advise needed please

Hi,

Our 10 year old neutered cat was diagnoesd with diabetes about 4+ months ago he started off on 3 unit of cannisulin twice a day he is on MD dry and tinned food,

We check his urine with Keto-Diastix sticks a couple of months ago he had to be admitted to vets to be flushed as his ketones were high and he was in a bad way they also had to put him on a drip for potassium he recovered and we carried on,

Then just over 2 weeks ago the same thing happened again and he had to stay in for 3 nights the vets said she was concerned he had cancer or some other tumor so they did a scan which showed nothing,

He is now on 5 units twice a day and this morning i tested him and his ketones are on the rise again, His last trip to vets virtually wiped out our xmas really and i am now worried what is going to happen today as we cant really afford another big bill

When testing him with the strips his glucose is never below the second to last square which is 1000 mg/dl or 56 mmol/l when he has a blood test at the vets they lowest its ever been is 14.8 (not sure of the measurement type as i see people on here saying theres is over 300)

I know couple people with diabetic cats, who's cat have never gone ketonic when they go to vets and blood is tested, insulin is raised no problems at all,

According to his urine test today his ketones are bewteen 15 to 40 mg/dl, I have just made a appointment for the vets in a hour

When i ask about upping his dosage they say the are concerned with him going glycemic, Does anyone have any advise for me?

Thanks in advance
( 911 icon removed by mod as this is not an immediate emergency at this time )

 

Hi,

As a update to this i have just come back from the vets, I told them his ketones had gone up and she said hospitaliztion is the ideal option then she did a blood gluclose and he was 23.8 last time he was like that it was when he stayed in for 3 days, As its a bank holiday here she told me they cant hospitalize him as they close early but i can take him to the local pet hospital (who i know will be £250 before the even before they do anything) so I had to go for option 2 which is increasing his insulin to 6 units twice i day, When i queried the fact that his blood sugar never goes below 13.9 she said its hard to manage some cats and sometimes its best to put them to sleep, Well thanks for telling me this after about 1000 pounds on treatments and stays in, seroiusly considering swapping vets

 

I'd switch insulin as well as the vet, but first the ketones need to be resolved.

I started on Caninsulin with my cat Shadoe and she did quite poorly. We changed to Lantus and then when she tested positive for insulin resistance, we switched her to Levemir and she is doing immensely better.

Increasing the dose may help but you will likely get better results from a longer lasting insulin.

First thing, can you please change your subject line of your first post to include Ketones - help needed and you can put Caninsulin dose 6u as well if you like. Try to catch the eyes of others who can help you with the ketones problem. I wish I could but I have no experience at all except to know that it's very serious and should be resolved as soon as you can.

Also, posting in the health section may get more attention as not many people are active in this section.

I wish you the best in getting your cat feeling better and clear of ketones.

 

I agree with Gail that posting on the Health forum will be better, as you will get lots more eyes on your thread. Just copy the url at the top of this thread and past it into a new topic on health: viewforum.php?f=28 We don't have very many kitties on Caninuslin in the US. They have had quality control issues and it is not prescribed often by vets here: viewtopic.php?f=19&t=311 It may not be an issue in Europe as several UK users have recently had it prescribed. But you just won't get many answers on this forum as so few people use it. The heath forum has much more traffic and we do have several people who are experienced with ketones who may have some advice for you.

One thing I would advise is to learn to test your kitty at home. Some kitties are highly stressed at the vet and stress raises bg levels, so their numbers are much higher there. You can test at home in a relaxed situation and find out exactly what the insulin is doing. Here is a good beginning site: Newbie hometesting site and a video: Video for hometesting We test our kitties with human glucometers just like we would test our children. It can give you a clear picture of the insulin and whether it is working for your cat. It is a much cheaper way to manage the disease and much safer for the cat.

We don't use the metric system on this forum so multiply your blood glucose numbers by 18. We use US numbers so we have a common "language".

