Any advice to this Newbie re. glipizide greatly appreciated!

Hi, I'm Tigger's Mom. Tigger is a 10 y/o neutered dmh orange & white cat we found nearly blind as a tiny kitten when we bought a few acres in a rural area of California. Tigger was starving, had foxtails in his eyes, and herpes. He eventually lost one eye, was diagnosed with bartonella & has really bad stomatitis mouth & lost most of his teeth. Otherwise, he's in great health and spirits, a very happy & loving fellow. He lives here with his 2 brothers (one is a blood brother), all rescue cats found on our property.

April 18th, I took tigger to the vet for a dental infection, that's when he was diagnosed with the LPGS (stomatitis) & given a cortisone shot. I was concerned about the shot, but the vet told me cats tolerate cortisone really well. Prior to that, on October 8, 2013, his glucose was completely normal at 149, & on September 20, 2014 it was 123. (tigger accidentally went into the pantry & ate our dog's rimadyl on September 20th, & I rushed him immediately to the vet where they were able to induce vomiting & retrieve the pill - we did blood work on 9/20 & 10/8 to check for any liver toxicity, and thankfully there was none)

Due to the stomatitis, we scheduled tigger for a dental on 5/15. Prior to the dental, we did blood prep work and his glucose was 383. His plateletts were at 1470 (!) & he was also borderline anemic. A urinalysis showed 3+ glucose, & fructosamine level was 390.

Tigger has never presented with any diabetic symptoms, other than drinking water, which he's always done - he's a large cat, looks like Maine Coon, and his coat is quite heavy. Having been a starving feral kitten, he's always had a good appetite, but he's not overweight. I previously fed Fromm grain free kibble (soaked in water) & combined with Wellness Turkey & salmon canned or Lotus canned food, all mixed with water to a gruel consistency.

Once I knew the glucose level, I switched Tigger to Wellness canned w/ water only, & recently ordered Nature's Variety Instinct canned for the lower carb count. I also ordered Tiki Cat fish flavors & will try their chicken.

Our vet placed him on amoxycillin, a 3-day painkiller (nsaid - oops) for tooth extractions, iron for the anemia, & glipizide 5 mg (1/2 tab every 12 hrs) w/ food. It's been 1 week now, & he's doing fine.

When I asked, our vet said Tigger's diabetes could have been brought on by the 1 cortisone shot, though it is rare. She feels he already had the diabetes because of the fructosamine test - but Tigger already had the effects of the cortisone in his system for 4 weeks when the fructosamine was done. But - if steroid-induced diabetes is the case, we are looking at up to 7 more weeks of elevated steroid-induced glucose levels.

Tigger went to the vet's today for his first glucose curve - it was great, low number was 201, & high was 264. Yea! The vet would like to keep him on glipizide & do a glucose curve in 2 weeks. If at that point he's still doing well, we may be able to start reducing the glipizide. The vet doesn't want to reduce the glipizide yet, and says home glucose testing with human glucometers doesn't work very well. From other posts, I am going to try home testing anyway. I figure it can't hurt.

I have read that glipizide can actually contribute to permanent diabetes, due to the other protein secretions it causes the pancreas to produce as well as insulin. My vet says that Tigger's case is so mild she's had great results with glipizide and the insulin swings in his case would create more potential for problems at this point. She says the glipizide is mild compared to insulin, and feels strongly Tigger should remain with the glipizide, not switch to insulin, and not wean off the glipizide yet.

I would love to get feed back from Members with glipizide experience, and brands of glucose meters. I see there is a veterinary brand, AlphaTRACK 2, that gets good results on Amazon, but it's expensive at $113. But - if that's whaqt we need, we'll do it. I'll also read the forums about that. My main concern is the glipizide at this point, and creating a hypoglycemic situation if any steroid-induced high blood glucose were to reverse. I am also probably in denial, and really anxious for this to be transient. We have 8 rescue cats, and not alot of financing.

Thank you all so much for reading this, and for any suggestions you might have. I feel like I've found an oasis in the middle of the desert, and am so grateful!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

My understanding, is that the glipizide can actually lead to continued damage of the pancreas, making remission of the diabetes impossible.

From vet article in the Merck Veterinary Manual

A success rate of 15% is abysmal.

