkier, so at about 9AM after feeding him my dad let him out (in the freezing cold, pouring rain, and howling wind, D'oh!) when he proceeded to go to the toilet off under a bush, then disappeared over the back fence into the wilderness, and we haven't seen him since. I'm terrified again, and I've been out scouring the neighbourhood and knocking on doors asking if anyone has seen him scrounging in their houses.

My mother is starting to worry me as well. She appears to be almost giving up. She keeps talking about putting him to sleep, saying that she doesn't want him to end up like a "pin cushion" getting injected and poked and prodded every day (even if it improves his health and saves his life), and saying that it's "not fair on him", and it doesn't seem like she wants the financial burden too. Apparently it's as bad as her having a nightmare last night that she went downstairs in the morning and found him dead in the corner of the front room!

I'm sorry to clog up the boards with more long posts about how helpless I am, but I'm terrified, what can I do? :cry:

 

[hmjohnston]

Sorry about how things are going.

You are talking about a lancing device- have you tried free-handing the lancet? I found the device to be useless and scared Sneakers so I don't use it at all. It is easy to learn to use.

Can you go to another vet in your area? One that would listen to you? That's what I did. And the first visit I told him I did my own research and made my own food to keep the carbs down and, by the way, here is some information about the insulin I want to use.

Kidney infection- what kind of food are you feeding Tango? is it canned?

And cats love to roam. I had one that would leave for days at a time and then come back. No, she didn't need insulin and that would scare me today. Since Tango does use the litter box is keeping him in okay?

Regarding mom... that might take time. Especially if she is phobic about being sick or is in the habit of spending time in a depressed state. And how, in any way possible, is putting the cat down better than seeing if he can become diet controlled?

 

[Julia & Bandit (GA)]

I'm going to give you some documents for you to print out and give to your vet. Tango has been on Caninsulin for more than a month, which is more than enough time to see that it's not working. 4u is a crazy high dose, and is likely way too high and dangerous, especially since you got there without home testing. Caninsulin and Humulin N (NPH) often get overdosed because of their short duration of action--without home testing, the vet does not realize how low the cat is actually dropping because their numbers bounce back up high again.

Have you tried free-handing the poke with the lancet instead of using the device, or taking the cap off it and poking that way? You don't have to have the device in order to get a drop of blood.

Show your vet this document: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Note where it says "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats,
behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates
compared to longer acting insulins."

Here is an article comparing Lantus to Caninsulin and PZI:

And an article that explains the remission rate with Lantus and Levemir, as well as their safely and efficacy:

If your vet will not change the insulin after you've provided him with these articles, take them to a vet who will change the insulin.

Also, are you in Canada or Europe? If I remember correctly you may not even need a prescription for the insulin if you're in Canada. It's helpful to have a vet that's on board with you, but if you don't, many people here treat their cats diabetes on their own, and use the vet for emergencies and other health related issues. In my case, I had a great vet who recommended the right diet and insulin, but her dosing advice was way off (she had diabetic dogs and was dosing Bandit that way), so I read the dosing protocol for cats and starting making adjustments myself with input from the experienced users here while I learned the protocol. That's what human diabetics do--they self adjust their insulin with input from their doctor, but the doctor doesn't control every decision they make.

I would NOT give up on your cat until you get on the correct treatment plan--a low carb canned diet, Lantus or Levemir, and dose adjustments based on home monitoring. The large majority of newly diagnosed cats go into remission on this treatment--and that is a fact, not an opinion. My Bandit has been in remission for nearly two years, and is healthier today than he was before his diabetes. My friend's cat, Sydney, was untreated for 2 months, and then on NPH for 4 months, and deteriorated to the point where my friend was considering euthanasia. She switched to Lantus on my urging, and today Sydney is perfectly healthy and in remission.

 

[Link]

You are talking about a lancing device- have you tried free-handing the lancet? I found the device to be useless and scared Sneakers so I don't use it at all. It is easy to learn to use.

Can you go to another vet in your area? One that would listen to you? That's what I did. And the first visit I told him I did my own research and made my own food to keep the carbs down and, by the way, here is some information about the insulin I want to use.

Kidney infection- what kind of food are you feeding Tango? is it canned?

And cats love to roam. I had one that would leave for days at a time and then come back. No, she didn't need insulin and that would scare me today. Since Tango does use the litter box is keeping him in okay?

Regarding mom... that might take time. Especially if she is phobic about being sick or is in the habit of spending time in a depressed state. And how, in any way possible, is putting the cat down better than seeing if he can become diet controlled?

Thanks, Tango never normally uses a litter box, we've only had that recently when we've been keeping him in since he scared us last time. Other than that he never went too far from the house, and it was always very similar places, but I've checked them all and have no idea where he's gone... I'm just worried that he might have hidden under a bush somewhere over by the fields to get out of the rain and gone unconscious...

We're feeding him Felix as Good as it Looks from the pouches, and occasionally cooked chicken and fish.

