9 week old kitten with diabetes :(

Hi, for the last couple of weeks one of our kittens became very sick. It began with him slowing down and sitting a lot while his siblings played like normal kittens. After about a week of this he got quite a large pot belly. He was still eating normally but we did notice he was urinating more than usual.

During this time we had him at the vet a couple of times but no diagnosis was made. His growth had now slowed and he became the smallest in the litter.

He had his first vaccination shot at 8 weeks with his pot belly. He was getting noticeably skinny besides the pot belly. His activity level still decreasing. About a day after the vaccination he stopped eating and drinking. He wouldn't get out of bed and he stopped responding. His breathing was rapid and deep. Back to the vet. He is now a bag of bones a day or two later.

His condition rapidly declining, being syringe fed we basically got told to say goodbye. He won't make the night. Finally a blood test came back, BG was around 500. A choice had to be made. Give him insulin now or wait for a diabetes confirmation test.

We gave him 0.2u of lantus. It was either that or he wouldn't make the night. We checked him every hour over night. Syringe fed him what he would take. He was basically in a coma.

I tested his urine for ketones. The result was very high which explains the totally muscle disapearence.

Dosing tiny doses of lantus was very difficult so he was changed to caninsulin twice a day.

He has started to recover now. In the last 3 days he has put on 100 grams. He is still a bag of bones but slightly fuller stomach. He will eat unassisted and go to the toilet. Occasionally he will have a bit of a play with his mother and siblings.

I have noticed that a lot of the time he doesn't recognize me but all of a sudden its like a fog has lifted and his tail goes up like he's just remembered me.

My problem that I'm hoping I can get some help with is, his BG keeps spiking up to 500 in the morning.

I have been giving him 0.5u twice a day with a 0.2 booster sometimes if his BG is above 300.

So his chart is: 500 at 6am, 120 at 10am, 300 by 2pm, 500 6pm.

So he goes from very high to normalish but back to high well before 12 hours is up. Which is why I've been giving a small booster shot at about the 8 hour mark.

I'm thinking of putting him back onto lantus this weekend and trying to give tiny doses twice a day. The vet has agreed that putting him back on lantus is a good idea because caninsulin doesn't last long enough. I have been using an app on my phone to do BG curves every 2 hours.

Does anyone have some advice on how to proceed?

Thanks

 

Absolutely.
Food - an over the counter high protein, low carb, wet, kitten food will help put on the weight if feed small meals frequently and keep costs down. See Cat Info for more nutrition info and a downloadable pdf of nutrition info. Canned Evo Cat and Kitten is one brand that you can choose.

Lantus last a bit over 12 hours in the cat. This results in overlap between shots. It is very important to keep the overlap consistent, by shooting 12 hours apart consistently. The doses are adjusted by the lowest glucose post-shot, called the nadir. This usually happens about +5 to +7 hours after the shot. Unless the glucose is too low to give insulin (below 200 mg/dL for new folks), we never adjust the dose based on the pre-shot tests.

We have 2 protocols for using Lantus. You'll want to read them over thoroughly and select one to follow.
Tight Regulation
Start Low, Go Slow

It can be difficult to measure tiny doses for a kitten. Lantus cannot be diluted. You may find that ProZinc (U-40), which is 40% the concentration of Lantus (U-100), is easier to microdose using a U-100 syringe.

See my signature links Glucometer Notes and Secondary Monitoring Tools for other helpful information.

 

Oh my gosh, I already want this little guy! All but one of my kitties were very sick and or near death, it just goes against my grain to let them die. You might also ask your vet about ProZinc, it does last longer, but takes longer to act as well, so with the high number to start with, I not sure that it'd be right. Wouldn't hurt to ask tho. I sure wish you all the best with him.

By the way, what's the little fella's name?

 

This is Ichiban (number 1 in Japanese) at 7 weeks before he got sick.

