Lucy is back...not responding to insulin after trying everything

Hello - Lucy is back again and I have a long post. I had initially joined this board determined and was posting regularly to try to help my furball, Lucy. A family member I was very close with passed away and it completely shut me down for a while with life in general and I disappeared from the boards. Long story short, I am back, in a good place, and needing help with Lucy and will do whatever it takes. The vet suggested putting her down as she was an uncontrolled diabetic which I am extremely against and absolutely NOT willing to do at this point so need help. My finances are also completely shot from the extensive ER visits in the past year - money (credit card) wasn't even a consideration when I took her in though, I just wanted her to be okay.

I wasn't as good at testing at home as I should have been (I admit) because she did not want to have one bit of it and was extremely difficult to draw blood from (even wrapped in a towel), but has since gotten better. She was back in the ER (again) a few months for ~36 hours due to ketones which I caught at home using the ketone strips. They said her pancreas values were low so she's been taking half a tablet of PancreaPlus 2x a day now for ~2 weeks. She has been on both ProZinc and Lantus but has been on Lantus now for about 6 months. She was a previous diabetic and went into "remission" a few years back, was taken off of insulin, had severe pancreatitis in Dec 2016, and was put back on. Her current dose is 5U 2x per day. When I had initially taken her in to the ER, I was feeding her Radcat. They told me to stop as the raw food could trigger a bacterial infection more easily which is not good for diabetic cats. They switched her over to Purina DM which I've been feeding her but am not a fan of due to the seafood and her BGs on this food. Her BGs for the past several months have hovered between 215 - 400, but they seem to be a tad higher on Purina DM than the raw. For the past several days, I've been feeding her a mix of Purina DM & Radcat in an attempt to switch her back to Radcat. I am very, very familiar with Dr. Pierson's food list and have tried most of the foods with low carbs, higher protein, and moderate fat. Nothing has helped. It makes it more difficult that she has a tough time eating shredded food and really only likes pates. I've tried different foods, different insulins, different doses, and nothing gets her even close to the numbers she needs to be at.

- Do I keep her at 5U of Lantus for now? Should I start over?
- Do I keep her on Purina DM only? Switch her back to raw only?
- She went into remission on ProZinc, but she was also a newly diagnosed diabetic at that point. Do I try switching her back to ProZinc? Keep her on Lantus?
- What are the best times (beside before she eats 2x a day) to test? I work a standard 9 - 5 and run errands after work. I am home for about an hour in the morning.

What do I do? Where do I even start to "start over" and figure this out?

 

Welcome back.

By any chance, do you have any additional data? I know I would find it helpful to get a feel for what you're describing. Likewise, it's hard to know how Lucy is responding based on only data from today.

As far as a raw diet, I'm not a fan of DM either. I don't like the notion of feeding a cat mostly by-products. Dr. Lisa's site talks about heating raw chicken (I think you dunk it in boiling water) if you're concerned about bacteria.

 

Welcome back! I'm so sorry to hear all of you've been through this past year! Hugs to you, first of all!

Do you still have your old spreadsheet? It might help if you link that in your signature too, to give folks an idea of her journey so far. And also any data you have from the past months - even if it's spotty. Any numbers you have will help.

I think if she's on Lantus right now, probably keep her there. Over in Prozinc we usually send people this way if their kitty isn't getting regulated, or is hitting higher doses. And also considering your work schedule. Lantus and Levemir tend to be a bit more stable and predictable once you get the data built back up.

As for the food, lots of us feed our diabetic cats raw food, so if Lucy likes it, and you like feeding it to her, I'd say go for it.

It's good to see you again! I look forward to watching Lucy get back on track again!

 

Thank you both for the encouragement! I just added in a link to her old spreadsheet. I tried to add in notes as I went along so hopefully those are helpful and this gives a better idea as to her "normal" numbers.

