Add Oral Meds to Insulin Injection? Vet wants to do this

My sweet baby, Sophie, seems to be insulin resistant. She is up to 3 units of Lantus twice a day. At the vet, her number have always been high. We just started testing on a Walgreen's gulcometer, and her numbers ranged from before breakfast 276 and before dinner 375. When stressed, she spiked to 471. Not sure how accurate the numbers are, but at least it shows a trend (any advice on if these are high or low would be great- vet is trying to convince us to buy that AccuCheck meter and says our is unreliable).

We took her to the vet today for another curve (results pending, but we expect high) and our cat was dehydrated and had lost another half pound. I almost cried, she's only 8 pounds to start with, and okay, I'm totally crying right now. I'm trying to do everything I can for her, but I don't know what to do. She's eating ravenously and drinking/peeing so very much. The vest is testing for a UTI and doing sub-q fluids.

*The vet says she is insulin resistant, so she is considering adding an oral med to with the insulin shots. I haven't seen anything about that anywhere. Anyone know anything about that or have personal experience with that?

The vet also says we need to do another $600- $800 ultrasound to see if it's cancer or something or if something else is going on. I wonder if that's worth it because we wouldn't put our kitty through surgery as she is 8 years old, and I worry about her surviving it.

I'm so upset, I'm not communicating clearly, any perspective would be so welcome.
My sweet, baby girl, Sophie.

 

Hi Katie and bootiful Sophie!

Oral meds don't work for kitties - the oral meds force the pancreas to try to work causing even more damage to an already fragile organ. 3 units isn't all that high of a dose. Yes you may be dealing with some insulin resistance but that can potentially be broken by following the protocol we use here. We have quite a few members with high dose kitties.

HUGS and welcome again!

 

Many thanks!

 

Hi Katie,

First up, I'm sending these because I think you could do with 'em:




Next up, based on what you've written above I'm a tad concerned about how knowledgeable your vet is about feline diabetes. I don't know what your history is with your current vet but I would suggest that perhaps you do a phone around of vets in your area to see whether you can find a practice with a better handle on feline diabetes - if only to get a second opinion. Having the right vet makes a world of difference to treatment.

For information, a couple of months after Saoirse was diagnosed, an external feline diabetes specialist <... cough ...> told our own vets that she was "a true diabetic" who had "no real hope of remission" and would "be insulin-dependent for the rest of her life." Saoirse obviously didn't get the memo because, following a change to an appropriate diet for a diabetic feline and a few months' treatment with a long-acting insulin, Saoirse went into remission and remained that way for just over a year. (Knocked out of remission by pancreatitis problems.)

Now that you're testing it would be really helpful if you could start to record your blood glucose test results in one of our shareable spreadsheets. When experienced members can see your data they will be able to make better suggestions on how to improve Sophie's blood glucose levels. There's no maths involved; you just fill in the insulin doses and test results as you go along. As you get more test data it will help identify how Sophie is responding to her insulin and it will act as a guide to improving her treatment. I've posted a link below to instructions on how to set up a spreadsheet. If it's all too horribly techie for your tastes just let us know and we'll find a member to help you to get started.

Spreadsheet Instructions

As you will often read here, diabetes regulation is a marathon and not a sprint. It is not that long since Sophie's diagnosis so please don't lose heart. (Saoirse was on insulin for a couple of months before she became some way decently regulated.) You've found a great place to learn and to get help. You're not alone with this, OK? We'll do all we can to help you to help your very beautiful baby girl.


Mogs
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For other members reading this thread, here is Katie's previous thread with details of diet (and more comments from the vet).

http://www.felinediabetes.com/FDMB/...etty-confused-and-scared.152209/#post-1597451.


@FurBabyMamma -

Please can you post what you're feeding Sophie? Is it still Hill's w/d? Also, are you feeding the dry or the canned version?


Mogs
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We are feeding the wet version of the Purina DM twice a day (we were doing the Hills W/D because they said it was the same thing but cheaper, don't know if that's true) at 12 hour intervals when we inject her. Also, our other cats are on the C/D diet, so we have to feed them together to make sure we aren't mixing diets. Also, spending money on expensive cat food seems to be my hobby... I think we are going to slowly mix in the suggested Fancy Feast variety on this board into the DM and switch Sophie to that.

We have the dry version of the Purina DM for the snacks that the vet recommended to feed her in the middle of the day (which I am not sure why). The snacks are very small (like maybe 1/8 cup).

Thanks, all. We are spreadsheeting up starting tomorrow after Sophie gets back from the vet today.

