2 months and cannot get my baby regulated - help?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by cocat, Sep 12, 2017.

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  1. cocat

    cocat New Member

    Joined:
    Sep 11, 2017
    Hi there! New to the forum (although I have been stalking others posts since finding out about his diagnosis)! Warning - Long complicated post! I apologize!

    Tom cat is his name, and we have been through quite the ringer. He is a 13 year old male Siamese that I've had since he was a kitten.

    In February of this year is when his health really started to act up. He has been through five surgeries (four minor, one fairly serious) to repair a hernia/fistula/megacolon situation. He's also apparently got some severe allergies and a heart murmur and gallop rhythm (luckily all under control with no progression). The surgeries went on from February until June. At of the start of July he fully healed from those operations. I still was a nervous mama because I noticed he was eating a lot, still losing weight, and extremely thirsty with lots of inappropriate urination (we have 8 litter boxes for two cats, plus have gone through hundreds of potty pads and two gallons of enzymatic cleaner!). I brought him back in to the vet for blood work and lo and behold - the birth of the diabetes diagnosis.

    For two months (Since July 7th) we've been trying to regulate the diabetes with no success. This is a complicated case because of the megacolon (and the required diet he was on to maintain that) as well as lots of lifestyle changes - including a new companion cat for him (adopted early this year) and just recently within the last 3 weeks a big house move. When it rains it pours! I know all of these changes are not good for my baby and could perhaps be contributing to his diabetes treatment not taking. But I'm hoping to find some help here.

    He was on a dry megacolon prescription diet (for the last 5 years) which was one of the only things that regulated his colon. He has successful had surgery and we have cautiously switched him first to Purina DM dry, and now (as of 09/02) he is fully on wet purina DM. He is supplemented with fortiflors (a probiotic that also stimulates appetite) as well as psyllium (a fiber powder for his megacolon). He is also on a colonic motility medication called cisapride.

    We started his insulin (lantus) at 1.0 units during July. I did not have home monitoring during this time. By August we increased him to 1.5 units and I got the alphatrak (loaner from the vet). We've gone up to 2, back down to 1.5, and back up to 2 again between mid-august and now.

    He had one really good day where he was getting low on the 2.0 units and we closely monitored for hypo. We did go back to 1.5 after that day because we thought the low readings were due to his now being fully wet food. But 1.5 didnt seem to be doing enough, so we bumped it back to 2 about 4 or 5 days later.

    I've made the spreadsheet. I did misplace some data points during the move :(

    It is the weirdest thing, because you can see the insulin is working sometimes, and sometimes not. I know there have certainly been a few fur shots on my part, but not every other day! Maybe a handful of times since starting this and once in the last week or two. So he is randomly getting these hi spikes and I don't know why.

    We are also unsure if his insulin pen might have frozen during the move (we had it in with a few ice cubes trying to keep it from getting hot). It could have some decreased effectiveness because of cold temperature it was exposed to, so we were watching it and I think now we will get him a new pen.

    Luckily, I live across the street from one of the best vet schools in the country... oh boy and let me tell you he has LOTS of friends there! He has been a regular to soft tissue surgery, internal medicine, dermatology, cardiology... just the works! And he is such a sweet boy, everyone loves him! So I am so lucky and grateful to literally have a team of extremely caring, competent, and up-to-date with the latest treatment options, vets behind me.

    But this has even them stumped. I'm hoping some more eyes on this can help me figure things out.

    So a quick run down:
    Wet Purina DM (3/4+ of a can 2x a day - trying to get his weight back up)
    Lantus Glargene Insulin pen
    Currently on 2.0 Units
    Diagnosed 07/07
    Home testing with Alphatrak (using pad of foot, his ear doesn't seem to bleed, I've seen the sweet spot diagram and still no luck)
    Other meds/supplements: Cisapride, Psyllium, Fortiflora
    Other conditions: Heart murmur, megacolon, repaired hernia and fistula

    Other things I've noticed:
    Insulin pen might have gotten too cold
    When first switched he was eating an entire can of DM no problem, now he only eats about 3/4's of it, and eats it in sittings (for example he will eat for 5-10 minutes, then break for 10-20 minutes, then go back to eating) this usually last 2-3 "cycles".
    He gets his insulin shot in the scruff area (I find it very difficult to tent the fur toward his hind end). We did just start rotating sides to prevent injecting the same site every time.
    Insulin is given after he starts eating (during the first "sitting") after I see his appetite is good. He will continue to nibble for an additional 30 minutes to an hour after first bite.


    I think that's everything (and my oh my its a lot!) If you're still with me I appreciate it and look forward to any advice, tips, items I've overlooked, etc that would maybe help with this.

    Thanks so much! I am about ready to pull my hair out! I feel like I'm doing everything I can and just can't get this figured out :(


    Tom and I both thank you in advance! :)
     
  2. cocat

    cocat New Member

    Joined:
    Sep 11, 2017
  3. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Should this have been "Diagnosed 07/17"?
    With all of Tom's problems I suspect he will be hard to regulate. Regulation requires consistency and medical problems can cause inconsistency in food metabolism, insulin absorption and stress.
    I had my already-diabetic adopted cat, Bailey for almost 10 years and could never get him regulated. He succumbed to a heart problem.
    Getting Tom's BG is a spreadsheet viewable in this forum can likely result in suggestion that result in better BG control
     
  4. cocat

    cocat New Member

    Joined:
    Sep 11, 2017
    He was diagnosed 07/07 of this year. Not 2007 lol. Sorry for the confusion. I guess the exact day doesn't really matter. I have uploaded the data that I collected into the spreadsheet. For the first month I wasn't doing home testing so no points there. The link is above. I think it should be working? At least I feel better about it having been 2 months and still not having this under control (since it sounds his other health issues can contribute to this process taking longer). I'm hopeful we can get this better for him. His other health issues are mainly resolved/regulated now, so this is the main priority!
     