 

Oh he's adorable! So, so cute!! I'm so sorry he's been diagnosed so young and wasn't doing well but it seems that you're getting it under control for him. Caninsulin often doesn't last a full 12 hours in cats, as you've found out - I'm thinking possibly even less in kittens as they have a faster metabolic rate too. I really hope you can find a way of getting him back onto Lantus or ProZinc - I'm sure that would be able to give you better control of his BG levels. The micro doses are really tricky to measure - I know a lot of people here have had success in measuring tiny doses with calipers and a magnifier so that might be something you might want to try to ensure dosing consistency.

@Mogmom and Goofus - I agree. My 2 had cat flu when I adopted them (and were feral, so were really quite difficult to treat)...the rescue center wanted me to choose different kittens, but I just couldn't - I fell in love with them the first time I saw them. I almost lost Regan a few weeks later when she ended up with pneumonia as a secondary infection but I got her through that as well. I have a thing for taking on the cats no-one else would take because they're not "perfect"...but they're perfect to me!!

 

Hello and welcome to FDMB.
I am so sorry to hear about your kitten's diagnosis. But he is blessed in having you both as his caregivers.

I'm going to tag Kay @KPassa whose cat, now 3 years old, was also diagnosed as diabetic when he was a kitten.

Keeping fingers and paws crossed here that your little one is soon restored to full health.

Eliz

 

Awww little Ichiban is quite the cutie. Does he still have the pot belly?

We used to think lantus couldn't be diluted and the manufacturer does not recommend it but some carers here have done so without any problems arising, see the note just above the how to draw a dose video here http://www.felinediabetes.com/FDMB/threads/lantus-levemir-info-proper-handling-storage.151/

 

Ok, now I REALLY want him! He just looks like he needs all kinds of love! I just want to snuggle him!

 

We have protocols for Vetsulin/Caninsulin and for ProZinc/PZI, too. You'll be able to consider how to use all of them optimally.
Vetsulin Guide
ProZinc Protocol

 

Thanks for your replies. Tough times at the moment. He continues to get better. He's now moving around my house and responding happily when he sees me.

Its Saturday here, so I've just started him back on Lantus. I did what I can only guess is 0.4u. I loaded the syringe and test shot it 4 times to see if it was consistent which it was.

I will be doing 3 hourly tests of BG and using an android app to record.

What numbers should I be aiming for on his first Lantus shot after being on a roller coaster with caninsulin?

This morning he was his usual 450.

 

Lantus takes a few doses to build the depot in his system, so you might not see an instant big reduction in his numbers - that will come a few days in. It will be a case of monitoring him over the next few days to see what lowest point it starts getting him to once that depot builds up. Dosing adjustments for Lantus are based on the lowest number he gets to in the cycle, not the pre-shot number so checking his BG every 3 hours will definitely help you to find out what that number is and about when in the cycle it usually shows up. What you should also find is that it will start helping to smooth out those real highs as that happens, so he shouldn't keep heading back to 500 towards the end of the cycle once you find the right dose for him.

Oh, and the better he starts to feel and the more he plays will help too - exercise helps to reduce BG as well.

 

There is a spreadsheet and instructions on how to set it up here
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
Using this spreadsheet helps us to help you as we can all see the numbers you are getting (your vet too if you send them the link). As April says you don't expect to see a huge response initially. This is because lantus is a depot insulin - you can read about how it works in the stickies (posts stuck to the top) in the lantus/levemir insulin support group forum. The initial starting dose is held for 5-7 days to see what it can do, unless kitty goes too low and needs a reduction.

I strongly recommend you start posting daily in the lantus/levemir forum (where all the experienced lantus people hang out) while we work on getting little Ichiban regulated.

 

Thanks for that, i have now started the online spread sheet. Not much to see yet because i wont include his first week on caninsulin.

 

Just as a side note to Ichibans progress.

