Wally diagnosed with diabetes last week

Hi all:

Wally my 15 yr old orange tabby cat was diagnosed with a tumor over his adrenal glad. He also has IBD and a heart murmur. After the tumor was discovered he gained a tremendous amount of weight, at the rate of 1 lb a week. The tumor was too risky to remove and I could not afford the surgery anyway. At the rate he was gaining weight we brought him home and planned on doing palliative care. We did test for Cushing Disease as his symptoms seemed to indicate it but he was negative. He became very large. I stopped weighing him at 26 lbs, I couldn't bear knowing how quickly he was gaining weight. I believed he was going to have a heart attack and that would be the end. He seemed pretty content, not to aware of his illness but as he got larger he started having mobility issues. Well Wally did not have a heart attack. Instead he lost weight, ate a lot, drank a lot and lost muscle mass in his limbs. I assumed that the tumor was doing weird things but out of the blue decided to test his BG and It was 497. We went directly to the vet and got a prescription for insulin. Wally started on two units twice a day on 6/12/16. I ran his first curve today and set up a chart for him. The results have not been very promising with the lowest reading being 313. Does anyone know if this type of tumor can make him a acro kitty? He has a pot belly. Any way Wally is a large kitty normally. His normal weight is approx. 17 or 18 lbs. I wanted to use the start low. go slow method but think I already blew it. My last diabetic kitty was started at a high dose and we had hypo scares. His doctor also insisted on changing his diet immediately which ended up being fatal as he would not eat. I had to syringe feed him for months, never got his BC under control and he passed away within 7 months of diagnosis from pancreatitis and fatty liver disease. I don't want to go down that road again. Wally is only eating wet food but it isn't very low carb. He like Friskies with gravy. I tried to give him the pate but he would not eat it. I don't know if he is a acro kitty? I read the article about that but still am not sure. He has a tumor but not on the pituitary gland. I believe it is over the adrenal glad and not in it but he definitely has a pot belly. The picture attached is a few years old. He isn't that handsome any longer. His head is smaller as well as his limbs.

Anyway I have been reading up on this website and I have a lot of questions. The doctor wanted to start Wally on 3 units of Lantus twice a day and I talked her down to 2 units believing that was low. Now I see that 1 unit is the recommended starting dose. The doctor told me not to curve Wally the first week as his numbers would be all over the place. I started the curve yesterday actually (it is attached) and his numbers are in the 400 and 300 hundreds. I spoke with the doctor and she said to raise the dose to 3 units. I agreed to .5 a unit. Now I'm concerned that we are overdosing him. Could he be bouncing or are these true numbers? Should I reduce the dose or keep it at 2 or 2.5 units. I know I need to transition him to a lower carb food and am working on that.
I gave him Fancy Feast Medleys in broth (10%) carb last night and this morning. He ate it well last night but not so much this morning. I am leaving wet food out for him to graze on during the day as I am gone to work like 11 hours a day and I don't want him to go hypo while I gone with no food. I don't know what to do, his numbers are awful. Has anyone had such terrible starting numbers and been successful in bringing them down. Please advise, I'm really confused and want to help my poor kitty.

 

Hello and welcome.

 

Hi, I'm new here, too. My 6 year old yellow tabby Butter just diagnosed 2 weeks ago. His BS was 459, tried him on diet only for a week, was then 330. So started on Lantus 1 unit twice daily. Take him in tomorrow to vet for checkup & BS. I don't have as much experience as others here so sure someone can help. Good luck with him. He looks very pretty.

 

Thank you for the warm welcome scoobydoox. I'm not getting much response here. I think I will copy and post to the heath board. I'm dancing between giving a 2 fat or 2.5 insulin dose. but running out of time to make my choice, any suggestions?

 

Thank you spikesmom. You had a nice drop with the diet change. I think you were smart to start with one unit. I am afraid I may have started too high again per the vets instructions. I am going to be strong and hold out till the 3 cycles are finished. Luckily I will be off a half day tomorrow and will be able to get a mid day BC reading. Wally is still alive but his BC is up tonight. We might be over dosing him. I wonder if the results are bad, that I should drop back down to 1 unit and start again. Any input from veterans would be appreciated. Good luck with spike! I wish you success! Your off to a great start!