 

Do you check in between the shots?they are usually high before shot time and lowest readings are between the shots.

 

I'm sure the curve at vet will tell you what is going on but will be higher than usual cause was done at vets.the bg goes up from the trip to vet.

 

Yes, we do check in between. We plan to follow the glucose monitoring/insulin plan on here starting tomorrow.

 

I noticed on your other thread that your increases have been in whole units......that's way too fast to increase and it's totally possible that Sophie may be getting too much insulin!!

We do increases in .25 unit increments, never whole units.

If a cat is getting too much insulin it can look like too little because the high dose causes them to drop too low (or drop too fast) and their liver releases stored sugars and hormones to bring them back up quickly....we call it "bouncing"

Bounces are caused by 1. dropping too low 2. dropping too fast (like 50 points in an hour) or 3. just dropping into numbers that the cat's body isn't used to being in anymore.

Most of our cats have been diabetic for quite some time before we see the signs and get them diagnosed. During that time their body has adjusted to living at those higher numbers, so even just dropping from 400 to 250 could seem like it's too low....so the liver releases those sugars/hormones to bring them back up

Bouncing is a normal (but frustrating) part of the sugardance, but usually, as their body gets used to being in "normal" numbers again, the bouncing will get better

When you're home testing, we should be able to tell you if it looks like Sophie is getting too much, so it's important to get on that as soon as possible

 

Thank, Chris! I just trusted the vet would know what was best. After today, I am not thinking this vet knows what is best, and we are home testing all the way and following the Tight Regulation Protocol. Although, have we messed that up by being at 3 units already. We'll find out because clearly our current path isn't working.

Really good info on the bouncing; that makes sense, especially in some of the behaviors we saw.

Being honest here, I am frustrated that I have learned more helpful things on here than at my vet. I feel I should be refunded the thousands of dollars (yep), I have already spent on this and distribute it here.

I'll report back on what the vet says/recommends when I pick up Sophie in about an hour and a half or so.

 

You're far from being the first one here who's really upset with the advice they've gotten from their vets! We hear it a LOT around here!!

We do have to remember though that a busy vet doesn't have a lot of time to stay up to date on all the latest treatments in all the diseases in every type of animal they see. The people here do nothing but deal with feline diabetes and the complications that tend to come with it

We're on vet #5 ourselves, but she only see's China for routine exams and when she's sick or needs a dental....I believed in the people here and have listened to them when it comes to treating China's diabetes. When we do have to go, I tell the vet she's getting X units of insulin and her blood glucose numbers have run between XX and XXX....if she has any "suggestions", I listen, nod my head and go home and continue to do what works for us ...which is listening to people who've been doing this dance for many years and know what works!

 

It isn't. They're only the 'same thing' in that they're both cat food. Purina DM canned has an acceptable carb level for diabetics; w/d canned doesn't. If I recall correctly the Purina DM dry is too high in carbs as well.

NB - if you ever decide to feed something else instead of the DM dry snacks you need to be home testing throughout any transition period because with the reduction in dietary carbs the insulin dose may need to be reduced. As always, post asking for help if you decide you want to make any diet changes.



Mogs
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Okay, got her back. She looks/acts worse than when we got sent her. She is not a meower, and the vet said she was meowing all day, and she meowed like she never has before in the way back, like a distress meow constantly in addition to her coat looking worse. I've never seen that. When we let her out of her cage, she was wobbly in the back legs more so than I have ever seen. This poor cat; she came back in worse condition. Her gait is terrible right now; she is so wobbly in her back legs.

When they did blood work on her, her glucose was 520 at the vet; the vet also said her glucose was also over 500 the entire day. We used our glucometer right after she got home, and it said 450, so we at least have a picture of the potential difference between the two, but I am sure she was less upset in the carrier in the car than the actual vet office. Even if our glucometer is off by -100, 520 is still much, much higher than normal. Tight Regulation Protocol and spreadsheet starts tomorrow.

The vet suggested going up to 4 units of insulin (we're going to follow the protocol before we do that), and then said she really doesn't know what to do from here. She said 4 units was a ton of insulin, and she thinks something else must be making things worse because so many kitties respond well to the insulin therapy, and Sophie hasn't. She said Sophie is clearly insulin resistant, and also prescribed .25 mg of Arbacose twice a day with the insulin. We're not going to give it to her based on feedback here (if you have other experience, I'd love to hear it). Sophie had some test results that were high this time, but not high last time, so she said there might be some kidney failure that is early stage, which is heartbreaking if it's true. She said maybe the uncontrolled diabetes was finally taking a toll. Luckily there is no infection or keytones; she did have to have fluids because she was dehydrated, which is scary, but I guess that's an uncontrolled diabetes thing?