 

Thanks for addicting the link. The old SS sort of helps. Will you be able to get some additional tests in? Like you, I was working when managing Gabby's FD. Gabby had an early nadir so I shot at 5:00 as this allowed me to get early tests in. I could also be home by 5:00. When you are limited in getting tests during work hours, it's helpful to get tests on the weekends, at night, and on holidays/vacations. In other words, whenever you can so you begin to fill in the white spaces on your SS. It will give you a sense of what happens throughout the cycle. It's particularly important to get tests during the PM cycle -- especially since you're gone during the day. Without the PM numbers, you're missing half of your data. It makes it impossible to know if high numbers are due to a bounce or whether it's truly a high, flat cycle. If Lucy is bouncing an you're not testing, we have no way to sort out whether you've missed a number that requires a dose reduction. Unfortunately, too much insulin can look like too little insulin.

The New to the Group sticky gives you information on what a "typical" cycle looks like and the Shooting and Handling Low Numbers sticky discusses becoming data ready and what tests times may be useful.

 

Yes, I do her shots at 7:30AM & PM. I will start grabbing more PM numbers after her shots and definitely testing more on the weekends. I'll keep the spreadsheet updated as well. Can't wait to help her and figure this all out!

 

Hi and welome back,
Good job convincing Lucy that the pokes are necessary.

As you've been away for a while you might want to check out her new searchable list, this is the most up to date link and a useful tool, you can search for specific parameters, here's the link, just in case you haven't come across it.
http://catinfo.org/chart/index.php

With a little more data hopefully we'll be able to help you figure out the next move.

 

Wishing you luck with Lucy. What kind of vet would suggest putting an animal down because the diabetes not controlled?! I'd try and find another vet for sure.

 

I've added more data in to her spreadsheet between her shots. As you can see, she is all over the place in terms of numbers. Any ideas or "next moves"? I'll continue adding to the spreadsheet.

 

I've been filtering the heck out of this list and have tried most of the foods on it (under 6% carbs, 20 - 45% fat, remaining protein) minus all of the fish ones. Not a big fan of the top ingredients in Fancy Feast so have skipped that one for now. She has a hard time with the Tiki Cat. Same with the Weruva. I have such a hard time finding for her that is pate-like that she will actually eat

 

You could add FortiFlora to try to help with the loose stools. What time do you get home in the evening? I test 5:30/5:30 so I can get a +4 some nights before bed. Take advantage of days off to get additional tests bv

 

Review the dosing protocols on the lantus forum and see which one you are most comfortable with.

 

Have you tried ZiwiPeak?

 

I get home anywhere between 6 - 7:30, usually because I have to run errands after I get off of work. She doesn't really have loose stools with these foods, it's just she has a huge problem eating any food that is not a pate. She takes probably 6x as long to eat shredded food like Tiki Cat or Weruva - and I can tell she doesn't like it nearly as much as she leaves some of it untouched which is very, very abnormal for her. Low carb, moderate fat pate seems incredibly difficult to find.

 

Well your other option is to blend the shredded into a pate texture.

 

I haven't - I normally put the 'fat' content filter between 20 - 45% for her because of her pancreatitis issues though. Not sure if this is the correct thing to do... (put the fat filter percentage at this range)?

 

Weruva bff cans are pate.

 

Good job getting those midcycle tests in during the daytime cycle. FD is a game of two halves though, and with many cats throwing their lowest numbers at night I would strongly advise getting some pm data. Do you think it's at all possible for you to at least always get a before bed test?
It will help fill in the blanks, at the moment we don't know if she's dropping low at night and bouncing during the am cycle, or if she's simply just staying high.

Sorry the lost wasn't much help. I'm in Spain we have different foods here, so can't offer any suggestions.

 

The nutrient percentages for those look awesome! The only problem with those is that they all have tuna in them which I am trying to avoid in finding a 'staple' food for her

 

Thank you! Yes, I definitely think I can add some more PM tests in. I got to bed fairly early during the week so can get a few right after her insulin shots, and some later shots on the weekends (like tonight, as I have tomorrow off).

