treatment of ear cartilage inflammation

Status
Not open for further replies.
J

jacklechat

Member Since 2013
Hello
My cat has had diabetes for 1 year, he is 11 years old. In the last 2 months his one of his ear flaps has swollen right up so that the ear is completely distorted. At first i thought it might be a haematoma or an abscess but the vets did not agree. They thought it might have been an insect bite and aggravated by him scratching it. He has had various antibiotics and creams and tests. The vets have now taken biopsies and bacteriology is negative but histology has showed up inflammation of the tissues, maybe immune system related. It seems that the only treatment is corticosteroids which obviously we can't do. Since this started his BG is high and despite increasing the insulin (glargine from 4 units twice a day to 7 units twice a day - he weighs 5kg), we have not been able to reduce it. We are actually only monitoring his urine at the moment which continues to show high glucose readings. Thought there must be someone with experience of inflammatory conditions and diabetes on this board as this all seems to be new to our vet. Any ideas?
Thanks
 
Do they believe the steroids will correct it or would he have to go on steroids for the rest of his life to treat it? Sometimes, you have to treat the condition and simply adjust the insulin dose around it. So, if he needs steroids, give it to him knowing that you may need to increase his insulin dose while they're in his system.
 
The vets seem really unsure but another appointment on tuesday so will see what they say then. I think they are unhappy because his diabetes is out of control currently but i feel it is a vicious circle, his sugar is high because his body is trying to fight this inflammation and if the inflammation went down we could get back to "normal". Trouble is the vet has no previous experience of this. We live in a rural area and don't have much choice of vets.
 
The high glucose may be from the inflammation, or vice versa.

I see it is your 2nd post and you note your vets are not very experienced. There are some things which may help, depending on your answers to the following.

What are you feeding him? Vets can be out of date on feline nutrition and they get minimal training on it in school (generally from the manufacturer). Vet-written Cat Info is an excellent resource for everyone. Given that you are still seeing glucose in the urine, a gradual change to low carb canned food, if you aren't already feeding it, may help stabilize the glucose levels.

Are you testing, or would you be willing to test the blood glucose at home? It is more accurat than urine testing and will help keep your cat safe.
 
Hello again
The food issue is tricky as some years ago he had cystitis which took ages to clear up. We kept him on the Royal Canin urinary s/o pouches for ages. Several times when we tried to introduce other wet foods, he would have a little flare up, never as bad as the first time. So we do give him other wet food from time to time but mainly he is on low magnesium stuff. still has the royal canin but also integra and kattovit. We live in europe so the cat food range seems to be different from the usa from what i have been reading. Our current vet thinks there is little advantage to giving the special food so i did some research and contacted the companies to find out the carbohydrate and Mg contents of their foods - with mixed success. It seems that there is not a great deal of difference between the "quality" cat foods that responded to me. I would like to give him more protein but feel the cystitis is another problem we don't need right now. On the plus side - he will eat anything and loves a change so changing his food isn't a problem if anyone has any ideas.

Has anyone else reading this got a cat with cystitis and diabetes?

many thanks
 
Hello again
Does anyone know by how much you can increase the insulin to try and reduce BG. Should we be looking at changing the type of insulin?
Any help appreciated.
 
When there is another medical condition interfering with the glucose control, you treat that condition and adjust the insulin to compensate.

Increases in insulin dose should be made cautiously and in small amounts of 0.25 to 0.5 units, depending on the type of insulin and how low it is taking the glucose level.

So, a few questions.
What insulin are your using?
What is the current dose?
When you increase, how big a change have you made each time?
How much does your cat weigh?
How much should your cat weigh?
Are you testing the glucose at home?
 
Answer to some of your questions:
Food - we have started to change. How long to notice a difference?
Insulin - Lantus glargine was stable on 4 units twice a day. Have increased by 0.5 and now at 8 units twice a day - still glucose in urine - max on test strips.
Do not want to take blood from ears because of inflammation - any other suggestions?
BG is high each time he goes to vets anyway with the stress of the vets. When the vet tried to do a glucose curve last year she had to give up as he clenched himself so tight she couldn't get blood out of him and the results were no good anyway.
Cat weighed about 5.5kg before ear problem and is now about 4.5kg - this is not too light, he was a bit tubby before but the loss is worrying.
The inflammation started over 2 months ago.