 

Sending healing prayers your way. I know you must be anxious about him as well as the costs.

First thing, of course, is to get him through this crisis. I have no experience with this - hence the prayers. That's the best I can offer. I do know that he needs fluids and insulin to keep his blood glucose in normal range. And he needs to be getting food.

Ketones usually need more than high BG to form - a lack of enough food and/or an infection of some sort, such as bad teeth, urinary tract infection, pancreatitis, etc. combined with high BG. Has he been checked for any of those?

Once he is home, I strongly recommend that you learn to home test so you know what his actual blood glucose is at that moment. Urine testing only tells you an average over the time since he last peed.

Where are you located (just country and city)? Maybe someone posting here is nearby and can recommend a vet who has more experience with feline diabetes and its complications.

As an aside, because this info is not helpful while he is crisis, he is probably getting way too much insulin. Caninsulin starting dose should have been 1u every 12 hrs, not 3u and that may have set him up for rebound (where the body releases stored glucose to prevent a hypoglycemic reaction) and, as the dose was raised, he developed insulin resistance and that compounded the problem - and left him with constant high BGs. Also, any dry food is not a good idea as it is higher carb (raises BG) and depletes the body of water to process it. Most of us feed only wet (tinned) food that is low carb (no gravy) and a lot of us add a little water to that. But, you can't change his food to lower carb without knowing his BG (home testing) and, most likely, lowering his insulin dose. His BG could drop way too low.

FYI, Caninsulin is called Vetsulin in the USA, if you see anyone use that name. Both of my boys were started on that, but I switched them to Levemir and they are doing much better.

Hoping and praying your boy recovers and you can get him regulated and feeling better.

 

Hi Klunk,

First of all, If you can't translate your kitty's numbers to American numbers can you tell us what color the ketones are testing on the ketodiastix? Are they trace? small? medium? Is he eating? Is he acting sick? I have a ketone prone kitty. He will throw ketones if he doesn't like the way I look at him. While ketones are never a good thing by any stretch of the imagination, they don't always require hospitalization. (This is not coming from 'me' by the way...it is coming from a veterinary text book). There is a difference between ketosis and DKA.

There are a lot of things that can be causing the ketones but since I have no idea what the numbers are (European and not American), I really don't feel right offering advice at this time. But I do agree that you should consider a new vet and a different insulin(Lantus or Levemir) as your cat appears to be getting too much Caninsulin right now and probably bouncing a lot which is probably not helping the ketone situation.

You also should learn to home test. That has been a saviour for me with Alex's ketones. When he is over 300 for more than 6 hours, I KNOW that he is going to have trace ketones and I start giving him fluids before it even happens. When you can start working on a situation before it becomes one you are that much better off. But you have to be on top of it to do that. A meter for glucose testing, ketodiastix, subQ fluids if you can get them and the proper dose of the correct insulin will make a huge difference in battling your kitty's ketones(unless of course there is some underlying infection that hasn't been found...then he may need antibiotics as well). But all of these things would be a good start.
Keep your chin up...it's not a lost cause. I thought it was but it's not.
Please feel free to ask any questions and let us know what's going on. I would really work on changing vets and insulin once this bout with ketosis is under control.

Caryl

 

Hi,

Thanks for all the responses, I now have concerns he didnt get hospitalised yesterday as our vets closed early due to the holidays so couldnt take him, they recommended a pet hospital near me, but we didnt take him as we have used them before and they are very expensive we we simply didnt have the funds, I told the vets this and they said he should be fine over night.

He was taken to the vets this morning his ketones were at +1 this morning his blood gluclose( hope i worked this out right to american standard) was 419 yesterday it was 428 ,

The vet said as he seems bright and his ketones havent increased he didnt need hospitalization today but i was told as his blood gluclose hasnt dropped we have to up him to 7 units twice a day i did ask about swaping him to a differant insulin and was told if we get to 8 or 9 units twice a day with same things happening they will look at swapping him to a longer acting one,

We bought a glucose meter and tested him before and got a reading of 246 dont know how accurite that was as its our 1st go testing him is there a differance between blood drawn from the ear and from the vein on the paw as the vet does it?