He has a large abscess in the right lower part of his belly which we first noticed about a week ago. The vet has him on a liquid antibiotic and has drawn puss from it once. The abscess is around the size of a ping pong ball and hard with a clear sign of a claw mark or bight from one of his litter mates during play fighting

 

Well done, I can access the spreadsheet fine so you did it just right

 

The abscess may be kind of good news as it may be what's causing his diabetes. Infection can raise BG.

 

6 hours after his first lantus injection and he's down to 77 from 450 this morning. Does he need a smaller dose than 0.4?

 

Wow - I guess Lantus is his insulin. What a result! He definitely needs his level checked again soon - I'm finding it difficult to even figure out how long with that fast a drop...maybe 30 minutes if you can do it - if he goes under 50 he'll need carbs as soon as possible to bring him back up. It does look as though he's having a very strong reaction to the Lantus - I think you might have to monitor him really closely with that sort of drop going on. And yes, it's quite possible he is going to need a smaller dose.

 

That's quite a big drop on a first dose...I'd be sure to continue testing and if he drops below 50, you'd want to give him some gravy from a high carb food to get him back up

If he does drop below 50, you might want to use the 911 prefix (available when you edit the subject line) to get some eyes on your post

It'll also help to go ahead and edit it and change it to say something like "1st dose of Lantus AMPS 450, +6 77" ...if you'd like to add "Reduce?" and the ? prefix it'll let people know you have a question, but not an emergency

To edit go to the right of your subject line and find "Thread Tools" and there's a drop down box to Edit

 

Quick measurement check here - you indicated you gave "0.4 u."
Are you using syringes with half unit markings and measured between the 0 line and the first line after it?
Or did you measure 0.4 on a syringe, which might have been 4 units?
Were you using U-100 syringes with the orange caps?

If you could take a photo of the syringe with it filled, that will help clarify how you measured.

 

Here is a photo. I have the plunger so the top of the plunger is halfway between the first and second line or just a tiny bit less.

The syringe is marked 0.3ml U-100. There are 30 lines from top to bottom and i have worked out that the first line is 0.

 

You're doing it correctly; I just wanted to be sure. We might even call that 0.25 units.

 

Its very hard to be precise. Im afraid that i will actually give him slightly more one day soon. What is the smallest dose an insulin pen can deliver reliably? Maybe when he has grown up a bit he will need enough so i can use a pen.

Another question, currently im taking blood from his paw pads as directed from the vet because the veins in his ears are too tiny to get a drop. Is this ok?

 

Some folks use calipers to measure the dose, plus magnifiers to help see if better (ex Carson Clip and Flip, on Amazon and possibly in local craft/sewing stores).

An insulin pen only doses in 1 unit increments which is too much for the kitten.

Testing on the paw is fine. Give a low carb treat after testing.

 

The pens are whole unit dosing only which doesn't usually work that well for cats who often need micro doses such as Ichiban is having. I would suggest with such a tiny kitten that you be cautious with the doses - if you think the dose may be a little bigger than previous ones, I'd go with easing a drop out of the syringe. Better a slightly smaller dose than one that's a touch too big.

Yes, taking blood from the paw pads is fine - in fact my vet said they prefer it for adult cats too. I varied between ears and paw pads if I was doing a lot of testing on Rosa so she didn't get too sore (and twitchy).

 

I just took a look at the latest numbers on his spreadsheet (I was wondering how he'd got on after the green numbers he had) - looks like he's bouncing from the greens he got so he should be fine for now. Bounces can take up to 6 cycles to break, or it can be faster than that - it depends on the cat. When you do his next shot, if you can get a reading at +2, that can often give you a good indication of where the cycle is likely to go (though it's not guaranteed with Ichiban yet as there's very little data to work on). In general, if the +2 is about the same as the preshot, it's likely to be a normal Lantus cycle (though you'll still want to watch Ichaban's nadir point as he headed down fairly low tonight). If the +2 is lower than the preshot then it's likely to be an active cycle where you'll need to monitor more often. And if the +2 is higher than the preshot then it's likely to be a bounce cycle - these are the ones where you can monitor less often. However, with the lack of data on Ichaban and the really big drop he already gave you today, you'll still need to monitor him quite closely until we're sure he follows that rule!

