Alex Just Diagnosed this Past Week

I've pulled together a couple of posts from another thread in the hope of getting some feedback on my kitty's situation. My 16 year old chocolate point Siamese Alex was diagnosed with diabetes 7 days ago. I took him to the vet because something didn't seem right.

Since he's blind, got CRF, HCM, IBD, megacolon and can no longer tolerate sub-q fluids due to his heart problem, the vet wanted to take a very cautious approach. The first thing we did was take him off the 1/2 tablet of prednislone he'd been on for several years. Monday the vet began treatment with 1 unit of glargine at around 12pm. Prior to dosing his BG was 398, by 4pm it had fallen to 214, when I picked him up from the vet at 6:30 it was down to 94. When we got home he ate a little of his Royal Canin Renal LP Modified and we hung out together for about an hour watching TV.

At 8:30 I tested his blood sugar with the new Bayer Contour Meter I got at the pharmacy (after checking it with the test solution provided) and it said his BG was 19. He was a little lethargic but had no other symptoms. Alex's BG tested so low that I decided to test my own blood and got 89 (without having eaten since breakfast). I immediately gave him 4ml of pancake syrup and in about 30 minutes he'd perked up enough to nibble a little of his food on his own. I retested his blood at 9:30pm and the meter showed his BG to be 97. It turns out my meter is 15-20 points higher than the vet's.

I continued to test a few more times during the next 12 hours and got the following:
5/2 @ 11:04pm = 101
5/3 @ 2:40am = 125
5/3 @ 8:23pm = 155

After this hypoglycemic episode following his first dose of 1 unit, I was all but certain I was going to have to make the decision to send my little pal to Rainbow Bridge. The plan was to give him a day and let his BG bounce back then try half a unit. I took Tuesday off from work to get some sleep and make sure Alex would be OK.

I took Alex to the vet Wednesday morning and went to work. The idea was to start him on 1/2 a unit of insulin and watch him throughout the day, but when they tested him on their meter before giving insulin his BG was around 225 (don't remember exactly). He spent the day there and they tested him again around lunch time and his BG was around 255, and again when I went to back him up at 5pm and it was 289.

Since his BG wasn't high enough to warrant the risks associated with his reaction to insulin in her judgment, the vet sent us home and told me to bring him back tomorrow and we'd try again. On Thursday morning when I measured his BG my meter said it was 127! I couldn't believe it; I still can't and am afraid this is just too good to be true.

So, I spent the yesterday and today monitoring his BG and this is what my meter readings were:
5/5 @ 8:54am = 127
5/5 @ 1:58pm = 145
5/5 @ 6:04pm = 151
5/6 @ 1:08pm = 175

It appears his BG is creeping up. Because of all his other problems (Mainly CRF) he's a free feeder and the testing wasn't specifically timed around when he ate. I don't know what to make of what's happening and have no idea where things will go. Is he producing some insulin again (or at least not resistant to it) because we took him of the 1/2 tablet a day of Prednislone? Did the hypoglycemia do something to jump start his pancreas? Is he showing this strange pattern of BG numbers because of his CRF and all his other health problems?

At the moment Alex doesn't need insulin and I hope things will continue that way, but I just don't know what the coming days hold. Any feedback is appreciated. I love him more than anything in the world.

Robin

 

What a roller coaster you guys have been through! Sounds like your kitty is very lucky to have you cat_pet_icon

Taking him off the pred could have a lot to do with it. The other thing that could cause the difference is the stress of the vet visit, which can greatly raise glucose numbers, even though they may be around normal range at home.

What food are you feeding him? Since he has CRF, you are going to have to balance between low phosphorus and low carb. I have read somewhere in a post lately about something that can be sprinkled on higher protein canned food that binds the phosphorus, which makes it better for CRF cats. Maybe someone else will chime in here that remembers the name.

 

Hi, welcome!

Since you seem to have a skewed idea of the levels of "hypoglycemic episode" and of "doesn't need insulin", I include this link to some common guideline levels:

http://petdiabetes.wikia.com/wiki/Blood ... guidelines

My view according to the numbers you're seeing: 95 is a great number but by no means hypoglycemic. It's within normal range.

100-175 is still a diabetic range and could use small amounts of insulin. Numbers creeping up will create further insulin resistance and pancreas damage which will cause numbers to creep up further, so it's a good idea to avoid these.

You have a small-dose case here, but by no means a no-dose case. And the rainbow bridge isn't really indicated either. What's indicated, to my mind, is to learn to give repeatable doses in the range of 0.25, 0.5, 0.75, or 1.0 units as appropriate.

Glargine/Lantus is a very long-lasting insulin (which is good), but it means you won't want to adjust that dose too often -- once every 4 days is generally plenty. And by no more than a quarter-unit at a time will help too. But remember, smaller dose increments may be inconvenient but they're very helpful.

http://petdiabetes.wikia.com/wiki/Fine_doses

 

Thanks for your relpy those links Steve. I'm reading everything I can get my hands on to be the best possible advocate for Alex and make sure whatever days he has remaining are comfortable.

His blood sugar had plummeted to 19 - definitely hypoglycemic. Only after I gave him the maple syrup did it rise to 97 about an hour later. This happened after just one dose of 1 unit so clearly he needs less. The vet thinks we should try again if his BG hits 250 and this time do half a unit. I'm thinking that 1/4 unit might be better even though it will be difficult to measure. If we discover he needs more then we can always go up to half a unit.

Alex is currently eating Royal Canin Renal LP modified, for his CRF and can no longer tolerate sub-q fluids. It sends him into conjestive heart failure so having him on a renal diet is the only treatment we can do now. His kidney numbers aren't terrible, but definitely elevated (last blood test showed 3.6 creatinine and 80 BUN). He's also taking benazapril and amlodipine for his HCM and high blood pressure, cisipride and mirilax for his IBD and megacolon and pepcid once a day for an acidic stomach caused by the CRF. He's also been blind for about 3 years, he's slow but gets around fine as long as I don't move the furniture.

 

Alex still isn't getting any insulin. I passed on the links on small dosing Steve shared to my vet. She's going to take a look at it, but dased on what I described she thinks it may be what Alex needs. I tested his BG at midnight and it was 201. When I woke up this morning I tested him again and it had fallen back to 178. I know he grazes on his food during the night so I'm not sure why it seems to drop back during the night and then slowly rise throughout the day. Still, each day the low is higher than the day before.

Robin