The long lasting insulins like lantus and levimir have a 70-90% success rate.

From AAHA Diabetes management Guidelines for dogs and cats, vet published journal in June 2010.

From wiki diabetes in cats. http://en.wikipedia.org/wiki/Diabetes_in_cats

Insulin, low carb canned food diet, home testing are in my opinion, better for your cat then the glipizide.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Welcome to the best place you never wanted to be! :YMHUG:

You've already done a great job with the food. :thumbup And Deb already has you covered on the glipizide front.

As to testing, most people use human meters to test their cats since the biggest cost isn't necessarily the meter (some of which you can get for free) but the test strips. AlphaTraks have quite expensive strips, anywhere from $1 to $3 or more depending on Vet mark-up. The ReliOn Prime (available at Walmart) on the other hand has test strips at $0.18 each. Even if you're testing the minimum of just 3 to 4 times a day, that's a savings of $3.28 a day. Here's a link to a great page with Ear Testing Tips that should help.

And please let us know if you have any other questions!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I agree with kpassa and deb. first glipizide is no good for cats. Don't even mess around with that. You want insulin.

When did you start feeding low carb wet? You may already be seeing a drop in blood glucose levels due to the food change, after all you got 200s at the vets and that's with stress of the vets which inflates blood glucose.

So I would buy a cheap human blood meter like kpassa said and start testing for a few days before starting insulin to see where his blood sugar is now (assuming no ketones.. Did the vet mention those?).., then start the insulin if he is high. (ideally lantus, Levemir or prozinc as those are good insulins)

Wendy

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thank you Deb & Wink, KPassa & Wendy & Tigger,

I also did some reading re. glipizide & have the same concerns as you all mentioned.

I asked my vet if insulin might be better for those same reasons, & again she said that with Tigger's mild or borderline diabetes insulin poses too many other issues of the time involved getting the right dosage & possible complications with that, etc. My vet has a good reputation, but I'm concerned about this & also her recommending against home glucose testing.

Do you feel short term use of the glipizide (1 week already) + 2 more weeks till next vet glucose curve might make this a long-term problem? In reading Deb's excerpt from the vet article in the Merck Veterinary Manual, Tigger is not thin or ketonuric or obese. He is a foody though, but I never free-feed & his diet before dx was grain-free, but higher than it should be in carbs. He does drink more than the other cats. He acts & looks totally fine.

I note it also says "Clinical response is seen at 3–4 wk" Do you interpret that to mean it takes 3-4 weeks for the glipizide to take effect? If that is the case, then does that mean Tigger's lower glucose numbers today are coming down on their own?
000]

Re. Tigger's canned food diet, I started him solely on Wellness canned Turkey & salmon May 15th. I will be introducing Tiki Cat Bora-Bora tomorrow a little at a time.

The 200's at the vet's was with the glipizide, after 1 week.

I'm heading to Wal-Mart for a ReliOn Prime meter tomorrow, thanks for the direction!

I also ordered some Purina "Glucotest' for the cat litter.

I wish I could just take him off the glipizide & do it with diet alone at this point, but I don't know if he's ready for it. Tomorrow's Friday & I don't know that I can get Tigger in to see a new vet.

Wendy & Tigger, are you thinking this might be the best course of action? Get a meter tomorrow, take him off glipizide, & monitor his readings? I don't know that my current vet will give me the insulin if I need it, though.

Oh - I forgot to mention - his anemia & plateletts are all back to normal - there was a bad infection that required 2 molars be pulled, one seemed to be showing the nerve - stomatitis in action ,as it was only 6 months since his last dental. That might also be helping his glucose levels, but its been 8 days since the surgery.

Thanks again for any additional input - it helps to not feel so alone - I am terrified almost to inertia that I am doing the wrong thing here.......

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Glipizide is bad, and you are causing more harm than good to your cat. Any vet who says glip is good and home testing is not good...... get another vet.

Glipizide makes your cat's pancreas work harder than it can.... the pancreas is already faulty but the glipizide just forces it to work harder.

How fast can you run? How about if you were being pulled along by someone riding a motorcycle? Can't keep up? Too bad. Run faster!

That's what you are doing to your cat's pancreas.

