Vet says he's borderline; doesn't advise insulin.

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Leah & Baby

Leah & Baby

Member Since 2015
I'm seeking wise counsel about whether or not I should push to get my cat on insulin again.

In November 2012, we went through a period of about 9 months with insulin, slowing weaning him off with a change of diet. He has been in remission for 18 months, until about 5 weeks ago when he started testing in the 200s. Average has been 205-225, with one-time low of 188 and one-time high of 273. Blood panel was fine; urinalysis turned up a UTI, which we treated with antibiotics. The vet said she doesn't recommend insulin unless the BG is over 300, so I took a wait-and-see approach. I had hoped that the infection was the cause of the elevation, but 1o days after completing the course of meds, he is still in the same range (I've been testing him once a day looking for improvement). The vet said to repeat a glucose curve on him 2 weeks post-meds, which is coming up in the next couple of days. She said that if he is still high, it means he is borderline diabetic. She didn't tell me what the course of action would be at that time.

Meanwhile, he is losing weight and muscle tone. He thinks of nothing but eating. The good news is that drinking and peeing are within what I would think normal. He's looking progressively weaker, although still jumps up on things and still runs around, especially at night when I've gone to bed.

The 64 million dollar question is ,if I have done everything I can to control his BG short of insulin and it is consistently in the low 200s, should I ask the vet to put him on insulin? I can't help put think that a prolonged period at this level is going to slowly kill him. I remember, though, that the dosage I was giving him in the initial period was so small that it was difficult to even pull and measure such a small amount. Is it the case that it is too hard to even dose a cat at that borderline level?
 
I would give insulin if BG is pretty consistently above about 180 which seems to be your case. With insulin you have a better change of remission.
 
(((Leah)))

I'm in a similar boat with Saoirse at the moment. Her numbers aren't as high as your little fella's but she can't go without food for any length of time or her BG goes out of regulation. She's losing muscle mass, her coat condition is disimproving and she has bouts of ravenous hunger, too. I'm trying to make the case with our vets to start her on a maintenance course of insulin microdoses (I'm in a position to monitor her BG very closely and I have several months of home BG test data to refer to. I don't think I'd be comfortable proposing reinstatement of insulin treatment if I wasn't at home all the time). Saoirse has pancreatitis, too. I feel the same way as you: I think the insulin will keep her healthier. She was in such better condition just after she finished insulin treatment in November/December, but her clinical signs are slowly deteriorating again and her BG averages are threatening to go out of the Tight Regulation optimum range. I want to propose to our vets that I trial her on the smallest drop of insulin (Lantus) once a day when her numbers are outside the TR range. I certainly don't want to wait till she's exceeding the urinary threshold before reinstating insulin therapy: in my book that's way too long to wait. Maybe you could express your concerns about glucose toxicity to your vets and discuss something along the lines of what Larry recommended above?
 
Critter Mom said:
(((Leah)))

I'm in a similar boat with Saoirse at the moment. Her numbers aren't as high as your little fella's but she can't go without food for any length of time or her BG goes out of regulation. She's losing muscle mass, her coat condition is disimproving and she has bouts of ravenous hunger, too. I'm trying to make the case with our vets to start her on a maintenance course of insulin microdoses (I'm in a position to monitor her BG very closely and I have several months of home BG test data to refer to. I don't think I'd be comfortable proposing reinstatement of insulin treatment if I wasn't at home all the time). Saoirse has pancreatitis, too. I feel the same way as you: I think the insulin will keep her healthier. She was in such better condition just after she finished insulin treatment in November/December, but her clinical signs are slowly deteriorating again and her BG averages are threatening to go out of the Tight Regulation optimum range. I want to propose to our vets that I trial her on the smallest drop of insulin (Lantus) once a day when her numbers are outside the TR range. I certainly don't want to wait till she's exceeding the urinary threshold before reinstating insulin therapy: in my book that's way too long to wait. Maybe you could express your concerns about glucose toxicity to your vets and discuss something along the lines of what Larry recommended above?
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I had not heard of a "microdose" before. I wondered what the smallest dose one could measure was. My gut is telling me this is what needs to happen.

I work at home, so I, too, can monitor and manage Baby more easily than a lot of folks. I am trying to sit on my hands until the urine testing paraphernalia that I ordered arrives (had to order online) and I have the results of a full day curve for the vet; I know she's going to ask for both. I'm trying to do as much on my own as possible to reduce the vet bills.

Thank you, Larry and Critter Mom!
 
Here is how I measured the smallest dose I gave Saoirse (Lantus - using BD Microfine 0.3ml U100 Demi syringes with short needle):

- Make sure syringe plunger is fully pushed in.

- Insert needle into insulin cartridge and squeeze plunger down as far as it will go and then release the pressure.