She's not normally like that, she just wouldn't like to see his quality of life get (what she perceives to be) worse by continuous testing and injections. I can't freehand the lancets from the FastClix lancet device because they're together in a sealed drum, they can only be used with the device and when removed from the device the drum closes over for hygine purposes.

I've been trying with other vets, but they say that UK vets have to abide by this legal "cascade system". They even put me through with a "Diabetes Expert" who told me exactly the same things.

I'm going to give you some documents for you to print out and give to your vet. 4u is a crazy high dose. Caninsulin and Humulin N (NPH) often get overdosed because of their short duration of action--without home testing, the vet does not realize how low the cat is actually dropping because their numbers bounce back up high again.

Show your vet this document: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Note where it says "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats,
behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates
compared to longer acting insulins."

Here is an article comparing Lantus to Caninsulin and PZI:

And an article that explains the remission rate with Lantus and Levemir, as well as their safely and efficacy:

If your vet will not change the insulin after you've provided him with these articles, take them to a vet who will change the insulin.

Also, are you in Canada or Europe? It's helpful to have a vet that's on board with you, but if you don't, many people here treat their cats diabetes on their own, and use the vet for emergencies and other health related issues. In my case, I had a great vet who recommended the right diet and insulin, but her dosing advice was way off (she had diabetic dogs and was dosing Bandit that way), so I read the dosing protocol for cats and starting making adjustments myself with input from the experienced users here while I learned the protocol. That's what human diabetics do--they self adjust their insulin with input from their doctor, but the doctor doesn't control every decision they make.

I would NOT give up on your cat until you get on the correct treatment plan--a low carb canned diet, Lantus or Levemir, and dose adjustments based on home monitoring. The large majority of newly diagnosed cats go into remission on this treatment--and that is a fact, not an opinion. My Bandit has been in remission for nearly two years, and is healthier today than he was before his diabetes. My friend's cat, Sydney, was untreated for 2 months, and then on NPH for 4 months, and deteriorated to the point where my friend was considering euthanasia. She switched to Lantus on my urging, and today Sydney is perfectly healthy and in remission.

Thanks for the documents! Your testimonies are excellent and I'm glad some of your cases turned out so well, but I'm not sure how receptive my vets will be with these documents: They maintain that they have "regular successes" with Caninsulin on cats, and that actually, they had two cats on Glargine recently, and one entered a critical condition and almost died following the change. Not to mention, according to all of the vets I've spoken to, they can't legally prescribe anything other than Caninsulin unless they have proven that Caninsulin treatment is ineffective in treating Tango. I'm not sure how much of this is true, but it worries me that these people are professionals and I'm getting such different advice on treatment from the people here, who have had much success.

I live in the UK, so I'm not so sure about the prescription issues, and I don't know about getting it without one...

I've got the low-carb diet down, and I'm trying to get my hands on that new SoftClix for testing if it ever arrives, but that just leaves the vet with his Caninsulin, and this suspected kidney infection. Not to mention, I'm still very worried where Tango is right now, considering I've been to most of his usual hiding spots in and around the house and still have no sign of him, and he's usually back pestering me to be fed by now.

Thanks again for the replies anyway!


EDIT- He just turned up on my doorstep looking fine wondering why I was so worried. The damned fleabag drives me to distraction.

 

[Julia & Bandit (GA)]

They maintain that they have "regular successes" with Caninsulin on cats, and that actually, they had two cats on Glargine recently, and one entered a critical condition and almost died following the change. Not to mention, according to all of the vets I've spoken to, they can't legally prescribe anything other than Caninsulin unless they have proven that Caninsulin treatment is ineffective in treating Tango. I'm not sure how much of this is true, but it worries me that these people are professionals and I'm getting such different advice on treatment from the people here, who have had much success.

I would seriously question your vet on what their definition of "success" is. I would ask how many cats they have go into remission (only about 25% of cats go into remission on Caninsulin, which is very close to the number of cats that go into remission by diet change alone, vs 84% of cats on glargine when treatment is started within 6 months). I would also question why the cat on glargine was in critical condition--was it hypoglycemia? If they have you up to 4u of Caninsulin already, I bet you they overdosed the cat on glargine and that's why it ended up in critical condition. The Lantus article I provided proves the safety of glargine when the proper dosing protocol is followed. Most of the current information regarding glargine came out in 2009, so many vets are just not aware of the recent changes to feline diabetes care. That's why it's very important to make them aware so they can get on board with you.

The first link I provided you above contains the dosing protocol for Caninsulin. It states that if the cat is not in remission on Caninsulin on 6-8 weeks, the insulin needs to be changed to glargine or PZI. If you are up to 4u in a month, then your vet isn't even dosing the Cainsulin properly. In 4 weeks, your cat should be AT MOST at 2u of Caninsulin. I am concerned because giving 4u of Caninsulin blind on a low carb canned is very dangerous for your cat.

I understand how tough it is when your vet is telling you one thing, and someone else is telling you another. Read what material you can, and make your own decision. Vets are far from infallible--they must treat many different diseases for many different animals, so it's impossible for them to stay current with every aspect of every disease.