 

Here are more methods for dosing very small amounts of insulin.

Droplet method:

• Take a syringe and some colored water (to help you see it). Fill to 0.5 units.
• Twisting the barrel, push out 1 drop at a time, with equal sized drops.
• Practice until you can get the same number of drops every time.
• Now you can dose by droplet.

Never discharge the excess back into the insulin container as you will contaminate it with syringe lubricant. (Thanks BJM - I took this from one of you previous posts!)

Fat/thin/touching method:

• 0.5U = on the 0.5U line
• 0.4U = thin 0.5U - touching the edge of the line
• 0.3U = thin 0.5U - no longer touching the edge - some daylight between
• 0.2U = fat 0.0U - not touching the zero line
• 0.1U = fat 0.0U - touching the edge of the line
• 0.0U = On the zero line

(Thanks to http://petdiabetes.wikia.com/wiki/Fine_doses)

 

Thanks for that. I tried the drop method but couldn't get it accurate. Judging by your table I'm dosing 0.3 because there is a small gap between the 1 unit line.

 

Just tested 49 at +6 after amps of over 522. I've given him a large lunch but should I be doing anything else besides watching and monitoring?

 

Re-test in 30 minutes. if he continues dropping, he may need some high carb gravy or a few drops of Kayro syrup.

Check out my signature link Secondary Monitoring Tools for some other assessments which may be helpful.
I would recommend testing for urine ketones and glucose.

Also be sure to update the spreadsheet with the glucose tests, plus any other assessments or notes on him.

 

Im more worried about the 49 i just tested at +6 after amps

 

What did you feed him - low, medium, or high carb food? (went and edited previous post)

 

Getting under 50 means he's still on too much insulin, so he needs a reduction in dose.

When you get a test under 50, don't panic.....a few teaspoons of his regular food should bring him up, but you don't want to feed too much in case you need him to continue eating later

Test again in 30 minutes

 

Boing! That big meal really gave him a boost. Was it food, or just gravy/syrup?

 

Royal canin kitten instinctive gravy sachet. About 3 teaspoons. Didn't realize it would make that much difference.

 

Ichiban is now at the emergency vet. His abscess just burst internally so he has puss floating around his belly.

 

ACK!

 

I hope he's going to be OK and that the emergency vet can get him better. Please update us on how he's doing when you can.

 

Oh, no!
Sending prayers for Ichiban, and hugs for you...

Eliz

 

The vet tried to syringe fluid from the abscess out but couldn't get any despite it being clearly visible behind his skin. He said just to keep up with the antibiotics.

Each day Ichiban shows progress. Today he was chasing his siblings around briefly.

 

I'm so pleased to hear Ichiban is making progress - it's lovely to see when they start getting back to their normal behavior! And I hope the antibiotics clear up the abscess soon - I do think you'll get better BG control once the infection has cleared up.

 

What a cutie he is! Please check for ketones whenever possible - at his age and his response to everything, no tellin' what he's going to throw at you next. I don't think that's really a worry but just to be on the safe side...he's been thru a lot in his short little life.

 

I'm wondering if the vet first injected sterile solution, he could then suction out some of the material.

 

Just a quick question. At about 3-4 hours after his pm injection he drops from around 20 to around 5. I then panic and feed him gravy food thinking he might go hypo while I'm asleep. I get up 2 hours later and he's up to around 20 again. Should I just not give him the panic food hoping that he won't go hypo during the night and stay lower for longer?

Thanks.

 

I think you could see if he'd stay in the high green/low blue numbers with just low carb food instead of gravy - feeding him the low carb at that point should help him surf in healthy numbers. I would try it during a daytime cycle first though so you know it works for him as he does seem to go from high numbers to healthy ones and then back to high numbers every cycle. If he's definitely going lower at night, picking a night when you don't have to be awake early the next morning and staying up to see what effect low carb food has on him at that point would help too.