It sucks up a tiny drop of insulin into the needle. I used once-a-day (SID) doses to help Saoirse towards becoming diet-controlled. Overall, she still is diet-controlled at the moment but that's because I really do control her diet. If it were not for the fact I feed her every two hours I'm 99.9999% sure her BG numbers would have been outside the healthy normal range well before now. As I said above, her clinical signs have been deteriorating steadily since mid-January (and the re-emergence of rusted fur indicates that she has not been able to use her nutrients properly for months). I think it is better to have a healthier, happier cat on insulin than a diet-controlled cat who is not well in spite of her numbers being within the healthy range, albeit at the high end. (The latter is not necessarily a bad thing given the situation with her clinical signs since it would be trickier to reinstate insulin therapy if her numbers were lower.)

If you ask a question about microdosing I'm sure other members will be able to give you plenty of tips on measuring small doses of insulin.

I do wonder about the criteria that many vets seem to use to decide whether a cat is or is not diabetic. As I said above, waiting till a cat's blood glucose levels are exceeding the urinary threshold is too crude a criterion in my considered opinion (and bad for the cat).

Please keep us updated on how things go, Leah.

:bighug:
 
The renal threshold in cats is 280, so as long as the numbers are below 250 on a regular basis, I think you can continue to hold out a little longer. Vets use the renal threshold as an indicator to start insulin because cats do not exhibit clinical symptoms from the diabetes until that point. It's more likely the weight loss was caused by the infection than his diabetes. If he is recovering from an infection, his BG will likely start to go down on its own after a 2-3 weeks. If it's still high (or climbing instead of going down) after 3-4 weeks, then he may need a little insulin boost for a short time, but I agree it should be a very small dose.

I just went through this with Bandit, and I know how nerve racking it can be. He had a severe case of pancreatitis that started around March 16th, and his numbers were in the 300s right up until 2 days ago. My vet kept telling me to hold off on the insulin because his BG would probably go down on its own after a few weeks of antibiotics if an infection was causing it, and I was insistent that we needed to start it right away because his numbers were so high. He finally gave me the script last Friday because Bandit had not had a number below 300 in over two weeks, and I ordered the insulin. Sure enough, I canceled the insulin order on Monday because his BG suddenly dropped back down to the 100s and is holding steady in the 100 range. I was really glad to be wrong, because if we had started insulin when I had wanted to start it, then Bandit certainly would have been at risk for a hypo situation once his numbers suddenly plummeted.
 
We are headed to the vet tomorrow for a re-test of the urine to establish whether the infection is gone, and to discuss the result of the curve I'm doing today. Baby has been in this 200-250 limbo for about 5 weeks, that I know of. Since he was in remission, I wasn't testing consistently anymore. I only discovered the elevation because I noticed the increase in drinking.

It has been 2 weeks since we finished the antibiotics and if anything, the numbers are creeping up. I haven't seen anything below 215 this week. He is getting too thin, with obvious muscle loss and diminishing strength and energy. It's painful to stand by and watch the decline, knowing that I might be able get him back on track with a little help from a syringe.

I have to consider, too, that there might be something else going on other than skirting diabetes territory. What that might be, I don't know. You can be sure I will ask the vet. It does seem strange to me that the numbers are hovering in a range below all-out diabetes.
 
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If he's symptomatic - losing weight, drinking excessively - he needs insulin. If your current vet won't prescribe it, I'd get a second opinion. See my signature link Vet Interview Topics if you need to search for a new vet.
 
If he's symptomatic and his numbers are creeping up and not down over time, then that is a different story. I thought you had originally said he was drinking and peeing normally.

I'm not saying that insulin might not be warranted, but just to be careful with the dose and make sure you're monitoring him closely, because when whatever is going on finally resolves his numbers could drop really fast. Bandit's sudden drop back down happened in a 24 hour period.
 
@Julia & Bandit - I have found your posts on this thread really helpful and informative. Saoirse's pancreatitis symptoms are worsening at the moment and her numbers are climbing.

Did Bandit's pancreatitis flare have a sudden onset or was it gradual? Also, I'd be very grateful if you could share details of the treatments that helped him to get better.
 
I was and still somewhat am, someone who didn't like insulin and was against it... My cat Frisky boy sadly passed away today. He was diagnosed with diabetes i October. I had to rush him to the vet on Tuesday because he was laying down and had peed on the bed. And he was making this very low moaning with every breath. The doctor said he was a complicated case.. They wanted to do so many tests but i didn't have money for it cause i had become unemployed a few weeks ago. So all they did was blood test and got him hydrated. He had stopped eating a day before and was drinking even less than he was a week before. He also was just licking and slurping his food from the weekend before. He lost his appetite and i had to force feed him the last week of his life. The vet said besides diabetes, he had Pancreatis, he had become anemic from the time of his last visit, less than two months earlier. And something called Acromegaly which probably caused his diabetes initially. They said his abdomen looked bloated as well, and his spleen most likely needed to be removed. So, i hope you can bring me some peace and closure by answering as to what most likely killed my cat. And were the vets completely honest with me. I will get all the test results from them, and message you again once you reply me back. Thank you i very much appreciate it.
 