You want to give insulin which helps your pancreas by picking up the slack that the pancreas can't do, giving the pancreas time to heal. Once it's healed a bit, you will notice that your cat's numbers are improving and you will be able to give less insulin..... why? because the pancreas had a bit of time to heal and could start to work harder on its own.

The Relion meter will be just fine. You will be able to tell how your cat's doing on insulin, and will be able to tell when your cat needs less or more insulin. Do NOT waste any more money on a vet curve because curves at the vet are not worth much. Why? Because your cat is stressed at being there so the numbers will not be true. If you have your meter, you can test your cat every 2 hours throughout one day and there's your curve, all for the cost of about 7 test strips.

Be sure you keep feeding a good low carb wet food diet, test with the Relion, and get insulin for your cat. I would not continue the glipizide as it's too harmful.

You need to see where your cat is with just good food and no influence from the glipizide. If you find that you are getting consistently higher numbers, then you will want to get a prescription for insulin.
I prefer Levemir (detemir) but Lantus (glargine) is also quite good.

If your cat has stomatitis, maybe you can mention it in your Subject to get feedback from others with experience treating it.

Gayle

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

i agree with Blue

- take him off glipizide
- Get a meter etc - shopping list below
- monitor his readings for 2-3 days to see where he is. Meanwhile talk to your vet- who works for you remember - and tell them what you want - insulin/home testing. If they don't like it start looking for a new vet. What's your nearest city ? We might be able to recommend one.

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie Ketostix or ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thank you Blue & Wendy & Tigger,

I'm going to get the test monitor and other items on the great shopping list you both provided, d/c the glipizide (unfortunately already gave it this morning) this evening, & do home monitoring.

I read last night that Glipizide can be helpful in sub-clinical cases of diabetes (under 250) where readings are too low to call for insulin, but I think if we can maintain those levels without the Glipizide, Tigger is much better off without it.

At what blood glucose levels would you start treating with insulin? Anything above 250?

If any knows of a good diabetic vet around Nipomo, California (can include 5 Cities & up to San Luis Obispo & South to Orcutt, CA) I'd appreciate all suggestions.

I've been pressing urine dipstix (until I get the glucotest for his litter) into Tigger's urine clumps in the litterbox (not the best, I know, but he's pretty private about peeing), & still am seeing between 2+ & 3+ sugar. He also pee'd on the towel in his carrier on the way home from the vet yesterday & it was showing 3+ sugar. No ketones yet, thankfully.

When I get home, I'll post a separate subject re. Stomatitis - thanks! I am not tech savvy - we live with satellite only & no cell reception, so this is my first forum.

Again, so thankful to you all, and any further advice you think of.

Tigger's Friend

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

A couple of things that were not addressed in your questions.

If you are going to home test and it looks like you are going to - then you can save lots of $$ and upset to Tigger by NOT taking him to the vet to conduct a curve!

Yes, you read that correctly - here is why

1) Vet stress - taking the cat out of its home environment causes undue stress to the cat and the BG can rise as much as 100 points or more - therefore giving the vet the inflated numbers and having the vet base the dose on these false readings.

2) You can (if you want) do a curve at home yourself. A curve is testing the cat every 1-2 hours during one cycle (which is 12 hours in duration).

3) Personally, I believe curves are overrated and put too much undue stress on the human let alone the cat. If you are home testing, getting tests in during each cycle then the need to do a curve diminishes. A curve will give you the information for one day only and while gathering that information is useful it is only one day's worth of information.

What I would rather see is that you

Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - the length of time insulin continues to lower blood glucose
How to do a Curve - a simple explanation

The links to these terms are included in this post: viewtopic.php?f=9&t=18139


Please note that normal BG range for a cat is 40-120 with most of the time at 100 or lower. Others talked about the dangers of glipizide - keep in mind that everyone on this board uses insulin - Prozinc, Lantus or Levemir as the three top choices for cats and even when getting lower and normal numbers continue using this insulin over glipizide.

So, how else can we help.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

There is no set number for treating a diabetic cat with insulin. The research is divided even on how best to diagnose feline diabetes, let alone when to start insulin.

