And now I have two diabetics...

Hello FDMB! I was on here a lot in 2012 when my Scout was diagnosed with diabetes. Thanks to the help of the wonderful folks here, she went OTJ within a few months, and has thankfully stayed OTJ on low carb wet food (currently Purina DM wet food - long story, and I know it's not ideal).

I'm fairly sure my other kitty Nipper is diabetic now. I took her to the vet this morning, her fructosamine will be back tomorrow, but I already know what it will say. She's not been grooming well, she's been eating and drinking more than usual, lethargic, and her BG was 325 (18 mmol/L) last night. I should have caught it sooner but I assumed it was Scout eating and drinking more than normal and have been testing her instead and not getting any high readings.

I asked the vet to go back and check Nipper's BG from earlier this year when she was sick. They had told me her bloodwork was normal, but according to their records she tested at 162 and 144 (9 and 8 mmol/L). They never thought to mention that to me so I could follow up with a BG check at home!

Unlike with Scout, I can't just switch to low carb diet. They've both been on low carb diet for nearly 3 years. Oh and I've moved to the UK which means different vet, different vet protocols, different insulin, different petsitter, and different canned food choices.

Mostly right now I'm feeling sorry for myself and for Nip. She's a sweetheart at home but a Demon Hell Beast at the vet. They often have to sedate her just to draw blood. When Scout was diagnosed, I whispered in my heart that I was glad it wasn't Nipper, since Scout is so sweet and docile and Nipper is so bolshie and difficult. I don't know how long she will sit still for injections and ear pokes, even if I bribe her with treats and use all my tricks. I don't know how my boyfriend or a petsitter is going to fare when I'm not around to look after her, which is going to be 1-2 days a week.

Anyway, sorry for long post, just wanted to say hi again and hopefully have someone tell me it's going to be OK.

Lori

 

Its going to be OK.

Did they run any other tests other than the fructosomine to rule out any infections?

With your experience at least you know how to guide your new vet. I don't remember what insulin Scout was on, but at least Lantus and Levemir should be available in the UK. And Nip may surprise you with the testing and shots. When I first adopted Spot, I thought there would be no way she would cooperate because she did not like to be petted or held. Once she started feeling better and realized she was getting treats when being tested, she just started sitting there like it was no big deal.

 

You said "They had told me her bloodwork was normal, but according to their records she tested at 162 and 144 (9 and 8 mmol/L). They never thought to mention that to me so I could follow up with a BG check at home!"
My vet did that with my Lightning. She thought Lightning was one of the already diabetic cats that I had.
At that time I think I has four other diabetic cats.

 

Vets often discount BGs elevated into the low 200s due to vet stress, they don't think its a problem until they are seeing 300s and 400s.

I second that you should make sure to do some testing for secondary things that can be causing it - infection, pancreatitis, dental issues. Any new meds? Since you are already feeding a diet that discourages the disease, something else might be triggering it.

I was the same way when Smokey was diagnosed, I thanked our lucky stars it was not Taz who would rather take skin off your arm than cooperate with being held, stabbed, and medicated. We are now 2 years into kidney disease and giving subQ fluids to Taz. It was a rocky start, but she purrs and eats treats most days while getting her fluids. I am sure you and Nipper will find a way to tackle this. Nipper is lucky to have a mamabean that is already knowledgeable about all this stuff.

 

Did the vet rule out hyperthyroidism, too? Eating and drinking a lot can point to that as well.

Time to really work on the positive reinforcement to shape the behavior.
- first, start reinforcing for going to the testing spot. Given your description, I'd make that a small bathroom. Take him there, say "test time" to him, treat and release. He should start going there on his own when you say "test time"
- add in a slight head massage, then treat
- refine to an ear massage , then treat
- evolve to holding the ear, then treat, and release
Each step may take weeks; just do your best.

While you work on testing, see my signature link Secondary Monitoring Tools for additional assessments you may make to evaluate him.

 

Thank you all for your replies. Once again this board has come through with great advice and support!

I am waiting her other blood work. I don't know what all they are testing for but the vet mentioned kidney function. I did get her fructosamine level which is 501. That's squarely in the range for a diabetes diagnosis. I'm just hoping that's all that's wrong with her. They thought she had hyperthyroidism in April but the test came back normal. Her symptoms then were gastrointestinal upset and lethargy. But because she was such a hell beast at the vet, they put fast heart rate and her being fiesty as symptoms. She's always been fiesty and I checked her heart rate at home and it was normal when she was not terrified.

They want to hospitalize Nipper for her first dose of insulin to make sure she doesn't have an allergic reaction to the insulin. I think that's a little much, has anyone else had that experience??

Unfortunately UK rules say she has to go on Caninsulin and if that doesn't work then go to Lantus/Levemir. I plan to do a curve as soon as Nip will let me so I can see how long it lasts in her system.

As for testing, Nipper put up with two home tests this week, but with a fair amount of whining and struggling. I was able to eventually get her to settle down so I could take both hands off her to do the test without her leaping off my lap. I'm hoping the treats and fuss will win her over. The funny thing is that Scout is so well trained that the second I sit in the testing seat and call Nipper, I have a Scout on my lap who won't go away until the machine beeps and she gets her treats.