As for food the vet suggested he be on md dry and wet food so he has a half or each twice a day before his insulin

 

To be blunt, I think you are getting scary advice from your vet.

Congrats on getting a reading at home. It should be the same from the paw or the ear; it is only different if drawn from the vein. So, if your number is right, that is a reasonable number for a new diabetic. When during the cycle was it taken - how many hours from the shot? And it is NOT a number you would give 7 - 8 units of insulin for, especially for a new diabetic. Please watch him closely and test about 4-6 hours after the shot. If you get a number below 50, go on the Health forum and ask for help. You could be looking at a potential hypo.

The reason your number could be lower than the vet number is that stress raises blood glucose levels. If your kitty was stressed by the strange people, noises and other animals at the vet, it is very likely that his number at the vet is higher than you get at home. That is the issue with vets taking bg levels at the office and prescribing insulin doses based on those levels.

The MD dry may be helping your kitty from having a hypo. It is high carb and raises bg levels and may be combating that high level of insulin. So I would not change food yet. Give some readings at home - before every shot and between 4-6 hours after the shot. (That low point will be your nadir - the point in the cycle when the insulin takes him lowest) Once you see how he is doing, you can lower the dose and start feeding wet lo carb. Many kitties here have been regulated or have gone into remission with that protocol - wet lo carb, home testing and the proper amount of insulin.

I have been watching for your posts over here, but I would still urge you to post on health. It is so much busier than this forum. Especially post there if you see a low number.

 

Hi again...

Your poor kitty. He is getting way too much insulin. A reading of 246 is not high. I agree about not changing foods yet because that dry MD MAY just be what's keeping your baby from going too low(as much as I hate to tell someone to stay on dry food).

Please, the next time you test for ketones..can you tell us what color the stick turns. I am good with beige, light pink. dark pink, magenta;etc.....
I am SOOOOO happy to hear that your kitty is alert. Just make sure that he keeps eating. If you ever notice that his appetite seems to be waning, that is when you should be the most concerned. Like I said...not all ketones are DKA and hopefully if you stick around here, and I hope you will, you will learn to tell the difference. Of course, that will take time, patience and probably(definitely)a change in diet and insulin I'm guessing once kitty gets past this...

8 or 9 Units twice a day is an awful lot..... :?
hugs~

Caryl

 

Hi,

Thanks for the replies i wish i had posted on here months ago,

I tested him again just after the last post and he was 253 so i called the vets and spoke to a different vet and who said to leave it at 6 units for now with the 2 readings we have taken our self,

As for the ketones colour wise he was between the 3rd and 4th colours so light pink to slighty darker pink, We just tested him now and his ketones on the strip have dropped down to the light pink colour

thanks for the help when i went to the vets this morning she said i seemed very knowledgeable and that was only from a browse through some of the posts on here,

We are going to do more blood gluclose on him tomorrow and see how it goes

 

GREAT!!!!!!! light pink is barely ketones at all!
TRY if you can to give more wet than dry food(same food but more wet) as maybe that will even help bring his bg down more which of course helps the ketone issue.
Like I said before, mkae sure he keeps eating and getting plenty of water..even if you have to use a syringe every hour or so to squirt some down his mouth. It will help..really!
(My goofy cats now both LOVE getting water from a syringe) :lol:
When you have a chance..why don't you read the stickies on the top of the Lantus support group....you may see some great benefits for your kitty and you in these stickies
Keep posting..please!

 

Please come on tonight before you are scheduled to shoot and post your bg number. I am really worried about your dose. The vast majority of kitties here use 1 unit twice a day, or less.