 

I believe the issue of the amount of fat in the diet of a cat with pancreatitis is to consistent with current thinking.

This is a link to a roundtable on pancreatitis by experts in the area. They pretty much conclude that you need to feed your cat and sometimes that means finding something your cat will eat.

 

That was interesting. I am not positive Lucy has pancreatitis, but am always trying to err on the side of caution. She was hospitalized in Dec 2016 for severe pancreatitis, but that is because her vet told me she was free of diabetes about 6 months prior and never gave any follow up information. I was very naive as to how this all worked and trusted the vet. Since she was discharged from that episode, she has not had pancreatitis (although her abdominal ultrasound in Sept 2017 showed very slight inflammation of the pancreas, which they said was "normal"). Her pancreatic enzyme test results came back slightly low from her recent ER visit (Sept 2017, ketones) so they prescribed PancreaPlus which I've been giving for about 3 weeks. So many different variables. I am always so scared to switch things up because of her ER history.

 

IF you find a food you'd like to try but it's a shred or chunk instead of a pate, you can always get a cheap small food processor and turn it into a pate....
just a tho't......

and you can add a bit of water - an added bonus....

 

I've thought about doing this as my options right now with the filters I have (no fish, carbs below 8%, fat 20 - 45%, pate) are incredibly limiting! Or even trying to sneak in to the higher fat food category as it really increases what there is to choose from.

 

If you mean her amylase and lipase values, these are not reliable values in cats.

 

Was thinking same...could work with the radcat or other raw. I do this for one of my senior civvies. Adding a little extra water and 1/2-1tsp plain egg white powder to the blender mix makes it kinda like a mousse, too.

 

try moving the line to 9 % or 10%.....
see if that give you a few more options.....

the goal is 10% or less....
sometimes the lowest number of carbs isn't the answer..........
My girl actually went lower with 9 % foods than she did with 1%.

I know what you mean trying to avoid seafood.... Some foods say turkey or chicken but when you read the ingredients, you still find fish.


@Sienne and Gabby (GA)
I think you were autocorrected, ?
weren't you saying that the amount of fat in the diet with pancreatitis is inconsistent with current thinking?


Will Lucy eat rabbit or kangaroo?
For most kitties, that's a novel protein, they don't seem to add seafood to it, it is often in pate form.....

 

@rhiannon and shadow (GA) - Yes, thank you.

 

I just spoke with the vet and they said it was her TLI value that was low (9.7, reference range starts at 12+) and this is what prompted them to prescribe PancreaPlus.

I've never tried kangaroo with her, but she will eat rabbit. Honestly, she'll really eat anything. I put a filter only on carbs at 10% (left filter off of fat) and was looking at a few - Wellness Core, the Ziwipeak mentioned earlier in this thread, Beyond pates, Blue Healthy Gourmet pates, and the Koha pates. Are any of the listed better than others? Is there any specific major protein ingredient besides from seafood that should be avoided as part of regular feeding?

 

only if Lucy has a sensitivity to a specific protein....
it's the ibd kitties that have to switch to novel proteins.

I found the Koha pates to be a good company. And I fed Ziwi whenever mine would eat it ( haven't tried it on the new kitties )

Why are you avoiding seafood? There are some with good quality.
I avoid them because of quality issues myself and the new cats doesn't seem to be interested in seafood.
I was so happy with Tikicat chicken with turkey carnivore and they had to quit making it because of turkey issues overseas.

I would say my own order of quality with those listed is Koha, ziwi, wellness, blue, then beyond ( since it's Purina)

 

I avoid it mostly just based on recommendations to do so as it may cause them to become 'addicted' to it. Not sure I really buy that though - Lucy FREAKS out over Radcat chicken raw food wayyyy more than the Purina DM (which has salmon). I've also read it may increase BG numbers (no clue if that's true). I guess I also just feel like it's more difficult to monitor the quality of seafood. Honestly, I'm not sure. I've read things against it but not much for it which is the main reason, to be on the safe side.