Another question - looking at the european food info they do not say how they do their calculations (apart from stating the no of calories per g of each component). Does anybody know whether they work out carbohydrate by difference as this is not listed on the ingredients? I am a former food scientist and I don't agree with some of the calculations, however the people doing the lists may have had more information than they have recorded.

Vet is suggesting changing insulin. Any ideas how to best approach it given that we can't take blood from ear and i do not want him hospitalised. We are all reluctant to put him on steroids as it could send him dangerously hyper.
 
Some folks test on a paw pad. Be sure to wipe the pad with an antibiotic ointment before and after to prevent infection.

Fish oil is supposed to be helpful in inflammation; adding some to the diet may be helpful. Check with your vet as to how much. May even help if used topically.

Is the whole ear affected or just part? If just part, I'm wondering if surgical removal of the affected are would resolve the problem.

Food calculations for cats and dogs use 3.5 calories per gram for protein and carbohydrate and 8.5 calories per gram for fat. The calculations are for percent of calories, not weight, from carbohydrates.

Vet stress will raise the glucose 100-180 mg/dL. (5.5 to 10 mmol/L higher)

Have your vets considered testing for a high insulin condition? Acromegaly, insulin auto-antibodies and Cushing's disease are 3 which may result in diabetes. The dose you are giving is getting up into numbers where this starts becoming a possibility.
 
Thanks for ideas. I will run them past vet this week.

The whole ear is affected now and i think it might be starting on the other ear.
 
It can take a few days to see a difference but you would need to be testing at home to see that. You might see it on the strips but if he is bouncing (which is very likely if you are on such a high dose) then you wont.

Here is more information on food info. Generally they have to call the food company since they do not provide enough info on the label to calculate % calories from carbs as fed. http://www.catinfo.org


Wendy
 
BJM said:
Fish oil is supposed to be helpful in inflammation; adding some to the diet may be helpful. Check with your vet as to how much. May even help if used topically.
Click to expand...

Just make sure it's not cod liver oil (too much Vitamin A).
 
Thank you all you helpful people.
There is still no change in Jack's condition despite reducing his CHO intake. If anything he is drinking more water. The vet still does not know what to do, and is not in a hurry as his biochemistry is OK apart from the sugar. The only suggestion being to change to Caninsulin. If we go down this route , would we have to start back on a very low dose? This worries me as he could go hyper - how I wish I could test his blood. Will definitely look at the fish oil thing.
 
Topical steroids are less likely to have any systemic effect.

Also, in general, if you have a condition that needs treatment with steroids, and you have a diabetic, you adjust the insulin dose around the treatment effects for the condition.
 
jacklechat said:
The only suggestion being to change to Caninsulin. If we go down this route , would we have to start back on a very low dose? This worries me as he could go hyper - how I wish I could test his blood.
Click to expand...

Caninsulin is not really a very good insulin for cats as cats have a faster metabolism than dogs (it was made for dogs) and it wears off too quickly. Glargine (also known as Lantus around here) is considered a very good insulin. Why would they want to switch?

You can also test his blood via his paw pads instead. You just have to get slightly larger lancets for it (the ones for "alternate site testing"). I've PM'd a member that occasionally tests her kitty using the paw pads to have her stop by and give some advice.
 
jacklechat said:
Thanks for ideas. I will run them past vet this week.

The whole ear is affected now and i think it might be starting on the other ear.
Click to expand...
Hi there! A fellow member has asked me to pop in and give you some paw pad testing tips. (To introduce myself: I'm Kat and Gobbles is my (still sugar-sweet) diabetic cat in remission. He was diagnosed in November 2012 and went into remission this past May--without the awesome help, care, compassion and education from members here at FDMB, I'm scared to think where we'd be now!!!).