In the March 2013 special edition of Veterinary Clinics of North America Small Animal Practice Feline Diabetes issue, there was some research that indicated any number over 117 was pre-diabetic and should be watched closely. Any diabetic cat in remission that had BG numbers >117 was more likely to fall out of remission.

The 250-280 BG number is the renal threshold. That is the point at which excess blood glucose is filtered out by the kidneys and excreted in the urine. Numbers over this level cause slow, accumulative organ damage and nerve damage.

Some vets think any BG under 300 is ok. Others have chosen 200 as a good number. I think any number over the non-diabetic BG (blood glucose) range of 40-130 calls for at least a diet change to low carb food and then insulin if the numbers do not come back down in a week or so. Anything over 200 is probably a need for insulin sooner than later.

We here follow the University of Queensland recommendation that the goal for a diabetic cat is remission, not simply regulation of the BG numbers, not only getting a BG under the renal threshold. With a good long lasting insulin, low carb food, home testing, good management of the diabetes, remission is the 'brass ring' we like to shoot for.

Not every cat can achieve remission. but why not try your hardest to see if your cat can be in that 70-90% of cats that do achieve remission?

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I am glad to hear you are testing for ketones; I think some cats are prone to them, so at the start, it's always good to find out if your cat is prone. My girl was also very shy and her back end was always to the wall so I had to use the ketostix like you do.

Curves are not ever every hour. The only time that a person would test every hour would be when first starting to use a fast acting insulin along with your basal insulin. A full curve is every 2 hours between 2 shots / 12 hour period; a partial or mini-curve is every 3 hours over the same period.

I suggested a new post on the Stomatitis as the Subject will catch the eyes of those who have experience and can give you good advice and tips.

When it comes to getting a vet, there are not really that many who are current on feline diabetes treatment, so just look for a vet who will be good in all other areas and is willing to work with you to treat your cat. Any vet who says to use glipizide for feline diabetes is likely way too out of date in many areas of treatment. If you make a short list of questions, you can easily find a vet that will be decent..... asking what type of insulin they prescribe for diabetic cats, what should be fed to diabetic cats, and what they think of home testing are three good questions for starters.

You want your cat's numbers to be under 120 all the time, so if a vet does a fructosamine test, which is the average of your cat's numbers over the past 2 weeks, and the result is high, you would want to be sure you have the correct diet, then start home testing and also start giving insulin.

Gayle

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thanks again Blue, Wendy & Tigger & KPassa, your advice all makes sense & my goal is to get Tigger off the glipizide & in remission as soon as possible.

I took your Hit List to Wal-Mart & got a Relion Confirm meter, lancets & 50 test strips, all for about 1/2 what it cost for 4 test curves at the vet. Thanks so much!

After reading KPassa's link for ear testing tips & watching some UTube videos, it was time to give it a try:

Originally feral, Tigger's pretty fearful & squirmy when restrained, but he got treats beforehand & that helped. Of course the first poke was way too hard - we had blood flying all over & Tigger escaping down the hall. When I caught him the blood was still wet, so I tested it - & got a reading of 533! I must have done something wrong. I botched the 2nd try - the blood was too dry. Third time was the charm - we moved to a different location, re-loaded equipment & treats, did a nice small poke, & voila - got a reading of 180! Considering 5/15 Tigger's fructosamine was 390, this feels like something's working in our favor. Still, 120 seems awfully far away.

I did relent & give him glipizide 1.5 hours before testing - I still don't have an insulin source. I tried several vets today but no luck - the holiday weekend through Monday will make it really difficult, but I'll try again tomorrow.

Tomorrow AM, we'll test before his medicine is due, & see where he is. If Tigger's glucose is below 200 - do any of you feel I could discontinue the glipizide if I don't have insulin? I'm worried what would happen at night when I con't monitor him. I assume glucose levels can shoot up dangerously high in a short time if there is a problem and no insulin to moderate it.

Tigger also started an even lower carb canned food today, so hopefully that will help, too. His diet was moderate-hi carb (around 25%), so I don't know how much his glucose will change due to diet, but I'm hopeful.

Re. unrine testing - Tigger usually sneaks into the litterbox when no one's around - & at night. He rarely ever pees when I'm around, so I'm still trying to test those clay-soaked patties I find in the litterbox. We have multiple indoor cats, but at night he's the only one that uses the litterbox, so I'm always able to test that nighttime patty. any other suggestions ?

