Tucker, 3 separate hypo days in two weeks, back from vet

I dont know what to do anymore. I've lowered Tucker's dose of Lev and his numbers are high more often than not, but even on the low dose of 1U, right now I can't get him away from 40. I've given LC, and then some LC dry food. Just now gave him some Temptations.

I've updated the spreadsheet (says Bean's SS), it goes back to 6/25.

On 7/5 his +12 was 33, his dose was a fat 2Units at the time.

On 7/6 at +6 - 41, then +7.5 - 36, gave him temptation treats both days.

I dropped his dose down to 1U BID and slowly worked up the present 1.5U, but his numbers are high for a long time, yesterday they didn't budge from the 300s and today we drop too low, I realize some may not feel 40 is horrible, but from a drop at 281, being on Lev which is supposed to be gentle, and the fact that for over an hour I've been feeding him with numbers at +6 42, then every fifteen minutes the numbers are 40, 40, 45, 44, I'm not sure where to go from here.

Tucker takes Prednisolone 5MG in the morning.
Potassium (Tumil-K) 1.5 pills BID
He has IBD, Pancreatitis, food and airborne allergies and a tumor on his brain. This morning was the first time his IBD has acted up since the Pred was started late March for the brain tumor - circling constantly.

Any thoughts would be greatly appreciated.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Is there a possibility that Tucker has a really long lasting rebound effect? I tend to hold doses longer than most, but you might try holding the 1u or 1.25u for 5 days or more to see if there is any rebound that needs to clear.

You mention a brain tumor - is Tucker an acro cat with a past history of high doses?

 

Re: Tucker, 3 separate hypo days in two weeks, need help

No history of high doses, in five years this is his first time ever coming close to hypo.

Should add, been testing for ketones, none present.

I have asked my vet about the acro possibility as his features are growing very large. Bridge of nose is much wider and front paws. We have an appointment tomorrow for her to look at him and pictures from a few months ago however she refuses to test for Acro as he is not and has never been insulin resistant.

Highest dose of Levemir is 2.5 U, before that his highest dose of any insulin was Humulin N which the vet prescribed based on his weight.

He had a mast cell tumor removed from the back of his about a year ago. Starting in November he began circling, it got worse and worse until it got to the point when he would circle when he got up, started walking, wanted a snack, tried to eat, he just kept circling. The pred was started after his potassium crash on March 29th, since then the circling has almost stopped.

Have asked the vet if pred could cause the growth of his nose/paws, she doesn't think so.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Prednisone/olone is a corticosteroid, and can cause "moonface" in humans. Think about Gary Coleman ("Whatchu talkin' bout, Willis!"). He was on corticosteroids for decades, and he had the classic round belly and moonface.

Don't know if that would be the case in cats, but it couldn't hurt to take a looksee.

Best-
Michele

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Michele, thank you. The larger features didn't start until after the pred, so that would explain a lot. Hopefully after my vet sees him tomorrow she'll ask on VIN or something.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

had posted elsewhere but wanted to repeat that maybe switching Pred to BID would even out the numbers more. i know how frustrating it must be to see higher numbers yet still big drops (could be just slower rebound clearing but could just indicate need for adjustments elsewhere than insulin dose).
there must be something we can do re pred dose adjustment to BID and/or change in carbo percentages. maybe even periodically you could increase carbs a small amount to see if that evens out shed, too.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

I never thought about changing/increasing carbs. He's allergic to wheat and corn gluten so I've stayed with only Fancy Feast gluten free flavors for years. Had tried Wellness but it caused CP flares. He has just started eating another low carb food, Soulistic grain free tuna, twice a day with his meds.

I will talk to the vet tomorrow about switching to BID dosing, but I thought pred was SID dose because of how long it lasts in the system, however at this point, I don't think the insulin is causing these low numbers.

