Vinny: No longer in remission :(

AspenMarshall

AspenMarshall

Member Since 2024
Hi folks,

I have always really appreciated the insight and advice that I have been able to get from this forum, so I wanted to share our most recent update on Vinny's health after his follow up appointment with his specialist today.

We noticed Vinny having more frequent accidents outside of the litterbox (specifically peeing on the floor right outside it) so figured it was time for a recheck. Today after blood and urine samples they found that his glucose was about 350 and there were ketones in his urine.

The specialist vet then went on to recommend he start bexacat in addition to the cabergoline since it would be more convenient as a treatment plan than injecting insulin twice a day. She said there is not a lot of documentation about using the two drugs together. While she was out of the room I googled bexacat and immediately clocked the message about it being only for cats who have never had insulin before and I asked her about it when she came back in the room. She said yes that's a good catch, this would be an "off label" use of the drug...

Now I'm home and reading these forums and based on the presence of ketones in his urine and reading some of others' stories, I am really scared and feeling that this is not the right move for us. I am not willing to take the risk to see if it will work when there is such a possibility of him getting really sick. We had a hypo event about 1.5 years ago where he had to be hospitalized and frankly I'm still traumatized from it.

We enjoyed about 15 months insulin free and it reduced our stress across the board. I am so grateful we had that. But it looks like the best move is going to be putting him back on insulin at least for the time being. I have reached back out to the specialty clinic with our decision and I'm waiting to hear back. If anyone on here has any additional insight or even just words or encouragement, we will take them. Thank you for reading.
 
Good catch on the bexacat and ketones. That is a strict no-no and we've seen a few unfortunate cases where cats with ketones did not make it when they were put on bexacat. Are you home testing him for ketones? With ketones present, you need to make sure he's getting plenty of fluids and calories each day. Fluids can help flush the ketones. Is he eating well? You do need to start insulin ASAP to prevent DKA. Which insulin do you think the vet will suggest?

Looking back at your previous post, looks like it's been a year and a half that Vinny has been on the cabergoline? Anything changed in dosing for it in that time? He still the same weight as back when he started? Dosing is based on weight.
 
Hi, thanks for your reply. I am hoping the vet will prescribe glargine - this is what worked for him before his remission.

Yes it has. For dosing, the vet increased a few months ago based on a recheck of his IGF levels that showed elevation. He has been taking 60mcgs daily - good flag that it is based on weight. I wonder if it actually needs to go down. I will ask, thank you for bringing this up. The vet did notice that he is down about 3.5 lbs since his last visit.
 
AspenMarshall said:
Hi, thanks for your reply. I am hoping the vet will prescribe glargine - this is what worked for him before his remission.

Yes it has. For dosing, the vet increased a few months ago based on a recheck of his IGF levels that showed elevation. He has been taking 60mcgs daily - good flag that it is based on weight. I wonder if it actually needs to go down. I will ask, thank you for bringing this up. The vet did notice that he is down about 3.5 lbs since his last visit.
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Also we haven't started home testing for ketones yet - hoping our vet will send more info on that soon.
 
What is Vinny's current weight? Dosing is 10mcg/kg of cat weight. 60mcg means 6 kg or cat or around 13.2 lbs. The fact that he's diabetic again could explain weight loss. He could put some back on when he's back on insulin.

Here is a post on home testing for ketones. You can buy urine ketones strips at most pharmacies. Tips to catch and test a urine sample. You can also get blood ketone meters, but I read back that you were used to the Libre and not blood meters? And a bit more about there here: Ketones, Ketoacidosis and Diabetic Cats: A Primer on Ketones
 
Hi, I am replying with a few updates. I have updated my signature to include a spreadsheet that I am starting this week. Right now it is blank but that will change. My goal this week is to get more comfortable with the at home glucose monitoring, as Wendy mentioned at the start of our journey we relied heavily on libres but they frequently failed and became costly, and required extra vet visits for our little guy. I have purchased the ketone test strips and will attempt to get a sample over the next few days. We have increased Vinny's food intake this week to try to help him gain a healthy weight back - he's very happy about that lol. His current weight is 10.6 and he is a bigger boy and vet says he is healthier around 14lbs. Thank you Wendy for your support.
 
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