I will try calling Nipper to the testing seat and just warming her ear with the sock full of rice a few times each day until we start on insulin so she can get used to it, but I can't afford to not test for a month while I train her. Hopefully fuss and treats will win her over, plus she's seen Scout get tested (and then treats) so many times that she probably knows the drill. However I'll ask my boyfriend to start the process above to get her used to him testing her. I reckon he can handle it as long as Nipper is game, and she loves him.

Hopefully I'll have good news this afternoon that it's "only" diabetes. I'll post an update then.

Thanks again all and thank you for looking after your sugar babies.

Lor

 

Any reactions to insulin are very very very rare. The very few that were discussed here were not immediately life threatening like a peanut reaction is in humans. I would not hospitalize a cat for that reason. I would do it at home when someone is there to observe and when the vet is open in the very unlikely case a vet visit is required.
I have not seen any reaction in the 12 diabetic cats I have has so far.

 

Thanks, Larry!

I spoke to the vet, good news is Nipper "only" has diabetes. We will start her on Caninsulin Friday morning since I'm out of town tomorrow. I convinced the vet to let me take her home after the first injection and do a BG curve myself. I just hope Nipper is cool with that plan. :roll:

Lor

 

Doing my first curve this morning!! So far I have APMS: 280 (15.4mmol/L) and +2: 250 (13.9). Nipper was a good girl for both tests and didn't even want to get down when they were done. I am SO RELIEVED about that. I'm going to do every hour until after the nadir has passed. Vet seems very cautious and she made sure I was happy to give the injections and home test and treat a hypo before she let me leave the office.

Now to start the process of finding lower carb low-carb food that doesn't upset any tummies. I will be careful to introduce it slowly so as not to cause a hypo. While she's on 1U it shouldn't be a problem.

Lor

 

We've a number of UK peeps on here, so I searched the forum and found this list:

 

Somogyi effect?

Thank you for the link! I love the sheer amount of resources on this site.

I tried a few of those foods earlier in the year before settling on Purina DM because Nipper had some stomach issues during that time, and that was the one food I can get here that I fed her in the US and it didn't upset her stomach. But this gives me some more options to try!

I am doing a curve and it is not good at all, her BG went down slightly and then went way up. (See spreadsheet) She didn't eat much in that time so I don't think it was due to food. Does this look like it could be Somogyi effect? If her body is not used to having insulin yet it could have reacted like this was a sharp decrease in BG, even though from the curve it looks mild? My vet said that increases in BG were not uncommon when starting insulin, but that's not something I remember reading on here.

Lor

 

There is no convincing research that Somogyi exists in cats.

That pattern is typical with Caninsulin, which is a mixture of 2 different durations of insulin. It must be rolled well before drawing up a dose so the mix is consistent. The shorter insulin has a nadir around +3 to +4 hours after the shot. The longer acting insulin may nadir between +5 to +7 hours after the shot. It often wears off in cats by +10 hours after the shot. We seldom find good control of diabetes in cats with Caninsulin, which was developed for dogs (canines) which have a slower metabolism than cats.

We prefer Levemir or Lantus over Caninsulin. If you are in the UK, your vet must start with Caninsulin until there is proof it isn't working well for the cat.

 

I learned to ALWAYS ask for a copy of any bloodwork or lab tests and keep them for reference.
Most vets just give a these test results a quick glance, don't bother to compare to previous tests, and wont tell you if something is a just a "little out of whack" or borderline.

When Katie was first diagnosed I asked for a copy of previous bloodwork taken a month earlier. It was around 200. Yes, he probably thought is was just stress, but if he had bothered to look at all her previous bloodwork, he would of seen her BG wasn't high at all, always under 100, on any other occasion, and she was stressed at those times too. If I had seen it, it would of been a red flag to me. Especially considering her symptoms at the time.

Another occasion happened years ago- my elderly cat had bloodwork and I was told everything fine. Few months later she was very ill and was diagnosed with CRF. Again, I got of copy of the previous bloodwork and her creatinine and BUN were borderline high. He should have alerted me to this, considering her age.

Lesson learned- Always look at the results yourself.



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Hi Katie's Mom. I agree and I think part of the problem is vets must see a lot of people who either aren't interested in preventative medicine or are not knowledgeable enough to do anything with the test results, so why bother telling them something's a bit high? But I thought that because I had a diabetic already they'd maaaaaybe have mentioned it. They were concerned about her high heart rate so I bought a stethoscope and checked her heart rate at home and reported back to the vet that it was normal at home when she wasn't stressed. Clearly I was interested and willing to follow up.

I dunno.... the amount I paid for Nipper's multiple vet visits earlier this year, I expect better care.

Update: Nipper is coping with the injections but her curve was high and I've not had any good numbers yet. I'd love to switch her to Lantus but that's not easy to do here. I'm giving her a break from testing until I get home later this week. My amazing and awesome boyfriend is giving her her insulin and keeping an eye on her in the meantime. I'll probably do another curve Thursday and then consider increasing the dose.

Lor