  5. Yong & Maury GA

    Yong & Maury GA Well-Known Member

    Joined:
    Jan 11, 2017
    Welcome Tom and his bean!
    Your cycle on 2 Sept with 2.0U was like textbook perfect. Your first 2 months reminds me of my boy. If you were worried about him going in the low 100's if you were away you could try the 1.75U dose. It's easier if your syringes have half unit markings. Let's get your Signature setup with a lot of the information you provided above in your quick run down so it will always be there when you post. It's also where you can put your SS link :). For your missing data points, you should be able to cycle through the AT2 meter and find them :smuggrin:.

    As a safety measure, are you testing Tom for ketones? If he's never been DKA (diabetic ketoacidosis) we usually recommend weekly tests while kitties are in higher numbers. I use a spoon with my boy's name on it (so I don't accidentally use it :rolleyes:) to slide under him when he pees to catch a small sample. You're doing very good with him so don't be disheartened that it's been 2 months. There are many who don't see big changes in numbers in the first 1-3 months. An important thing to keep in mind is how is he feeling? Sometimes we get caught up in numbers.

    It's also possible Tom is bouncing longer than the average cycle. Take a look at the Lantus protocols when you have a moment and ask any other questions you might have :cat:
     
  6. vbc2000

    vbc2000 Member

    Joined:
    Jul 18, 2017
    Aww, he's a sweet boy inside and out!

    My Tigger has food allergies and behavior problems but wow, you've got me beat! Good work keeping at it. With just his two issues, it took me 4 months to get Tigger regulated. He had been on Hill's Z/D.

    I'm guessing you can't switch his food for fear of his other issues acting up right? I believe the food he is on is too high in carbs and is interfering with regulation. There is a food chart at the beginning of this board's postings. If he must be on that food, I suspect it's just going to take persistence to find the right dose. My boy ended up at 1.25 of Vetsulin. You wouldn't expect it but those .25 increments really make a difference. I had to get the half-marking syringes to pull that off so that might be worth looking in to.

    As someone else suggested, we get lost in the pursuit of a number when we try to regulate but the control of clinical signs (excess thirst and urination) and their general demeanor is another deciding factor in regulation according to my vet. How are those things?
    Welcome! It will happen, don't give up :)
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! You're doing all the right things and we can help you tweak a few.
    • Re food: which DM are you feeding, the pate (about 6% carbs) or the chunks version (10% carbs)? The pate might be better and all wet food is the way to go. Will he eat other small meals through the day if presented to him? Vets often suggest twice a day feeding but most of us find that multiple small meals is better. Just take food away in the 2 hours prior to the pre shot BG test.
    • I agree with @Yong that you had a perfect cycle on 02 Sept. when you gave 2 u. You went down in dose after that, his BGs rose and they've stayed higher since even at 2 u. It's possible that he has a bit of glucose toxicity going on from being higher and that can make it harder to get the numbers down. Careful dose increases of 0.25 u at a time is the way to get past it. If you have U100 syringes with half unit marks you can eyeball 2.25 u.
    • The Lantus protocols (TR and SLGS) give very clear dosing guidelines. Have you read them?
    • You can learn to give a full dose of insulin even if the PS is a blue number. The TR protocol tells you how and there are lots of people here to help. :)
     
    Yong & Maury GA and tiffmaxee like this.
  8. cocat

    cocat New Member

    Joined:
    Sep 11, 2017
    Thanks so much for the replies and feedback! It feels so good to know I'm not all alone in this! :)

    I will look into adding that information to my signature when I get home from work.

    In the meantime he is on the Pate food - I've read the stuff with Gravy is no good. I can possibly see about cautiously switching him to another brand. I'm giving my other cat the Fancy Feast Pate just in case Tom gets over there and gets a bite or two before I can stop him.

    He does get hungry between meals. I find if he eats during the day (we've tried that) he doesn't eat much at dinner and I get nervous about the insulin injection. I never thought to pick it up before dinner time though, so that might help.

    I've read a lantus information sheet (I'll have to find it again). I'm not sure if its the same thing you are describing. But it looked like it was written to a vet. If this is happening, then do this... kind of scenarios

    I'm going today to get a new pen of insulin (as the other one got very cold during the move and I'm concerned the concentration throughout the pen isn't equally effective) and I'm also going to request the smaller needles with the half unit markings. That's what I wanted to do after his good day between 1.5 and 2, but since I've got the needles without the markings the vet said she didn't think it would be very reliable (that I wouldn't be able to give that dose consistently just eyeballing it).

    Awesome I did not know the Alphatrak stored the numbers. That is perfect!

    Tom's is pretty good (and is it a little weird he is exceptionally affectionate when his glucose is hi?) I mean he is spunky and hungry and loving. I would think he'd feel bad.

    Overall he has good days and bad days. His urination is a glucometer in its own right - if he pees outside the litter box I'll check his glucose and 99% of the time its pretty high when that happens. He is still a happy cat, goodness despite all that's going on with him that past seven months, wish I could have a temperament like that! What a trooper her is! He lost a good amount of weight, and we are worried that he is still losing weight. I just purchased a digital scale and it appears to still be going down. I hate seeing him like that. It is heartbreaking trying to get this under control.

    I have been testing regularly for ketones and they have all come back negative! So that's a plus :)

    Thanks again for all the feedback!
     
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