 

Welcome Michelle and Wally!

Do you know what tests were run to rule out Cushings? It's my understanding a simple urine test can be done but is not conclusive but rather suggestive of the condition so other testing is required. Normally until a cat gets to a dose of 6u or more twice daily, vets don't entertain a diagnosis of acromegaly but there are Acro cats who do not require large doses of insulin so it might be worth having the test done as it is more common than once thought. The IGF-1 test for acromegaly is a relatively inexpensive tests with most of the cost being the blood draw and shipping of the sample to the Univ. of Michigan lab. I am going to tag another member who has a cat with Cushings and is very familiar with the testing required to reach a diagnosis for Cushings.

@Tuxedo Mom , Mary Ann, can you provide Michelle with some more info re: the Cushing testing you had done for Tux? Thx.

It looks like Wally's pre-shot tests have come down a tad with the increased dose to 2.5u. You don't have a lot of data yet but it doesn't look to me like he is bouncing. I understand your concern over hypos and I would recommend that you make dose increases when you will be around to monitor Wally for a day or so (eg. weekends) but his numbers don't suggest he's in any danger of hypo right now.

 

Initially with my Tuxie, I became suspicious because he was totally impossible to regulate. was gaining weight rather than losing any, had the "pot belly" tummy...to the point he looked as if he were pregnant...symmetrical hair loss, no hair regrowth after ultrasound ( now 1 1/2 years with no regrowth) and thinner skin. The ultrasound showed enlargement of the pancreas, liver and both adrenal glands, but no visible tumours.


As far as Cushing's goes the least invasive test is the UCCR (Urine cortisol creatinine ratios) which is done by collecting a sample of urine at home (in order to avoid any stress) and having the vet send it to a lab that does this test. IDEXX should be able to do this test. I had the oral HDDS (oral high dose dex suppression) test done, but the main goal of that test would be to determine whether Cushing's is PDH (pituitary based) or ADH (adrenal based) With Wally having a tumour on the adrenal gland then, if he were diagnosed with Cushing's it would most probably be the ADH variety. Since ADH Cushing's is far less common than PDH, usually having all the symptoms and a tumour on the adrenal gland is a good indication of Cushing's.

 

I don't know the name of the test but will find out. It seemed it was specific for cushings. The test cost approximately $350.00. I thought I was getting a reliable test. I think it measured hormone levels but don't really recall the specifics. I was kind of devastated at that point and resigned myself to it being the end but Wally is very resistant and has a strong will to live and high tolerance. He has really been good about letting me test his BG and I have bruised his ears terribly in the process.

 

The UCCR test cost me $96 Canadian...1 1/2 years ago.....$81 for the test at IDEXX and $15 shipping cost. The UCCR test is the least invasive test and one of the highest accuracy tests. The ACTH stimulation test requires 8 hours at the vet ( I did not have this one done) The HDDS test I had done involved taking 3 oral doses of dexamethasone and having a urine sample checked for cortisol...similar to the UCCR test but after taking dexamethasone. The LDDS test involved a blood draw, then a shot of dexamethasone followed by 2 more blood tests at 4 hour intervals. Here is some information on testing:

http://www.petwave.com/Cats/Health/Cushings/Diagnosis.aspx

My Tuxie was diagnosed as early Cushing's Septemeber 2015, although the ultrasound and other symptoms pointed to Cushing's as early as 1 1/2 years ago. Since he has pituitary affected Cushing's the treatment is either removal of the pituitary gland, which has a poor prognosis or radiation treatment which I cannot afford. With PDH there is a drug that can be used, but results are mixed and come with other complications. Adrenal based Cushing's ...ADH..can be treated by removal of the adrenal glands with replacement daily medication given.

So although I have not done any specific treatment for the Cushing's, my guy is still doing well, except that his diabetes is hard to regulate.