One thing you can do to help the ketones is to add water to the wet food you are feeding-make it kind of soupy. Hydration helps keep ketones away.

 

It's 10:45pm here he had 6 units at 7:30pm and is due his next at 7:30 tomorrow morning in so just under 8 hours

 

Can you get some tests in tonight? Like one now and one in 1.5 hours? Leave out some food tonight so if he goes low and feels lousy, he can eat to bring up his blood sugar.

It would also be helpful if you could have a running record of his numbers so people can give you advice on dosages when you need it.. It can look like this:

amps ### 6 units of caninsulin
+3 ###
+5 ###
pmps ### 6 units caninsulin

amps = morning number before the shot ### represents the blood glucose number you got
+3 is 3 hours after the shot
+5 is 5 hours after the shot
pmps= evening number before the shot

Giving us times is difficult as we are all in different time zones. The +3 tells us exactly when that number was taken.

Eventually you can put it in a spreadsheet and attach it to your signature. If you are bored tonight and computer savvy, here are the directions: viewtopic.php?f=6&t=18207 You would want to choose the World template. If you need help, just ask.

 

doubt ill be doing a test in 1.5 hours having trouble keeping eyes open now, he wolfed his food down earlier, and he has been on 5 units for about 3 weeks and had 3 shots at 6 now so im sure he be fine till morning,

we have 2 other cats so leave food out not much use wouldnt know who ate it

 

You may be right - he has been on that dose awhile. Just don't change all the food to wet lo carb until you have a free day to test alot and watch him.

 

HI,

Just done the final test of night, it was 334 that was roughly 4 hours after his shot of 6 units

We going to try and do a curve tomorrow as you suggest

 

Sounds like a safe number for overnight.

 

Hi,

Ketones tested this morning and were 0 :smile:

So looks good

 

Wonderful! No ketones and no problems overnight. :razz:

Several suggestions;

Find a day (soon!) when you will be around all day and do a curve. Start transitioning to all wet food and try adding water to it to stave off future ketones. Dr. Lisa's site has great tips for transitioning from dry to wet: http://www.catinfo.org And as I nagged before, set up a spreadsheet so you can easily see what has happened and what is happening. Setting up a spreadsheet If you need help, just ask. You will need the world version which will convert your numbers for us.

I will assume that with the wet lo carb diet, your kitty will need a lot less insulin. It will be interesting to find out. There are several conditions that require more insulin - time will tell.

 

Hi,

As requested i have started a spreadsheet, We will be looking to swap his food to totaly wet normal tinned low carb cat food next weekend when we can watch him over a 2 day period

Thanks for any Info

 

The spreadsheet looks great. The good news is that you are getting a longer duration from Vetsulin than most cats do. Most vetsulin users see a sharp drop around +5 and then a sharp head up. And the 200s are good numbers for a beginning diabetic. it will be interesting to see how much lower the wet lo carb takes him. I would consider lowering the dose when you start the low carb.

Things are looking good. Just remember to post in Health if you have a problem and need an immediate answer.

 

Kimmee and I are wondering about your flat curve and the fact that 6 units is giving you 200s. She suggested asking some of the high dose people to come look at your numbers. It is hard to figure out with a new diabetic if he is getting too much or too little insulin. High dose members are used to seeing kitties on 6 units and higher;they may have some new info/ideas for you.

 

Hi Klunk, hi everyone,
I was looking for more info on Timmy - trying to see where things began - saw the post on health -

numbers are so the same on alllllll doses - no change at all on vetsulin - pretty strange - I've used vetsulin on 2 of my kitties so I know how it's supposed to work. Now I see that Timmy is a 10 year old male - not that this is the end all be all but I'm beginning to wonder.....

he's now on canned food
flat curves on up to larger doses of vetsulin
and a 10 year old male cat

I've asked her a few more questions over on health -

I'd love any of your input too! You are the experts with the vetsulin!