The vet ended with she really didn't know what was going on and said she could send us to a specialist. Based on Sophie freaking out after this visit, we're going to hold off on that until we've come to the end of what the Tight Regulation Protocol can do (if it doesn't help).

Pretty discouraging, but I have hope with our home testing and such. Thanks, all, for the kind words, advice, and support. I am so thankful to each of you who have contributed.

 

I think if you can get her off the dry completely and onto nothing but any of the foods less than 10% carbs, it will help

Remember, being at the vet is very stressful, and that stress can cause an increase in BG up to 200 points, as well as making them look just awful....after all, she's been in a cage all day surrounded by other animals and people she doesn't know.

Dehydration is pretty common in diabetic cats, especially if she's still eating dry, so hopefully the extra fluids will help her feel better tonight

As far as the kidney's go, it's also pretty common for diabetic cats to have some stage of kidney failure, but it's still VERY treatable at home. If you can get the test results and post them here, there are several people who can tell you how "bad" it is.

I totally agree that you should stay at 3U until we have a chance to see how she's doing with the home testing. Don't freak out over what your vet is saying just yet....We don't even recommend testing for insulin resistance until they're above 6 units twice a day

 

Thanks....ugh...

 

Thanks for the encouraging words. I'm really hoping tomorrow is a better day.

Deeply appreciative of everyone on here.

 

@Marje and Gracie is one of our best at reading lab results....Hopefully she'll have a chance to take a look soon, but I know I've seen worse numbers and the cats have still had lots of good life

You might want to start reading Tanya's Comprehensive Guide to CKD....It's the Bible of kidney disease treatment

 

Hello and welcome,

you have got some great advice, just reading through the thread, it's refreshing that your vet admits that she/he doesn't know what to do and is at a loss, sounds to me that they would be willing to work with you. There's a pdf of the study that the protocol is based on, perhaps you could print it out and give it to her, she may be interested to learn, I know my vet has been open to learning, and is supportive of the protocol.

I'll go find it at post a link for it for you.

George diagnosed mid October went on oral meds for two weeks and they did nothing for his BG, started lantus November got up to 3U and is now down to 1u, don't despair

 

http://www.felinediabetes.com/FDMB/attachments/tight-regulation-protocol-roomp-rand-2009-pdf.18421/

 

The high phosphorous and low potassium indicate kidney insufficiency. BUN is high too but that is very diet dependent an a high protein dies will cause high BUN. Creatinine is normal which is not consistent with the kidney insufficiency.
The HCT being 28 is also an indicator of kidney insufficiency.
Did you have a urine analysis performed? Urine specific gravity (USG) is a very good indicator of kidney insufficiency.
Did the vet discuss use of potassium supplement and low phosphorous food/phosphorous binder?

 

I don't actually agree with this statement. I've seen an awful lot of FD kitties in this group and have had four CKD kitties (non diabetic) myself and I don't think CKD is more prevalent among FDs. It's that cats' kidneys, in general, tend to be their weak organ. CKD is not uncommon in cats above 10-12 years of age especially if they don't drink a lot of water and have been a dry food kitty most of their lives.

CKD is not diagnosed based on the phosphorus, potassium, or HCT. Those are values that may change with CKD but they are not diagnostic. Other things change them as well. For example, often diabetic cats will have borderline or lower potassium levels because insulin causes potassium to be taken up by the cells leaving lower serum (or blood) levels. If you look at my Gracie's SS on her lab tab, you will see her potassium often fluctuated and even got as low as 3.8. She never had CKD and I never treated those numbers. Although it isn't recorded, her phosphorus also went way up on her last labs because I had been feeding her bone broth for her IBD and bone broth raises the phosphorus. Low HCT indicates anemia but there are different kinds of anemia: regenerative which is not associated with CKD and nonregenerative which is. With regenerative, the cat's body might be able to correct the anemia without drugs. Conditions like IBD can cause regenerative anemia.

There is a caveat, though, if the BUN and phosphorus are high but the creatinine is low, it could still be CKD if she has lost a lot of weight and has muscle wasting. Diabetes might cause a lot of weight loss and muscle wasting but I would also think about hyperthyroidism. The reason is because an overactive thyroid pushes more blood through the kidneys and so they appear to work a little more efficiently so the actual creatinine level is masked.