The first lows were on 2.5U and now this one is on 1.5U, but getting good numbers since starting the Pred has been difficult. Up until late March his preshots were in the mid 100s, since the crash on March 29th, numbers are a crap shoot with him.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

(((Jenn))) I agree with Chris that maybe doing the pred bid would help... also, I give Fletcher's in the evening as I was told overnight is when the levels are the lowest. Maybe that's why it doesn't affect Fletcher's bg's. I also think he may hold the higher numbers for longer as the "panic" hormones may take longer to clear with him (I think it's not unexpected for numbers to be high for even 3 days after dropping low), so holding a lower dose for longer may let things settle down.

As for the acro.... well, it really can't be based on looks like most vets believe. The major physical changes are later in the disease process and we've learned that most of our acros look pretty much like a "normal" cat. In regards to doses... well, we do know another orinch boy who is acro and can range from no insulin to 60+ units a day, so that can't always be an indicator either. We actually had an acrocat on the catacro site that wasn't diabetic, just had the mouth/jaw/teeth changes. If you want to, though, testing for it wouldn't be totally uncalled for, especially with the tumor. Phoebe's Norton(GA) circled also and the Pred helped him.

(((Hugs))) and call me if you need to.....

 

Re: Tucker, 3 separate hypo days in two weeks, need help

My vet said no to the acro test, although we'll see what she says tomorrow when she sees him with his pictures from last year.

I chickened out tonight. BG went up to 171 a little over an hour ago, 287 now at PMPS so I gave only 1 U, I don't feel comfortable giving 1.5U right now. I may stick with the 1U for a while and just watch for ketones.

He's starting a new therapy in a few days, something I heard about from someone for cancer kitties, it's a supplement that will hopefully get him feeling a little better.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

what's the new supplement? Just curious.

Please be persistent with the test. I had asked my vet several times about Cole and she pushed it off. Finally I just said, "look, it's my money to waste, and I want to know. Test her." Just be firm. There should be no objection, especially if the cat is already getting some bloodwork. Don't forget to get the IAA done. Oh, and Cole? She turned up positive for acro and IAA. Needless to say, the vet was very surprised.

Hope Tucker starts feeling better. Sorry I don't have any ideas for you. Best wishes,

laur

 

Re: Tucker, 3 separate hypo days in two weeks, need help

4Life Transfer Factor Plus was ordered for him and should be here in a few days. Tucks immune system is shot from the pred and who knows what else. His tail is almost bald now, starting to look like a rat's tail and he's getting cysts all over. It's hard to keep up with all his ailments lately. Hoping this, along with his B12 injections can help him out.

I stuck with 1U this AM although preshot is 366. I'm no longer sure I want to stick with Levemir, this shed effect may not be best for him right now, perhaps BCP PZI would be easier. Lots of thinking to do, but first we see the vet after work and go from there.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Jennifer, are you able to get any spots check during the PM cycle? I am wondering if he was going a little lower during the night and rebounding with pinks and yellow during the day. I am sorry I haven't kept up with all of Tuckers ailments to be of more help. But can you try to stick with the 1U for 6 cycles and see if he levels out over time?

Of course I wouldn't want you to do this if he is prone to ketones at 200's and 300's. Does he feel bad when in the pinks?

I am certain that the low greens were from the 2U being too much for him. And most likely yesterday was when the 1.5U dose kicked in.

I would like to see you hold the 1U dose as long as you held the 1.5 to see where he goes with that. But it really is what you are comfortable with.

How long has Tucker been diabetic? You rescued him right?

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Thanks Paige, I have a hard time keeping up with his ailments, can't even imagine someone else trying too :mrgreen:

Yes, Tucker is a rescue, adopted at about age 13, June 05, previously sick, official diabetes diagnosis was not until November 2005. FD for about 5 years with about a year OTJ starting May 2006, has been on insulin for quite some time now, started Humulin N, Idexx PZI, BCP PZI, now Levemir since November of last year.

