Update on Austin-feeling like a bad kitty mom

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Shiframb

Shiframb

Member Since 2017
Austin, my 12 yr old Tuxedo cat was diagnosed in beginning of Jan of this year. Was on Lantus-gradually upped to 3 units twice a day with no BS under 400. Was quite discouraged, but found this forum and the advice I got here was encouraging. I saw how different treating a cat is from the straightforward treatment was for my dog. I started my spreadsheet.

With no change on lantus ( I was questioning if the vial I had was defective), I was able to get the OK from the vet to try Vetsulin (which I had on hand as my diabetic dog has been on it for a year now). She said to give 1 unit, twice a day. Shortly after, I ran out of my test strips. I continued to give the 1 unit, and after a week, I did a pretest and upped to dose to 1.2 units. On my spreadsheet, you can see I did manage to get a couple days of checks in at the time I thought he may hit a nadir, but he was still high.

My daughter, who works at my vet's office, asked how Austin was doing. She told the vet I had increased the dose, and I got an email that made me feel so bad. As I had said in my original post, the vet is suggesting that the reason Austin didn't respond to the Lantus was because he had some other condition that was causing the sugars to stay high. I had given Austin a course of antibiotics for an abcess just before being diagnosed (that infection may be what put him over the edge), so I really doubted a bladder infection. But I was talked into a needle aspiration to the tune of @$200, and it was negative.

My vet is now "concerned" because I upped the Vetsulin on my own and says if we don't get him under control, he may well go into ketoacidosis. She says random blood sugars don't really show how he is doing. I had planned to get a curve when I got my strips and had a day off. The vet wants me to get urine ketones. I have NO idea how to do that. I have a 2 cat household, with 1 litter box in the basement (to keep it away from my dog). I have no idea when Austin goes to pee. How do I isolate him, and get a sample. Easy on a dog-but a cat? And since his diabetes is not controlled and he has lost weight since diagnosis, it is a given he has urine ketones. At least to my understanding of diabetes.

My vet is again stressing that Austin may have a liver or GI condition that is preventing a response to the insulin and wants to test for them-an ultrasound, and endoscopy with biopsies. He has had no GI symptoms other than his extreme hunger. She mentioned if I doubt her judgement, I can choose another vet I trust. It is not that I don't trust or like her-she is very nice and calls or emails me often to ask how Austin is doing. But I feel like i am not doing right by my cat if I don't agree to even more expensive testing without giving the Vetsulin some more time. So now i feel like I've ticked her off or I must be neglecting my cat and putting him in danger.

Home from work now and in tears. I've been a nurse for 40 years and I feel so incompetent handling this.
 
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I don't think you should be altering a dose when you have so little data to go on. you should have a least one if not more than one curve done before just judging off of one BG that a dose needed to be upped. With so little data you can't tell if the high numbers are just high numbers or if your cat is bouncing from too low numbers.
 
Hi Margaret!!

Sorry to hear you're having such a tough time with your vet!! She's mostly wrong, but that doesn't make it any easier on you!!

DKA is a problem, and it is important to get Austin under better control, but trying to scare you into spending thousands of dollars is crazy...There's an old saying in medicine that applies here....."When you hear hoof-beats, think horses, not zebras"

Now I have no experience with Vetsulin, so there's not a whole lot of advice I can give you specific to that insulin, but you DO need to be testing more.....What's important with insulin is how LOW it takes them, so it's really important to get some tests in between the shots....especially on the PM cycle since most cats go lower at night

Can you try to get some more testing in for the next few days and keep posting? I know we can help you, but we're very data-driven here and need to know how Austin is doing in between those shots.

I'd go ahead and hold the dose you're giving (although I'm not sure how you're measuring 1.2)

You can test for urine ketones and I suggest you do, especially with him running this high. Here are some Urine Testing Tips to look over.....Most cats will go to the litterbox right before or after they eat, so that's when you should stalk him and see if you can get a drop of urine....that's all it takes is a drop. You just dip a urine ketone test strip into the urine and compare the result against the side of the bottle.

You can take a little Saran wrap and crinkle it up and put it in the litter box, put a plastic bag over the whole box or stick a soup spoon under him while he's "doing his business".....I know you can find a way and we'll all be here to help you!