In the beginning of Gobbles FD journey, I always tested him on his back paw pads, and then as time went on, I would test him there to give his little ears a break. Here's what worked well for me:

First and foremost, have a warm rice bag or warm washcloth ready. Sit in a position that is calming to you and your kitty. With Gobbles, I would sit on the floor with him in my lap, facing outwards (his back was to me). Place your lancet, glucometer with test strip partially in it (though not turned on) and a triple-antibiotic ointment. Then grab his foot and warm it a little (maybe 15 seconds), then gently rub (about another 15 seconds). Next, while holding his foot, take you lancet and do a quick poke (very fast) then "milk" the blood out....in my experience, it takes the paw pad longer to bleed than the ear. If you are still not getting a bead of blood after milking for about 30 seconds, do another poke about 1/4" away from first poke. Once you get the blood, push the test strip all the way in the glucometer and get his test. Once finished, apply pressure on the paw pad for about 15 seconds, then apply an ample amount of the triple-antibiotic ointment (and be sure to apply the ointment even if you don't get blood).

If you don't get a test the first time, then try it on the other back paw pad; if you still haven't got it, give kitty a short break, then try again. And give him a low-carb treat :mrgreen: . Don't give up--this technique took me a few tries. And keep an eye on his pawpads for infection; Gobbles never got an infection when I did this, even when he had diarrhea which stuck to his feet; key is the antibiotic ointment.

Let me know if this works out for you, and welcome to our family :-D
 
Thanks for the paw testing tips. Unfortunately, jack seems to have read your post as well as he is now in hiding from me - must have sensed my determination to give it a go and he is even more determined not to let me. After chasing round the house I am letting him relax again before i try again. Trouble with all this is that he gets more nervous of us and that makes it more difficult to do anything with him. He moved whilst I was injecting him this morning so I have no idea how much insulin he got, and that was before the chase.

re the change in insulin - the idea is that maybe the glargine isn't working for him anymore and that maybe another insulin would. Caninsulin, because the vet is more familiar with that.

BJM suggests that it is possible to adjust the insulin dose to cope with added steroids - sounds logical but how exactly would I do that? Any more details appreciated. The other ear is swelling up now and seems painful for him.

re cat food carbohydrate content and calculations, the way it is explained on catinfo.org is correct. that is the calculation i was using as well, assuming carbohydrate by difference, it was the other link to the european foods that might have contained some errors.

just tried the paw thing again - how do you see what you are doing? do you have someone else to hold the cat? seems like you need 2 or 3 pairs of hands.
thanks again!
 
You adjust the insulin dose based on the increase in glucose levels at nadir and pre-shot as you would normally do. Because of the need for steroid medication, both the glucose level and insulin dose are likely to be higher, but there is no exact ratio between glucose level and insulin. Its very much ECID (every cat is different) and you have to find what works for your cat.

So, if the vet is recommending steroid treatment and nothing else is helping, maybe discuss with the vet starting with a topical steroid first and see if it helps. If not, move on to the lowest possible dose of an oral steroid. Monitor the glucose and adjust your insulin as the protocol states.

For example, with Lantus and the Tight Regulation protocol, if after 3 days on the steroid and a given dose of Lantus (5 days if its the first ever Lantus dose), if the nadirs are above 150 mg/dL, you could increase 0.25 units. Then you hold the new dose for another 3 days and recheck, following the rules (they're listed in the TR forum).
 
jacklechat said:
....re the change in insulin - the idea is that maybe the glargine isn't working for him anymore and that maybe another insulin would. Caninsulin, because the vet is more familiar with that....just tried the paw thing again - how do you see what you are doing? do you have someone else to hold the cat? seems like you need 2 or 3 pairs of hands.
thanks again!
Click to expand...
How long has he been on glargine (lantus)--the whole year? I would give it at least 6 months. If you are going to change, the caninsulin is not a good choice for cats. You may want to ask for Levemir, Prozinc or PZI. As for how I could see what I was doing? I really never had a problem, really. When placed in my lap facing away from me, I would just get a good hold of his foot with my left hand, and doing the poking/testing with my right hand. I do hope your boy calms down and you're able to get some tests in. Hang in there!

Regarding the high dose: have you considered that maybe your kitty may be an "acro" cat (http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=373)? I don't know too much about it, but I do know that some high-dose cats have it.
 