Here's one more article for you to give them: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Note p. 218 where it states:

The insulin preparations with the appropriate duration of action in most diabetic cats are glargine (U-100) or the veterinary-approved human protamine zinc insulin (PZI U- 40).

This panel does not recommend the veterinary-approved porcine zinc (lente) insulin suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor. This insulin should be reserved for cats in which other insulin choices have not yielded satisfactory results.

If you bring your vet all this information and they dismiss it, I would NOT go to that vet any longer. A vet that ignores published veterinary studies and current treatment recommendations by national veterinary associations is certainly not someone that I would want treating my cat in any shape or form. I would definitely get a new vet in that situation. Call around; see who is willing to work with you with the treatment plan you want. All you need to get started on the right treatment is a script for glargine, and to learn to home test.

 

[Julia & Bandit (GA)]

Just looked up the info, and I believe your vet can legally change the insulin at any time. According to the Veterinary Medicines Regulations 2011, your vet can get permission to use Lantus for your cat if the cat worsens on Caninsulin (which yours is). See p. 10 of the RCVS FAQ here:

The ‘Cascade’ is the term applied to the (cascading) options of veterinary medicines
available to a veterinary surgeon to treat an animal. If there is no authorised veterinary
medicine in the UK for a condition, the veterinary surgeon responsible for the animal
may, in particular to avoid unacceptable suffering, treat the animal concerned with the
following (the cascade), cascaded in the following order)

a veterinary medicinal product authorised in the United Kingdom for use with another
animal species, or for another condition in the same species (off-label use); or
b) if there is no such product that is suitable, either:
i) a human medicine authorised in the UK; or
ii) a veterinary medicine not authorised in the United Kingdom but authorised in
another member State for use with any animal species (in the case of a foodproducing
animal, it must be a food-producing species); or

So I think all your vet has to do is go here and apply for the certificate: http://www.vmd.defra.gov.uk/sis/default.aspx

 

[Jennifer & Saima (GA)]

I am sorry it's such a struggle to get Tango on a good insulin there--I know that is through no fault of your own. I hope the information Julia has provided helps.

My 2 cents, I would not let him outside anymore for the time being unless he's supervised. He'll need his insulin at regular intervals, and you wouldn't want him to either miss shots or possibly go hypo when he was off by himself and you weren't able to monitor him. It seems he has developed a wanderlust that is not compatible with his diabetes treatment... plus if he is roaming far and wide, he could run into all kinds of other dangers that would not be as likely if he stayed on the property.

I know this is so challenging... best of luck to you. As others have said, with a low-carb diet (which you already have under control), home testing, and insulin, you can definitely get him healthy again. :YMHUG:

 

[Sue and Oliver (GA)]

I am sorry getting a better insulin is such a struggle.. But if Canninsulin is what you have to work with, I think you need to use it to its best advantage. We have had members here (particularly in the UK) who were able to get their cats regulated and even in remission using it. It is more difficult than the milder insulins but no necessarily an impossible task.

I think I would decide he needs to be an indoor cat for the present. Test before each shot. Do a curve (tests every 2 hours) as soon as you can to see how long it lasts for him and to give you some idea how it is working. Once you see how low it takes him and how long it lasts, you will be better able to adjust it to work best for him. You may be able to use food to soften the harsh drops.

For his ears, find a product similar to Neosporin with pain relief and start applying it to his ears. Be sure to hold the spot where you poked for a minute to lessen bruising.

 

[Link]

Thanks again so much everyone, you've all been so helpful! I'm going to call the vet and really grill him about this stuff and see just what he knows and whether or not he'll listen to this stuff.

I'm thinking of getting my hands on a radio or GPS tracker for him (once his BG is a bit more stable), for when he goes outside, that way if he's gone at the wrong time or I'm getting a bit worried I can always go out and pull him in ;-) Does anyone else have experience with these, or have a personal favourite? I live in a pretty rural area so there's a bunch of bushes and fields he wanders over to quite nearby (but I don't think he ever goes too far, it shouldn't be too difficult to find him), or he's stalking in other people's gardens around my house... I was looking at getting this one maybe, the Loc8tor,
http://www.loc8tor.com/uk/loc8tor-pet.html
Or perhaps it's GPS variant, or maybe this one, the Pingmee
http://eyespy247.com/shop/product/Pingmee_GPS-C29/
Depending on whether or not the Loc8tor can get through the foliage at long enough range. But then again, that makes me wonder whether or not the 2.5m minimum range on the GPS is enough to find kitty sleeping under a bush somewhere... And there's having all this weight on his collar to consider :lol:

As for the Neosporin, I don't think it's available in the UK, do you have any alternatives that might be? We have a product called Germolene http://www.boots.com/en/Germolene-Antis ... -55g_5498/ Which is a kind of antiseptic cream with some phenol for pain relief, but I think it might be poisonous to cats if ingested... Do you have any other ideas?

Thanks so much everyone