 

If you are meal feeding him, you might break it into 2 mini-meals and give the 2nd part about +2, as he's heading into his nadir.
Depending on how that works for him, you might use a teaspoon or two of medium carb food at the 2nd feeding, to help steer the numbers.

 

Just tested ichiban at +8 (54) and +9 (50) decided to give an early dinner.

Is this level considered hypo? There was no reaction from ichi. He was still playing as usual.

 

50/54 is kind of hypo and I would reduce dose but not easy to do withe your already low dose of about 1/4 unit.
You/Ichiban are in a tough spot since you are seeing very large swings of BG from preshot to to midcycle.

 

Yeah I've reduced his pm shot to about a drop and a half. The top of the plunger lines up with the middle of the 0 fat mark.

 

He is having an unusual reaction to lantus, not sure if it's because he's a kitten. I highly recommend you start posting on the Lantus board to get the experts views. In particular there are people with experience using feeding plans to manage lantus cycles better which may be just what Ichiban needs.

The 50s are not hypo, they're within the range for a normal cat, however, when on insulin we want to take action at that point to make sure the insulin doesn't keep pushing them down further. When you got that 54 it would have been good to feed just a teaspoon or two of low carb food to try and get him surfing at that level and also test again in half an hour to make sure the food was holding him up (I note that Vyktor dropped into the 30s a couple of times without any symptoms of hypo - definitely not where you want them to be when they're on insulin though as there's no room to move). If you can, you want to keep them surfing along in the greens as they are numbers that allow the pancreas to heal. It's better not to give a whole meal near the end of the cycle as it's generally going to cause the numbers to zoom up. There is a great sticky about handling low numbers that you'd be wise to print out and keep handy for future reference, it's in the posts at the top of the Lantus board.

Was that a 50 or a 40 that you got at +9, your spreadsheet says 40. Also what and how frequently are you currently feeding him as a regular thing?

I note that your spreadsheet mentions being concerned that .20 may not be enough. I wouldn't up the dose again just yet (in case that's what you were thinking) especially if that +9 was a 40. Give it a few days - unless he drops low again in which case you'll need to reduce. When people get to the lowest dose possible before OTJ some measure it as follows - push the plunger in as hard as it will go and hold it in while you insert the needle into the lantus then just release the plunger. The pressure release will cause the syringe to suck up a drop. I haven't done that myself so you might want to test with a glass of coloured water or cold tea or something to make sure that gives you a consistent dose and that it is smaller than what you're managing already. He's so tiny that he'll probably notice half a drop difference!

 

Agree with everything @Vyktors Mum says - I wondered if it's because kittens have a faster metabolism that his body's grabbing and using all the Lantus quickly so it's wearing off just a touch early too. I think the 0.20 is probably fine too - he looks like he's bouncing a bit but that's fairly normal when he's been down to 40!!

I did use the "reverse pressure" method that's described for getting a 0.05 unit dose for Rosa that she was on for close to a month - not only was it pretty much the only way of getting a dose that small, but it was actually easier to measure than some of the in-between doses heading down towards that point because I was using the syringe to get equal doses instead of trying to actually measure them. It does seem as though the dosing from it is pretty consistent - I did a few checks on it before I started using it. The only thing I would say is that it might well need to be the same person each time drawing the dose as you would want to make sure that the plunger is being pushed in just as hard every time. I'm pretty sure (and I can check this if you'd like as I do have some syringes left over) that my husband would likely get a slightly bigger dose than I would because he would apply more pressure to the plunger than I'm capable of while also putting the needle into the vial.

 

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it was set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

I guess you learned your lesson already (although I would have retested that 18 this morning it may have been a false reading) never ever shoot again if you think the insulin didn't get in, you have no way of knowing how much did get in.