Larry and Kitties said:
There is not one number for the renal threshold in cats. This
http://www.merckmanuals.com/vet/endocrine_system/the_pancreas/diabetes_mellitus.html
says
The renal threshold for glucose is ~180 mg/dL in dogs and ~280 mg/dL in cats.

http://www.vetsulin.com/vet/Cats_Monitoring_About.aspx
says
the renal threshold concentration of 200 to 280 mg/dL in cats.
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Just for clarification, Larry, would those values be as measured on a veterinary-calibrated glucometer?
 
My advice would be to get him/her back from the edge. Check out the hodgkins' protocol (yourdiabeticcat.com) and follow the sliding scale for tight regulation there. Many feel that blood glucoses above 150 or so damage/kill pancreatic beta cells, so some effort at this stage can prevent full blown diabetes. But just be advised it's quite a bit of effort. You'll be checking glucoses 3-4 times daily (at least initially) and dosing at those times per sliding scale to try and keep him in the 80-120 range (tight regulation) for a time in hopes of "waking up" the insulin producing cells that are still viable. You only need to measure in 1/2 unit increments to make that sliding scale work. But effort now will pay dividends later on. First step however is to make absolutely certain your kitty is on a low carb diet only (actually step #1, #2, and #3). Expect a good dose of religion on that site about how cats should ONLY be fed canned food, and while low carb is tougher to do with kibble, it can be done (think young again zero carb). But if you mention you are continuing kibble, expect "doug the thug" a particularly gestapo moderator from that site to BAN you. In truth, you can feed your cat garbage from a can or a kibble bag. You just need to be a bit discerning. For my views on that, visit here:

http://www.amazon.com/gp/review/RTQVX3N1SX5U2/?tag=felinediabetesfdmb-20

And while I was harshly critical of her book, and her message board (banned by "doug the thug") and quite angry over it, you can get much useful info over there.

As always, JMHO and do what you like.
 
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Frisky-JD-KitKat-Cozzy said:
I was and still somewhat am, someone who didn't like insulin and was against it... My cat Frisky boy sadly passed away today. He was diagnosed with diabetes i October. I had to rush him to the vet on Tuesday because he was laying down and had peed on the bed. And he was making this very low moaning with every breath. The doctor said he was a complicated case.. They wanted to do so many tests but i didn't have money for it cause i had become unemployed a few weeks ago. So all they did was blood test and got him hydrated. He had stopped eating a day before and was drinking even less than he was a week before. He also was just licking and slurping his food from the weekend before. He lost his appetite and i had to force feed him the last week of his life. The vet said besides diabetes, he had Pancreatis, he had become anemic from the time of his last visit, less than two months earlier. And something called Acromegaly which probably caused his diabetes initially. They said his abdomen looked bloated as well, and his spleen most likely needed to be removed. So, i hope you can bring me some peace and closure by answering as to what most likely killed my cat. And were the vets completely honest with me. I will get all the test results from them, and message you again once you reply me back. Thank you i very much appreciate it.
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I am very, very sorry to hear of Frisky's passing. :bighug:

When you get the test results, it would be a good idea to create a new thread on the Feline Health forum. That way, more people are likely to see your questions and hopefully share something to help you.

.
 
Critter Mom said:
@Julia & Bandit - I have found your posts on this thread really helpful and informative. Saoirse's pancreatitis symptoms are worsening at the moment and her numbers are climbing.

Did Bandit's pancreatitis flare have a sudden onset or was it gradual? Also, I'd be very grateful if you could share details of the treatments that helped him to get better.
Click to expand...

Bandit's symptoms came on rather sudden. He ate his late meal one night just fine (1am), and then I woke up to the sounds of him vomiting at around 4:30 in the morning. I was a little concerned because there was no hair in it, and then he went on to vomit twice more during the night. At breakfast (7am), he refused to eat and vomited up a yellow pile of bile. That's when I called my vet. I brought him in and they couldn't do bloodwork because they said he was too dehydrated, so they gave him fluids and sent him home and had me bring him back in the next morning. He still wouldn't eat, and his bloodwork the next day all came back as normal except he was severely anemic. That's when my vet sent me to Cornell because she said there wasn't any more she could do to help diagnose his problem. So we admitted him to Cornell that afternoon (not knowing what the problem was). After a LOT of tests, they determined that his pancreas was severely inflamed (from the ultrasound and the aspirate they did of his pancreas). He was on fluid therapy there for two days, and they started him on iv antibiotics. He came home the third day with two different antibiotics in pill form, and a liquid vitamin supplement called "elevate." They also found low B12 levels so I have to give him B12 injections once a week, and he's been going back to Cornell every 10 days for more testing to determine if the anemia is a separate issue from the pancreatitis or a symptom.