Whew! Feels like I've been living & breathing feline diabetes for days. Does it ever develop a rhythm that doesn't overwhelm you & usurp all your time? You all seem so confident and capable and helpful - I really admire that.

Thanks again for all your time,

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Good Morning,

Morning #1 with glucose meter.

Tigger's AM glucose reading 8:30 AM before eating & no medication is 224.

Tigger was really squirmy & anxious & ready to eat, so I think that might elevate the reading a little? What do you think?

I'm going to take his glucose again at 9:30.

If we stay in this range, do you think I should stay off the glipizide, even though I don't have an insulin source yet? Still no word from any new vets. Am going to make more calls in a few minutes.

Thanks again for all you help!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

When was the last time he got the glipizide? I would test a couple of times today to see where he is first.

He might just need a little more time on low carb food etc, and maybe a small dose of insulin to help his pancreas out

Quite a few members on here give small doses with cats on this level i.e. check out Lucy who is getting a small dose and levels are under 200- https://docs.google.com/spreadsheet/pub?key=0AvGjqMnCRvBhdDlZRlhtWkt1Z0xGSDNFOU5jTXhsV0E&output=html

Let me do a post and see if we can find you a vet in your area

Good job on the blood testing!

Wendy

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Hi Wendy,

Tigger's last glipizide was last night at 7PM.

At 8:30 PM last night his reading was 180.

This AM @ 8:30 AM, right before breakfast, & no glipizide, it was 224.

I'll test again at 10:30 AM, still without glipizide & keep you posted.

I found a well-rated vet in the area that I have a call in to to find out their preferred method of treating diabetes & their opinion of home testing & patient-empowerment. Keeping my fingers crossed.

Thanks so much,

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Tigger's 11;30 Am (3 hrs past time for glipizide & 3 hours past meal) test shows glucose levels increasing from 224 to 290.' (last night's reading following glipizide was 180)

I have a vet appt. tomorrow afternoon with a new vet that encourages home testing & insulin. For today, since Tigger appears to be benefiting with the glipizide, I am continuing glipizide until I can get insulin.

I'll do another test at 1:30, 2 hrs after glipizide & extra meal.

If anyone has any other suggestions, I'm very grateful & open.

Thanks again,

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

You said you switched Tigger to a lower carb canned food. This will help alot with the BG numbers.

What foods are you feeding?

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Hi Deb,

I'm feeding their base food, Wellness Turkey & Salmon canned, & am slowly adding Tiki Cat Bora-Bora & Blue Buffalo Chicken Pate. I have NV Instinct Chicken on order - not arrived yet.
Ultimately I'll go to NV as the base if they like it & supplement with the others.

Just finished a testing 2 hrs post glipizide - no change in glucose - still at 290. I lost some ground witholding the glipizide for 4 hours, but I felt it was important to see where Tigger was on his own.

Will do another test in 2 hrs & see if there's any improvement.

Thanks for checking in, I appreciate everyone's t ime, & I don't feel so alone in this anymore!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

hey there, there's another member in Nipomo in case you need help with anything or another vet referral. she's been on fdmb for a few years now. i'll send her a message pointing her here in case you need anything. Her name is Ann

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Insulins that work well in cats, because each shot lasts about 12 hours, include Lantus, Levemir, and ProZinc.

There are Vet Interview Topics in my signature link.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Honestly i think in the long run the glipizide is what is losing you ground - stressing out his pancreas and maybe making remission impossible. I really hope you can find a good vet and get on insulin asap to get the best chance for your kitty.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Is that Wellness Turkey and Salmon you are feeding the Grain-free one? That one is a nice 5% carbs, but the other Minced (13%) and Cubed (12%) are a bit too high.
Tiki Cat bora-bora is a nice low carb 2%
NV Instinct Chicken grain free is nice and low carb at 3%.

Member Vet Dr. Lisa Pierson had this to say about Blue Buffalo on her food chart.

So I can't tell you what the carb percent is on the Blue Buffalo since the company would not provide the data.

You could see some better BG numbers in a week or two on those low carb foods.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thanks, Deb. Tigger has been on grain-free food for 3 + years.