Thank you so much for putting those foods in quality order! I have a holistic pet store less than 5 minutes from me that I am going to swing by tomorrow and look for Koha & Ziwi Also, interesting to know about the cats with IBD needing to switch to novel proteins. Lucy's abdominal ultrasound didn't show any signs of IBD, but I am definitely going to keep it on my list of good to know information just in case.

 

I avoid fish if I can because my oldest cat had hyperthyroidism and one of the many theories is fish could be a factor.

 

Okay - so I just had a bit of a freak out moment. Lucy has been a bit tired or just out of it for the past 24 hours or so. No ketones last night or this morning. She threw up her food both AM & PM yesterday but ate the second helping. I started researching ProZinc vs. Lantus. I just came across a site that says a con about Lantus is that it has a short shelf life, 3 - 4 weeks. I JUST asked her vet about this less than 2 - 3 weeks ago. I was concerned the insulin was getting on the older side, but she said it was perfectly fine and to continue using this. I am not sure exactly how long I've had this bottle of Lantus, but it's most definitely been longer than 3 - 4 weeks, probably 3x that. I am really concerned now that this is what has been causing her BG numbers to slowly increase.

To add - another con I read was that Lantus has to be very timely, almost 12 hours on the dot. I was told the opposite by my vet, that the schedule was more flexible. Lucy is mostly given her insulin *approximately* every 12 hours, but there are days when I've been home late, etc., so now I'm really worried I've been acting on completely incorrect information

I am at the very bottom of the vial of Lantus so need to get a new bottle anyway and am doing so today. Should I continue with Lantus or try switching to ProZinc? Her numbers have never been great on Lantus but I know that could be due to a number of things. Does anyone have thoughts on this?

 

If Lantus is refrigerated, then it lasts 6 months. 30 days is if you keep it on the counter.

 

Phew. That makes me feel better. But I guess the insulin being old then is not the reason Lucy's numbers are so high.

 

Just curious, but why haven't you increased? With TR, we hold for 6 cycles/3 days and with SLGS, we hold for 14 cycles/7 days. I am not sure which one you are following.

 

This is the first time I've been following the TR protocol so need to get in the swing of increasing the dose after a certain period of time. I will increase to 5.25 tonight! Is 5.25 starting to push the limits in terms of units? I am always worried about the insulin resistance I've read about being the cause of her high numbers.

 

If you mean the # of units, no. There are acro cats that get 50 units! You keep increasing until you find the good dose.

Add TR to your signature.

 

Wow, that is nuts! Makes me feel quite a bit better about her dose creeping up, I thought we were at the way high end. I've updated my signature. Thanks so much for calming my brain down these last few posts!

 

I just saw your other questions. ProZinc is an in/out insulin. Lantus is a depot insulin. I used Lantus. If you need to buy more, the best place is through Mark's Marine Pharmacy. https://rxcanada4less.com/

It's better to buy the pens because if you do not open the pens, they last longer and you can use it all before it goes bad. They tend to expire in 2 years, I think.

With Lantus, you want to give insulin within 15 minutes every 12 hours. Sometimes you have to be late then you just work it back to the normal dosing time or skip.

 

Unless you are egregiously late-like 4 or so hours, I think skipping it is unwise. Others might have better information than have I. Oh, and I increase or decrease more like .5Us because I also have a high dose kitty. She was at 7U for a long time, now increased to 8U.

Here's a message I got from "Chris & China" about dosage increases- She's been around since 2013, so she knows a lot:
___________________________________________________________________________
"To put it into perspective a little, remember, when we first start (down at around 1U) we do increases in .25 unit increments.....so going from 1U to 1.25 is a 25% increase in dose

Once you get to (for example) 5U, increasing by .5 unit is still only a 10% increase in dose

So going from 7U to 8U is totally reasonable."