From what I can tell, when the pancreatitis is severe, all you can do is fluid therapy and feed in small amounts if the cat is eating. And if it isn't, a feeding tube might be needed. Bandit was very close to getting one inserted until he perked up a little and started to eat more.

He's not yet in the clear, though. Unfortunately, his BG is starting to rise back up again, and it hit 208 this morning, so we may be starting insulin if he continues to climb back up this week. :-( His appetite seems to be coming and going, too. For some reason, he only eats half his food when I'm feeding him, and he keeps spitting out his pill pockets when I give them to him, but when my partner feeds him or gives him his pill pockets he eats just fine. I'm getting really frustrated with the situation because I don't know if he's going downhill again or if I'm just freaking out too much. My partner says he'll get up and climb around his desk during the day, but when I'm home he just lies in his cat carrier and sleeps the whole time.
 
An update on Baby: after a negative urine culture and normal blood panel, the vet relented and prescribed 1x day .5u injections, starting 4/9. She asked for a long curve after 1 week, which I did. (First entry in SS) With each successive day except one, his AMPS has dropped and they all in blue. Seeing this, I have held back in reporting results to the vet; I wanted her to have a fuller picture of what's been happening during Week 2. I have been keeping a close watch on the first few hours after to gauge the effects of the dose and have adjusted slightly to keep him from dropping too far. We have yet to see an AM number in the green range, but making steady progress in that direction. He is responding so well so quickly that I am encouraged to think that he may heal.

I am pleased to say that he seems like his old happy, healthy self.
 
Those are lovely numbers. You're doing a great job!

I'm just wondering if it's possible to feed him a lower carb food than the one you're currently feeding (I don't know what that is, and it may already be very low carb for all I know...). But I'm thinking that, if there is scope for lowering the carb content of his diet, maybe that would be enough that he doesn't need insulin......?
 
Frisky-JD-KitKat-Cozzy said:
I was and still somewhat am, someone who didn't like insulin and was against it... My cat Frisky boy sadly passed away today. He was diagnosed with diabetes i October. I had to rush him to the vet on Tuesday because he was laying down and had peed on the bed. And he was making this very low moaning with every breath. The doctor said he was a complicated case.. They wanted to do so many tests but i didn't have money for it cause i had become unemployed a few weeks ago. So all they did was blood test and got him hydrated. He had stopped eating a day before and was drinking even less than he was a week before. He also was just licking and slurping his food from the weekend before. He lost his appetite and i had to force feed him the last week of his life. The vet said besides diabetes, he had Pancreatis, he had become anemic from the time of his last visit, less than two months earlier. And something called Acromegaly which probably caused his diabetes initially. They said his abdomen looked bloated as well, and his spleen most likely needed to be removed. So, i hope you can bring me some peace and closure by answering as to what most likely killed my cat. And were the vets completely honest with me. I will get all the test results from them, and message you again once you reply me back. Thank you i very much appreciate it.
Click to expand...
No insulin was administered? What kind of food were feeding? Just wondering for everyone's education and learning. Some people don't give their cats insulin and diet alone can put them in remission if caught early. You gave him love and that's all our furry friends want, may Frisky rest in peace.
 
Elizabeth and Bertie said:
Those are lovely numbers. You're doing a great job!

I'm just wondering if it's possible to feed him a lower carb food than the one you're currently feeding (I don't know what that is, and it may already be very low carb for all I know...). But I'm thinking that, if there is scope for lowering the carb content of his diet, maybe that would be enough that he doesn't need insulin......?
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Thanks for the support! Baby has been totally off dry/high carb food since his initial bout in 2012. That change was highly instrumental in getting him into remission (which he sneaked out of 2 months ago). He gets only Nature's Variety Instincts Raw mixed with a bit of low carb FF. Treats are freeze dried salmon bits. Honestly, I don't think I could do any better.
 
Dusty Bones said:
No insulin was administered? What kind of food were feeding? Just wondering for everyone's education and learning. Some people don't give their cats insulin and diet alone can put them in remission if caught early. You gave him love and that's all our furry friends want, may Frisky rest in peace.
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I am so sorry to hear about your kitty. Sounds like he was very sick, but you eased his transition as much as possible.

Baby had a bout of full-blown diabetes in 2012-2103, but a change of diet along with conservative, short-term use of insulin got him into remission. In February this year, he sneaked out of remission with pre-diabetic numbers (200-250). His health was visibly affected, so we had to give him some relief. He is getting insulin, but minuscule amounts: .5u, "skinny .5u, or even the almost unmeasurable .25u. He has perked up, filled out and doesn't look or act like the sick cat he was just 2 weeks ago.
 
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