If he ever has more than "trace" ketones, that's a medical emergency....but let's keep him from developing them in the first place!!

Getting extra water will help too....most of us add water to canned food to make a "gravy" to increase the amounts our cats get.

Hang in there!!
 
Thank you. It was not my preference to not test (though my vet says that I should have only done a glucose curve after Austin had been on the 1 unit for a week, at least. Not "random" testing, as she calls it.). I am looking to get him his own meter as my strips are for my pre-diabetes and my prescription is for once a day, so using them means I don't test myself. And the one touch uses one of the most expensive strips. I see that you guys test very often. When the Vetsulin was started, it was from the 3 units of Lantus that the vet had me slowly increasing on from starting at 1 unit in January, to 1 unit of Vetsulin when we switched. My strips were limited, so I chose to test when the Vetsulin was most likely to be peaking in it's effect-hence testing at about 4 hours, post dose. I was planning to do a full curve when I was able to refill my script, and be home for the day, after about a week, as the vet said.

I just woke up and it is 5 hours after the 1.2 unit dose. I got my very first number out of the 400/500 range! It was 374. Not a huge drop, but a huge drop is not what I wanted to see. I know 1 number isn't anything to base on, but it is a reaction!-something I have not seen since diagnosis Jan 4. And for me it is hope. Austin is calmly sitting here next to me. I will set an alarm and re-test in an hour, to get a 6 hour number. I just want to make sure he is not dropping too low. I work 3-midnight, so I will set my alarm as I am going back to bed.

It is rather easy to give the U-40 insulin as I have U-100 syringes (from the Lantus) and the dose of 1.2 units U-40 is 3 units on a U-100 syringe. That way it is a bit more to inject, and doesn't use my dog's syringes. I am always very careful with my injection and haven't gotten any "fur" shots.

Like I said-this 374 is what I have been hoping for-proof that he can, in fact, drop his sugar in response to insulin. When he was on Lantus, before I knew of this forum, I did do a curve -every 2 hours after a 3 unit injection- prefeed 497, then 485, 456, 437, 468, and 479 at 10 hours. There was a drop-but all numbers were in the 400s, and this was when he had been on the 3 units of Lantus for a couple weeks.
 
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OK, another "pink" number at 6 hours- 386. Will plan to stay on the 1.2 units. After a full week on that dose, I will do a Q 2 hr curve and see what he does over the time from one dose to the next.
 
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Shiframb said:
OK, another "pink" number at 6 hours- 386. Will plan to stay on the 1.2 units. After a full week on that dose, I will do a Q 2 hr curve and see what he does over the time from one dose to the next.
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Honestly I wouldn't hold this dose too long... It's getting you to high pinks but we need to get it down much further. You don't want to prolong these high numbers and increase the chances of resistance and dka. I'd do three days at 1.5 and see what happens.
 
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Glad to see another pink number today. Thank you for your input, Janet. I am doing a couple checks at the time for predicted peak effect of the Vetsulin, and will go up in the dose tonight at 12:3oam. Hoping that holding the same dose for 3 days gives a chance to adjust slowly. My vet had said that holding the dose at the same for a week was what she recommended, but I want to get out of these high numbers. As you said, I don't want to see DKA, but want to increase slowly to not miss the "sweet spot". If I keep seeing lower numbers, I will get a curve to see the dose to dose picture-and hopefully show my vet that Austin is responding. Thinking more and more that the vial of Lantus was the problem for the past 2 months.
 
Got a 367 at the 5.5 hour mark, the lowest number I have seen since diagnosis. Will increase tonight. The question is do I increase to 1.4 or 1.6 units? These are the easiest doses (instead of 1.5) to do on a U-100 syringe, using the Vetsulin.
 
It may be that the Lantus dose was too high. How was it increased? 1u at a time? We recommend making dose increases of 0.25u at a time so as not to miss the right dose and holding each dose for at least 3 days up to 5 or 6 days. Too much insulin can sometimes look like too little and this often happens when doses are increased by too much or too quickly. Getting a pre-shot test before each shot ensures BG is high enough to safely give the insulin shot and then getting a mid cycle test lets you know how low the dose is taking kitty. With Vetsulin, any time between +3 and +6 would be a normal nadir.