China's SS 2017--China White's Profile--DCIN Critical Care Fund
Civies..Cheaser & Cleocatra..Maine coon X's Drooler..Peaches (GA 12/4/14) Mid-Mo
Chris & China, Yesterday at 3:40 PM Report

 

Yikes - I was not aware of this. I'm usually within about half an hour of the time as I was under the impression from the vet that was okay, but need to be more of a stickler with the time moving forward then. Also, I just looked at the Lantus prices on Mark's Marine Pharmacy and am shocked!! I think I paid $280+USD at Costco for the 10mL vial Her current vial is almost out so I have to pay the price for it to avoid having to wait for shipping But will definitely be ordering from there this next go around! I just spoke with Costco and her current vial is from April!! Ugh, way time to get a new one. I've also been reading all of the posts about Lantus on this board and saw that you're supposed to handle it as carefully as you can to preserve it. The vet told me it wasn't required to be rolled like ProZinc, but that it couldn't hurt to "shake it beforehand". I feel like I have so much to learn (or re-learn from what I thought was right).

In that case, I think I will try bumping up Lucy's dose from 5 to 5.5U this evening instead of 5.25U.


On a separate note, is there a chart (similar to Dr. Pierson's food chart) for raw food?

 

Another Lantus question - I've always given the insulin injection 20 minutes after she ate (per direction on the vial). Is this necessary? Or can I give her the injection while she's eating? It makes it easier to track timing (especially knowing now I need to be way more punctual with her insulin shot).

 

Yes! Many of us shoot while their head is in the dish. It takes me 5 minutes to test / feed / shoot. If they don't eat much at that time, that's OK. You have a 2 hour window for them to eat before the onset.

 

Awesome, this is great news and makes things so much easier timing wise! I am very hopeful even with just the information I've learned today.

 

Another question Lucy is clearly an uncontrolled diabetic right now. So I give her a set amount of food at her feeding time (which is always more than the recommended), then I give her more after that (between 10 - 40 minutes after initial feeding) because she is still hungry. Does this throw of her values?

 

I free feed my bunch. If I don't free feed Zeke, he starts to get tummy issues. Food can be down all the time, you just want to be sure to pick it up 2 hours before preshot test.

 

Don't shake your Lantus vial!

 

It's fine. As Meridith said, it is fine anytime except the 2 hours before the shot times.

Feed Lucy as much as she wants right now because she's unregulated and her body is not able to utilize the food properly. When she starts gaining weight, then you can start limiting how much you give her.

 

Lucy's numbers have been high for 3 cycles so I've increased her to 6 units again. Still currently trying to find a canned food for her to split with her raw food. A lot of the foods on Dr. Pierson's food chart that are under 10 carbs are food in "broth" or "gravy". I've read to avoid those. Is that because the likelihood of a food in a broth or gravy is higher and doesn't necessarily mean all food in broth and gravy are going to be high carb? As an example, I'm looking at the Instinct Grain-Free Canned Chicken cat food as the protein/carb/fat balance is pretty good and it is much cheaper than her canned food now. The 4th ingredient is chicken broth but the carb count % is only 7. Same with the "Nulo - Shredded Chicken & Duck in Gravy" - not thinking of getting Nulo, just using it as an example. Should any foods in broth or gravy be avoid, no matter their carb count?

Also, is there a set phosphorous number goal to stay under on the chart? She doesn't have any liver or kidney issues.

 

Chicken broth as an ingredient is fine....it's just like what you make if you boil a chicken in water to make soup....it's there to add moisture and flavor

What you generally want to avoid are the words "in sauce" or "in gravy" in the name of the food....Like a chicken pate is low carb but a "chicken with sauce" or "chicken with gravy" are usually high carb