The Wellness is the grain-free pate, & one he's eaten for several years. The other 2 he was on (Fromm grain-free dry & Lotus canned) are too hi in carbs, so I d/c'd them immediately.

I also read what Lisa Pierson had to say (& took her list with me to the store). Unfortunately our local store didn't carry NV, & I don't want to be feeding the Tiki fish too often, so I got some Blue Buffalo as an interim food until the NV arrives.

I spent about 5 days transitioning tigger to the Wellness alone (from the higher carb Lotus), so he was on the Wellness by itself for about a week, with thevpartial introduction of small amounts of the even lower carb Tiki & Blue Buffalo the last 2 days.

Judging from your estimate, we have about a week to go with the diet.

Also, if this is steroid-induced from the cortisone shot on 4/18/13, the cortisone has a 2-3 month life, so we'd be looking at potentially 7 more weeks of artificially increased glucose readings, I think. Somewhere in the next 3-7 weeks, any cortisone effect should wear off (I hope & pray)

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Hi, I'm in Nipomo too. We have a great vet, very open to how I want to treat Tess. We have been treating herFD for over three years now. If you want to talk about vets or other resources in the area, I'll PM you my phone number. They do carry the NV canned food at Tails in SLO. They also have NV raw.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Steroid induced diabetes are usually among those cats that we can get to go OTJ (remission). We'll be trying hard to get you the best advice so that can happen with your cat in the next couple of months.

Once a diabetic, always a diabetic, but you can control with the low carb foods.

If your cat needs steroids again, be aware it can push them out of remission. But sometimes you have to treat the other health condition and deal with the diabetes and insulin and home testing again.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thanks Ann & Deb,

I'm grateful you all are hanging in there with me. Glad to hear from Deb steroid-induced diabetes has a good prognosis. It's always a risk trying a new medicine.

We met with a new vet this afternoon. She thought it likely Tigger's diabetes was steroid induced - rare with just 1 shot, but with the dental infection it may have pushed him over the edge. I told her about this wonderful forum - your encouragement & concerns re. glipizide - & she agreed with you all that Tigger needs to get off the glipizide & not keep pushing his pancreas. She also said Tigger was achieving results with the glipizide for now, & a few more days shouldn't hurt (My other vet this morning suggested the same). This vet's leaving town, so we're on first thing Saturday (first day she's back). All in all they spent almost an hour with us(!)

We lost one of our dear tame 'ferals' this morning to a spinal thrombosis. It was a huge shock, but thankfully we have an amazing vet (not full time sadly or I'd use her for Tigger in a heartbeat) that came out to our place so his spirit was able to pass here, outside in Nature where he's always lived, instead of at the Emergency Clinic.

That's partly why the new vet thought to wait - I'm scared of the first highs & lows often experienced with the insulin start-up (with 2 spinal thromboses & an epileptic I fear the dark side). I was willing to try today, but she said to keep Tigger on the low-low carb diet take him off the glipizide on Thursday or Friday. Saturday AM, I take him in, we'll check his glucose there, see how he's managing on diet alone, then feed him, & give him his first insulin together, after we've discussed & chosen the best insulin option for him. She also to test his pancreatic function, to see what the possibility for healing is at this point. Then they'll monitor him for a few hours before having him go home. She's said if Tigger regulated well on the insulin, there's no reason it will shorten his life. I'm on board.

Thanks again for everything - if there's anything else I should be doing, I'm open.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Yippee about the new vet and insulin - remember Lantus, Levemir or Prozinc are the best for cats for regulation and remission

Sorry for your loss though ((hugs))

Wendy

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

So sorry to hear you lost one of your civies today. It hurts, really hurts to lose a beloved family member.

Remember, it took your cat some time to become diabetic. It will take some time to regulate and make the changes.

Better to start the insulin when you are better rested. Please keep us posted.

Please be aware that "vet stress" can cause artificially high numbers at the vets. We would like you to sanity check the number with us here before the first dose is given. Rarely does a cat need more than 1 unit to start, sometimes only 0.5 units.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

{{Hugs}} for the loss of your feral cat.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Thanks for all the support re. the loss of our Tonto-cat. He was our garden cat, and his gentle spirit is sorely missed. He followed his beloved idol Max in passing exactly 8 months to the day.