I do agree a urine specific gravity would be helpful altho USG varies during the day. Low USG could also be attributable to the diabetes, hyperthyroidism, or CKD....the more water she drinks,to the more she pees, the less concentrated her urine, the lower the USG. The best time to test it is to take in the very first pee of the day and be sure the kitty did not receive fluids (IV or subcutaneous) the day before. Also, there is the fairly new SDMA test that is an indicator of CKD so you don't have to wade through all these other labs although I'd also check her free T4 and total T4.

The weakness in her back legs can be due to either diabetic neuropathy (which is treatable with Zobaline) or CKD.

Oral meds for diabetes do not work in cats. Stick with the insulin.

If you need help getting a SS going, send me a PM and I'll do it for you. One thing about Walgreens meters....I just was helping another member who had bought one and she is in the same city where I live. I took my Alpha Trak 2 over and her Walgreens meter had the kitty at 174 and the AT was 375. For me, that's way too much variance so she bought a Relion Micro which then seemed to read a lot closer to the AT. She could have gotten a dud meter from Walgreens but it's not the first time I've heard that they are inaccurate.

 

Katie, Sophie is beautiful. I can not add anything to the advice you've already received. Can only offer (hugs) at this time. Hope Sophie feels better soon.

 

How is Sophie?

 

I have to agree with Marje and Chris. and Larry-
This is my first diabetic cat and I have had about 20 or so cats --probably 10-15 with kidney issues. I have given fluids to all of them and they lived very good happy lives. VERY manageable .. That being said my now diabetic cat had normal kidney values until a few weeks after diagnosis and now gets fluids... what came first the chicken or the egg?? We just did another panel and my FD kitty now has normal ranges except for his BUN is 4 points over "normal" --we give fluids daily and they have for sure come back to almost normal as they were all elevated a few months ago.
He will probably get fluids indefinitely and that is perfectly fine with me. My non diabetic has been getting them for 6 years.

 

Kidney infections can cause kidney insufficiency but most if not all the insufficiency can be returned when the infection is eliminated.
Do yo what the current urine specific gravity is? Kidney insufficiency shows up there before creatitine before value becomes high

 

Thanks for the feedback. Once again, the email alerts for this didn't come through, so I didn't get this until I just logged in myself!

I didn't see any USG data on what was given, so I am guessing no.

Sophie has already on a potassium supplement since January, and she didn't talk about a low phosphorous food. The vet actually didn't talk about the results at all, and I had to request the lab printouts. All she said was that there may be some kidney stuff going on and no ketones. She didn't discuss numbers at all. She did confirm there was no sign of kidney infection.

 

Thanks for the wisdom and support all. I'm making my SS tonight; we've been tracking manually.

Vet said (means little to me at this point) that her thyroid tests came back fine, but she has lost a significant amount of weight. She was normally around 8.5 pounds, and now she is down to 7.5. She lost .5 pounds January to February alone.

Good to know about the Walgreen's meter. Maybe we'll try another one. I hope it was wrong today, but I am guessing it is not.

Today was a very, very bad day. It started with her throwing up at about 5:30 AM, and she had barely digested any of her food from 8:30 PM. We did let her eat a lot, though, so maybe that was part of it. Her appetite had been fine, but the she barely ate any breakfast, even after having nothing in her stomach. She was drinking a ton, but at points, her face would dip into the waterbowl like she was sleeping or something. She was so lethargic, too. Her values ran in the 500s all day, and even maxed out the meter at one point. They've dropped to the high 300s now, but it's still nowhere near what she needs to be at. I really thought we might lose her today, and I am worried if she will make the weekend.

It was so bad the we got the awful vet to do a prescription for sub-q fluids, and we had to administer some today because she was so dehydrated (even though they gave her fluids at the vet earlier this week). It is encouraging to hear the fluids have helped keep kitties with CKD alive. She felt better after, and her blood sugar dropped some.

We are scheduled to see an internal medicine specialist this Wednesday. Honestly, I am worried about taking her after how awful she came back from the vet.

Is what happened today normal at all? Is it a sign that things are too bad? I just don't want her to suffer, and I'm afraid I am doing things all wrong. I'm so worried.

I'm also thankful for all of you on this board. I'm so open to suggestions on what to do here.

 

Wait, she did do it a Urinalysis.

USG was 1.024, but no ranges were given. Any interpretation?
>

 

Hi Katie. I notice you're in Seattle - I'm not that far away from you in Covington. We did have a very positive experience with one of the IM specialists in the area for Rosa. I don't know if I'm allowed to share the name of the specialist and practice publicly - maybe someone could advise me on that because I'd like to see if we can help you get an appointment with someone who we've found to be good at understanding the intricacies of diabetes and CKD combined. We also have a pretty good vet - not perfect in their understanding of FD, but a place where they are at least willing to work with us on things. Again, I can share the name with you if that's acceptable on here (I know we can't do that on the Tanya's site forum and I don't remember if it's allowed here or not).