Could be a high dose cat - could be chronically going very low and bouncing very high Really need home testing to be able to tell.
 
jacklechat said:
Has anyone else reading this got a cat with cystitis and diabetes?

many thanks
Click to expand...

I'm new to the board and only just learning how to really control my cat's diabetes, but he also has cystitis and eats Royal Canin Urinary SO. I've been very reluctant to change his food, too, and the first thing we did was change from primarily the dry food to only wet. Another member gave me this link and I'm starting to mix in more low carb wet food with the Urinary food, and simply keeping a close eye on his litter box habits.
 
Hello again
Still finding it impossible to test him and feeling a real failure. After 50 years of living with cats this is coming hard. We got him as a rescue cat at about 4 or 5 months old and he has always been jumpy and timid, although not aggressive. It is so hard to get his trust and keep it. He is already hiding from us because of all the trips to the vet and the treatment i have been giving his ear. Not to mention the injections. It seems clear that the only way to know what is going on is testing, so we are in a no win situation, sometimes i feel really desperate because there is no answer.
To the new member with toby - good luck, hope you do better than me, jack was mainly on the wet urinary s/o food - to which we also added water. he loved the crunchies but only got them when soaked in water too as i have always been reluctant to feed cats on dry food. however, when they get older, sometimes it seems to keep them going. if you live in europe/ uk you can get other food on zooplus - integra and kattovit both do cystitis food which is lower in carbohydrate than the royal canin. we have been mixing them for about 8 months with no recurrence of cystitis (as far as i can tell), although nobody knows what is going on with his ears (crystals causing inflammation???). the kattovit in tins is like a pate and he loves that. integra (in tubs) seems more gristly. As diabetes and cystitis are 2 common cat conditions, there must be more cats out there suffering with both.
 
Given your testing difficulties, please look at my signature link Secondary Monitoring Tools. While less standardized than blood glucose testing, they will give you some clues about how things are going. Chart amount of water drunk daily, size of pee deposits, urine ketone/glucose testing, dehydration checks, and check for mouth odors (urine odor on breath is sign of possible renal disease; fruity/nail polish remover smell is ketones).

It won't be perfect, but it will be something you can track!
 
Needing some help folks
2 nights ago Jack had his insulin and some cat food with negligible carbohydrate. He didn't eat his full portion and was not right that night - staggering about drinking water and peeing a lot. could not get enough blood out for a test. urine sample in the morning showed ketones. took to the vets yesterday morning and they kept him in on a drip and gave him fast acting insulin. before the drip (saline etc) his BG was 290, with the insulin through the day it did not change - vets think insulin resistant. anyway, I think they are now stumped, this morning when i went to see him he was drinking lots, in a terrible state, on a drip but the drip not running as he kept sitting on the tube. the vet encouraged me to syringe feed him. although i had left his insulin with them they didn't give him any until i reminded them - prob 10am when he would normally have it at 7am - 7.30am. he hasn't eaten any significant amount now in 2 days. we have him home now, glucose at 6pm 210, probably still ketotic but has not been tested yet. going to try to get him to eat and give him some insulin. he is not in a good state - any suggestions?
many thanks
getting really scared now that we are going to lose him
 
I'm sorry to hear Jack isn't feeling very well. :sad: If he had ketones, the best place is usually the vet as it can be life-threatening and hopefully the vet knew how to treat him properly, although I'm not very thrilled to hear this:
jacklechat said:
although i had left his insulin with them they didn't give him any until i reminded them - prob 10am when he would normally have it at 7am - 7.30am.
Click to expand...

Did they give you any sub-q fluids to give him? Did they check for any blockages? Are you testing his urine for ketones still? Were you able to get him to eat yet? Sometimes cats get sick, just like humans. Hopefully he'll feel better in a couple of days, but it's important to keep him well-hydrated and to get food into him, if possible.
 
Urine testing for ketones, monitoring food and water intake and urine and fecal output, weight , etc.

See my signature link Secondary Monitoring Tools for these and also tests for dehydration.
 
Status
Not open for further replies.
Back
Top