Re. Tigger, I'm taking him off the glipizide today per the vet. He goes back to the vet Saturday to check glucose, pancreas function, & then choose an insulin.

On glipizide, his numbers have been ranging 228 - 283, I usually test 4 hrs after eating & 2 hours before 2nd glipizide dose, 2-3 tests per day. The glipizide has a short life, about 12 hours.

Today I plan to test every 2-3 hours. How high can his glucose go before I should be concerned - he has no insulin yet, & the vet is out of town till Saturday.

Also - how often do you monitor at night, or do you? I leave Tigger unattended from about 10PM to 7AM, - is this ok while he's not on any medications & also after he first starts the insulin?

If - Tigger's diabetes is steroid-induced from the cortisone shot he had 4/18, the steroid is still effective until approx 6/18 - 7/18. If he's on insulin at the time the steroid's effect wears off, can his insulin production return all at once, or do you think it would be gradual?

Tigger also has been coughing 1-2 times daily - a wet cough that sounds like a hairball - I haven't seen any from him in months, & he can have huge ones. He doesn't like the furminator. I normally give Petromalt, but tried canned pumpkin instead. Yesterday I gave Sentry HC natural hairball remedy because it has less sugar, but Tigger gagged & nearly vomited he hated it so much. Any suggestions?

Also, Tigger's appetite has decreased a little. I'm having a hard time getting him to finish his food. He'll eat mostof it if I sit with him & keep bringing his attention back to it. We switched over to NV Instinct Chicken & maybe he doesn't like it - I was feeding Wellness canned Turkey & Salmon, but NV is slightly lower in carbs, + no carageenan or gums. I'm not sure how much canned to feed, as I previously fed 1/2 dry + 1/2 canned with lots of water to make a nice gruel. Is it possible I'm feeding too much? He weighs 14.7 pounds & isn't really overweight - he's big, like a Maine Coon.

My vet said the most important way to monitor Tigger is to look for anything out of normal. So far he appears pretty ok - he grooms himself, he plays, he's affectionate, he jumps up on the bed to sleep in the afternoon & evening. Of course, I'm OCD now, watching him, he probably thinks I'm crazy!

Thanks for all your help, support & suggestions, you all really helped so much!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Forgot to add Tigger's glucose was 202 this Am before breakfast, 11 hours post-glipizide (which usu. has a 12-hour life)

Keeping my fingers crossed

Thanks again!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

BG's can go over 600. If you get readings over 300, I would advise getting a urine ketones check. Ketones can lead to DKA (diabetic ketoacidosis), a potentially fatal and expensive complication to treat. You can buy the test strips at any pharmacy or drug store.

Are you away during that time? or simply sleeping?

You can try putting a little Vaseline on his paw and see if he licks it up.

How many ounces of the wet food are you feeding?

We have the 5 P's plus the appetite to tell us how a cat is doing, the WCR or whole cat report. The 5 P's are peeing, pooping, preening, playing, and purring. Add in how the appetite is doing and you have the WCR. :smile:

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

EXPAND VIEW TOPIC REVIEW: ANY ADVICE TO THIS NEWBIE RE. GLIPIZIDE GREATLY APPRECIATED!
Re: Any advice to this Newbie re. glipizide greatly apprecia
by Deb & Wink » Thu May 30, 2013 7:23 am

Today I plan to test every 2-3 hours. How high can his glucose go before I should be concerned - he has no insulin yet, & the vet is out of town till Saturday.


BG's can go over 600. If you get readings over 300, I would advise getting a urine ketones check. Ketones can lead to DKA (diabetic ketoacidosis), a potentially fatal and expensive complication to treat. You can buy the test strips at any pharmacy or drug store.I have multistix, but can only press them in the cat litter patty - I rarely see Tigger pee. So far he is ++ to +++ but no ketones. I hope the clay smear is accurate enough for ketones. He didn't test positive at the vet for ketones at 390. Should I take him to the vet if he goes over 300 & I don't have a urine to check?