I have to totally disagree with your vet about random testing. While one number doesn't tell you much, over time random testing provides a pattern which can be very telling about what is happening with kitty. Curves are fine but if kitty happens to be bouncing from going lower than they are accustomed to or going too low, a curve can still suggest the dose is too low and lead to increases that are not needed. If curves are done in the vet office, stress hyperglycemia can give false data which again leads to unwarranted dose increases.

I'd increase to 1.6u tonight if you can test between +3 and +4 to see how much he is dropping. If you can't test, I'd probably be conservative and give 1.4u. Can you get a pre-shot test tonight so you can see how much he is dropping in the cycle?
 
Hello, Linda. Thanks for responding. Austin was started on Lantus Jan 4 at 1 unit. Over the course of almost 2 months, he was increased from that to 3 units. The increases in .25 unit increments, I believe (I did not have a spreadsheet then), about every 7 days. When I tested in between doses, I never got anything lower than the 400s. Once early in treating, I was really tired after work, and mistakenly gave 5 units-and I freaked! I tested every 2 hours, worried about hypoglycemia, but never got any results out of the 400s. I thought that that was really odd. That stuck in my mind as we were slowly increasing and seeing no change in his numbers. That's why I really pushed hard for a trial of Vetsulin before agreeing to the GI biopsy testing.

I can set my alarm tonight to get a mid-shot number to check the dip after the increased 12:30am dose. I will get a pre-shot glucose before tomorrow's 12:30pm dose, but I will be at work when the next mid-dose time occurs.
 
It sounds like doses were not increased too quickly or by too much at one time. I understand the difficulty of getting readings mid cycle when one is working but any tests you can get add to the puzzle. There are some high dose conditions that could be playing into Austin's numbers but until he gets to a much higher dose of insulin (6u twice daily +) vets will usually not entertain doing tests for them.

If Austin is showing no signs of GI or liver issues then I see no point in the tests the vet is suggesting unless there was something in routine bloodwork that pointed her toward those possibilities. I would discuss getting a snap test done for pancreatitis with your vet as cats can have low grade issues that cause elevated BG without full blown symptoms of pancreatitis. If that is negative and his dose continues to increase, then you might want to pursue testing for Acromegaly and Insulin Auto Antibodies. My cat has Insulin Auto Antibodies and was up to 16u twice daily for a while. Some cats just need more insulin than others so this is just heads up info for future consideration.
 
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Thank you. I am more sure that I made the right decision to change from the Lantus. Whether it was a bad vial, or not the right insulin, at least now I feel he is improving.
 
I second that "Yay for Yellow"! :joyful: I'd give the 1.6u higher dose a go for at least a couple of days to see if Austin comes down anymore as he adjusts to the new lower BGs.

I encourage you to get pre-shot tests too because it helps to know how much the BG is dropping between the shot and mid cycle test. As the BG drops down lower or if it drops a lot, it can set off some bouncing which makes it look like more insulin is needed when in fact it's not. The only way to be able to determine if and when a dose increase is needed is to get a handle on what is happening from shot to shot.
 
Pre feed glucose 414. Kind of expected. At least it's not upper 400/500. Will try and get one at about 4 hours for the nadir. I am hoping he will even out when his body adjusts. Staying with the 1.6 units for now. I will be off on Sunday-when he has been on this dose for 5 days. That is when I plan to do a curve so see from dose to dose. Is it correct to do it at prefeed-2-4-6-8-10 hours? Testing him every hour would be more than he would tolerate. Been trying to stalk him after he eats to try and catch a urine-but no luck so far.
 
When doing a curve, you have the option of testing every 2 hours for 12 hours or every 3 hours for 18 hours. That said with Vetsulin, I'd do the 12 hour curve given the faster action of the Vetsulin and the shorter duration.
Catching these guys in the litter box can be hit or miss....more often miss. Not sure if you are trying to catch urine while he pees but if so, you might want to try wadding up some plastic wrap in the box to hopefully catch a bit of urine or set up a litter box with fish gravel.
 
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