OK, I should have tagged admin for an answer on that @Carl & Polly & Bob (GA) @Jill & Alex (GA) @Robert and Echo - can I share the names of vet practices and IM specialists publicly or do I need to do that in PM?

 

Are you testing for ketones at home? With numbers that high, it's very important that you test and if you find more than "trace", she get to the vet.

You can get urinary ketone test strips at any pharmacy that has diabetic supplies and here are some Urine Testing Tips

As far as the weight loss goes, that's very normal in diabetic cats and a lot of times is what finally sends us to the vet for diagnosis. Until her blood glucose levels are better, no matter how much she eats, the glucose from the food can't get into the cells. Think of insulin as a "key" and the cells all have a lock on their doors....without the "key" to unlock the door, the glucose never gets in and the cells starve....the glucose just stays in the bloodstream.

I don't want to leave you thinking it's too late for your extra sweet cat either. This disease IS manageable and you can have many years left with your sweet kitty. I think these pictures are worth 1000 words
China at diagnosis...less than 8lbs (click to expand picture)
China after 4 months insulin therapy ...about 14lbs

 

If it's legit, I'd love to get a name! Thank you, neighbor!

 

Thanks; we aren't testing for ketones at home, but it seems like it's easy enough to do, so we'll be doing that starting tomorrow. Really good analogy!

What a beautiful kitty, and I'm so glad your sweet China is thriving. It encourages my very discouraged heart.

 

[Emphasis mine]

That may be a symptom of nausea. See this page on Tanya's Site:

http://felinecrf.org/nausea_vomiting_stomach_acid.htm

You may find something there to help Sophie. If she doesn't improve much very soon I think it would be safer to get her seen by a vet today.

My heart went out to you big time when I read this. I'm in a similar boat with my little one.

I am sending prayers for Sophie to feel better ASAP and some s for you.


Mogs
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Many thanks. She was very hungry this AM. She hasn't done the face in the water bowl thing after getting fluids yesterday, so that's encouraging. She was super hungry this AM, and devoured an entire can of Fancy Feast. She won't touch the DM stuff after throwing it up. Taste aversion?

Giving her the sub-q fluids really made a difference yesterday, so we are going to do that again today (100 ml).

She actually played with a toy this AM, and she was fairly chipper despite the high blood glucose readings, so my husband and I don't exactly know what to think. She's laying down now, so maybe it was just hunger? I don't know.

First time she's played in a LONG time, despite high glucose numbers.

 

I'm very, very glad to hear that Sophie is feeling better ... and eating (anti-jinx). Keep it up, Sophie. Your momma loves you.




Mogs
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Last reading maxed out the meter again, but she's acting so much better. WTF?

Happy she's better, but geez.

Is it possible the sub-q fluids increase blood sugar? I know she still needs the fluids for now anyway, but it seems weird she is eating better and acting 100% better than yesterday, but the blood sugar is wonky.

I even took my own blood sugar with the device to see if it was wonky, and it wasn't.

I'm looking forward to our appointment on Wednesday.

 

I don't think the sub-q's should be raising her BG level. It is quite possible for her to be feeling better even with very high readings - that insulin will be doing something to help her even if it isn't visible in the numbers yet. If you take a look at Rosa's SS in my signature, you can see she was still very high on numbers early on but she definitely started to feel better in herself very quickly just the same.

 

Just an update; despite getting 100 ml of fluids each day, she's so dehydrated by the next day (the skin takes a really long time to snap back into place and her eyes are a bit sunken in). That really scares me. Our SS is up to date, but she was all black yesterday, and after she had her PM meal/insulin, she became lethargic again, and hasn't perked up. I know we are doing all we can, but I just wish it was doing more.

I can't wait until our appointment on Wednesday to get in with the internal medicine specialist...sigh...

 

I've no experience with sub-q fluids, Katie, so I have nothing to suggest that might help. I mix a couple of teaspoons of water into Saoirse's wet food to help keep her properly hydrated but I don't know whether or not that would be a sensible thing to do for a cat receiving fluid therapy. Maybe you could ask your vet about this or perhaps other members might be able to advise you.

Saying a little prayer that you'll have a very productive session on Wednesday with the IM specialist. I know how worried you are about your little one.




Mogs
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