He's not prone to Ketones, have been testing quite a bit lately since Pred is new, but still no ketones.

Tucker feels best in the mid 100 to mid 200 range, over that he seems achey, low like yesterday he hides under the bed.

I did get one spot check last night, he was 287 at shot +4 was 271.

I'll try to get more eve spot checks, it's not always easy since Lilly Grace (my CH young lady) needs her feeding/outdoor trips for litterbox purposes, Tucker has other meds and the general clean up/dinner DH stuff, but I think eve +3s could work.

I feel comfortable staying with 1Unit for a while right now, but what I really don't get is I thought Pred would make his need for insulin greater, but before pred, he has not gone this low and his dose was 1.5U BID with preshots in the mid 100s.

Part of me wonders what role the brain tumor and low potassium issue is playing in all of this.

 

Re: Tucker, 3 separate hypo days in two weeks, need help

I was doing some reading on hypokalemia and diabetes and for people it stated that "too much insulin secretion can cause hypokalemia because insulin promotes potassium to enter skeletal muscle cells"

What are you doing for the low potassium? Are you giving oral K+?
Have they determined what type of tumor or the location of the tumor?

 

Re: Tucker, 3 separate hypo days in two weeks, need help

Tucker takes Tumil-K potassium pills, 1.5 BID, so three pills per day.

My understanding was that if it was the insulin that caused the potassium depletion it would have happened to a cat who just started insulin, but honestly, I have no idea. Before the Pred, which was started at the time of his potassium crash, March 29th, Tucker was well regulated, preshots in the blues, spending much of the day in the greens. He didn't seem to drink much water, so I don't know if increased PU/PD would have caused the potassium depletion. Seems that about 40% of senior cats can get hypokalemia.

Woke up that Friday morning to a limp, lifeless kitty, my vet thought we lost him, I was to take him home and spend the weekend with him and she would come in on Monday to let him go. Thankfully he turned around on Sunday. Since then we've monitored his potassium level, it's still on the low side, but I can't remember exactly what, I think 3.9 at last check.

Regarding the brain tumor, he had a mast cell tumor removed from the back of his head a year ago, vet said clean margins thankfully. However in November he started circling, due to the fact that the circling was only to the right the vet said that he has something pressing on his brain, but at his age and finances she didn't want to do any major testing.

Now she feels her research and the fact that the pred has almost completely stopped the circling proves it to be a tumor growing near his brain. Whether the mast cell tumor is back in the same spot which was mostly underneath and only a small portion showing on top of his head, or another type of cell mass, we don't know.

Tucker is also cyst prone, his tail is almost completely covered in cysts, he has some on his shoulder and a new one that just popped up at his flank where I normally give insulin. If I tried to count them all he'd probably scratch at me

I'm feeling very confused, I don't know which of his symptoms are causing what issues any longer and vice versa. My hope right now is to keep Tucker comfortable and happy for as long as possible.

Thank you very much for your thoughts, I greatly appreciate them.

 

Just got back from the vet with Tucker and Mr. Darcy.

First, I'm a terrible momma bean. I feel awful, especially since I was just telling Marvie to check Brady's claws a few weeks ago because when I adopted Sadie all of her front claws were grown into her paw pads.

One of Tucker's front claws had grown into his paw pad. He is not one to let me go near his paws, the one time I tried to trim his claws I ended up on top of him on the bed with him squirming underneath. But, I should have known something was wrong. So, the claw has been pulled from his paw pad and maybe his numbers will come down if he were in pain. I'm to give Buprenex for a little bit, just in case.

Second, vet says the bridge of his nose is not larger, his face is smaller. She called it atrophy. She said he's so old that he's lost much of the fat and muscle that used to be in his face and legs and that is why I'm seeing him as having some larger features. I think she may be right, as I look at him now, his cheeks might be thinner. His weight stayed steady at 15.8, not close to his healthy weight of 17.5, but at least he's stopped losing weight. Nov-March he was losing over a pound a month. There's been no weight gain in two months, but at least he did gain some of it back and is now steady.

Third, his potassium is okay, 4.1, the highest it's been since the crash, so continue at 1.5 Tumil-K BID.

And lastly, she said yes to giving him his pred half dose BID and we'll see if that helps even out his numbers. She'd like to see him stay on 1U of Levemir for a while and is looking forward to seeing how the immune booster may affect him.

 

Jennifer-

I just want to say that you are an incredible bean to Tucker. My Gosh! The devotion and persistance is incredible. Tucker is one lucky boy!!!

I'm driving to Dayville CT on Sunday evening to pick up my new cat. I've never heard of Dayville, have you?

 

Thank you Traci. I keep checking Tucker's paws and I can't find this paw that the tech said the claw was in. He has lots of dry scabs on his paws, I'm starting to wonder if she mistook the dry skin that's peeling for claw breaking skin because I really cannot find a sore paw pad. Very strange.

Dayville is part of Killingly. I believe it's a small town towards the Rhode Island border, probably a nice farm town. It's about an hour and a half past where I am in Milford.

I'd ask you to stop by with your kitty, but you're probably going to be tired and in a rush to get back home, but if I'm back from my great nephews baptism in time and you're in the mood, you're welcome to stop in.

Congratulations on your new addition. You must be very excited.

 

Bless your heart Jennifer. Hugs to you and Tucker and Bean!!! You've got your hands full but you're a wonderful momma. I agree sometimes all we can do is keep them happy and comfortable. He's got a good home ((((Jennifer)))) :YMHUG: :YMHUG:

 

Dear Jennifer,

Glad to hear that Tucker is doing a little better.

One thing I wanted to run by you is the fact that when I changed Charcoal over to Lantus from PZI insulin, he started getting worse numbers. I really wish I had never changed him from the PZI, as he started having all kinds of whacky readings, and with the PZI I could adjust the dose more easily, and with the Lantus, I could not 'mess around' with the dosage.

But, I kept Rudder on the PZI insulin and he almost always had fairly high numbers until a few months before he died. He started having hypo's and I started to have to drop his dose down because his numbers were really going much lower. I think the reason, and the vet agreed, was the fact that those last months when Rudder had so much trouble with his stomach and started vomiting blood, and having blood in his stool, that the vet felt, and I did too, that Rudder had cancer. So, what I am getting at, is that I believe and the vet did too that there was a possibility that the cancer was 'eating or living off of the sugar' in Rudder's body, which is why the insulin needs became less and less.

It seems to make sense, but I don't know if that could be a possible reason why Tucker could be needing less insulin???? If he has a tumor that you know of, perhaps, the tumor is causing the change in his insulin needs, as it did in Rudder's body? Just an idea, for you to possibly ask your vet about.

Before I finally had to let Rudder go, last July 23, 2009, he was barely using any insulin at all, and his numbers were fluctuating, but if I gave even a half unit of PZI to him, he could really drop quickly.

http://www.sciencedaily.com/releases/20 ... 184539.htm

The above article is interesting where it talks about cancer feeding off of sugar in the body.

I just wanted to throw out this information, and perhaps I am totally off base here, but I still believe that is why Rudder's numbers suddenly were skewing all over the place. Hypo's where he normally never had any, and then the continual lowering of his dosage of PZI insulin.

Take care! You are one great Momma Bean, Jennifer!
Hugs,
Jean and Charcoal (GA)

 

Just wanted to pop in and say I think you're doing great. Tucker is lucky to have you as his Mamabean...I'll keep the thoughts coming!

Best-
Michele

 

Hi Jennifer-

I almost had to drive to Old Lyme which would have taken forever, but then they reduced it to Dayville which is 50 miles less for me to drive. Thank you for the invite to Milford, but since he's going to be in the car for about 13 hours or more, I'm just going to head home. I'd like to visit you someday though!