Also - how often do you monitor at night, or do you? I leave Tigger unattended from about 10PM to 7AM, - is this ok while he's not on any medications & also after he first starts the insulin?
Are you away during that time? or simply sleeping?Just sleeping

Yesterday I gave Sentry HC natural hairball remedy because it has less sugar, but Tigger gagged & nearly vomited he hated it so much. Any suggestions?
You can try putting a little Vaseline on his paw and see if he licks it up. Don't like the petroleum in vasoline, but if that's what I need to do, I'll do it.

Is it possible I'm feeding too much?
How many ounces of the wet food are you feeding?Approx. 8.5 oz. daily, + water mixed in, + 1 T pumpkin

We have the 5 P's plus the appetite to tell us how a cat is doing, the WCR or whole cat report. The 5 P's are peeing, pooping, preening, playing, and purring. Add in how the appetite is doing and you have the WCR.Then I'd have to say he's doing well. If I didn't know he had diabetes, I couldn't tell.

Thanks, Deb

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

What numbers did you get? A few days of high numbers wont do any harm as long as you test for ketones - and call the vet if you see them.
Here are urine catching tips.. https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

We recommend you always do a test before every shot. Plus a mid cycle test (middle of the cycle if you can) and a before bed test ( a few hours after the shot). If the before bed test is the same or lower than the preshot test a few hours earlier then its advisable to get up a few hours to see whats going on. But it depends on what those 2 values were too. And we advise newbies to not shoot below 200.

its important that he eats. The Wellness is good in terms of carb % - we say under 10% but I prefer under 8% .... and the wellness is 5%. You could add a fancy feast classic pate if you want a lower carb.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Would you please provide us with some more information and put this in your user control panel? It helps us to help you better.

Go to the upper left corner of your screen and click on the words, User Control Panel
On the next screen, a row of tabs is presented. Select the Profile tab
On the next screen, there are a number of choices along the left hand side. Select Edit Profile.
Go down to the location field and enter your country, state/province, and city if you are willing to share that info.
Click on submit to save this change.

Still in the User Control Panel, Profile tab, this time select Edit Signature from the left hand list of options.
A free form text box appears.
We like to see information like your name, your cats name age and sex, the diagnosis date for the diabetes (DX 4/30/13), what meter you are using for testing, what insulin you are using, what you are feeding (wet or dry, what brands/style of food), any complicating health issues your cat may have, any additional medications your cat is receiving.

Click on submit to save this information. Now, this will appear at the end of every post you make. You can update the info when you need to.

Think of this as having some very useful information at our finger tips for those that are replying to your posts.

Would you please do those updates when you get a chance? Thanks.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Hi Everyone,

I'd appreciate if you could look at Tigger's SS again. We just don't seem to be moving out of this range at all. The last few days, Tigger's had an over 300 AMPS, which he hasn't had much before. Today, he had a 382 at +6, which is also unusual.

This is only day #4 (cycle #7) at 1 unit - am I expecting too much? Why would his numbers continue to go up with a higher dose? Am scared to see the +9 number - that's usually his highest.

Sorry, am getting a little discouraged, but trying to be patient.

Thanks for any suggestions,

Suzanne

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Patience my friend! It can take time to find the right dose but as long as you are giving insulin you are helping your kitty feel better. And hey, you are only on 1 unit so you have space to increase no worries!

In terms of dose, I think he needs an increase but I am not a PZI expert. Maybe post on PZI and even PM Sue & Oliver(GA) or Carl & Bob to see what they think...

Also it wouldnt be a bad thing to set the alarm for a test between + 6 and + 10 at night. Just to be sure he isnt dropping lower then. He probably isnt, but you have never gotten any data then so a spot check would ensure that nothing is happening at that time.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I agree with Wendy. You have room to increase the dose, however, I'm also not experienced with PZI, so I'm not sure what the suggested increase might be. I do know there are a few PZI people who use a sliding scale based on pre-shot numbers, so that might be something for you to consider doing. Here's the link to the PZI board where they might be able to advise you a bit better.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Sorry Wendy & KPassa, I accidentally posted in my old glipizide post thinking it was my PZI post - & re-posted there.

I do need to do a PM +6 or +10 - you're right - I'm usually konked at those hours. Need to try sleeping on the couch so I don't wake hubby with an alarm.

Just got your messages. Sue & Rob both felt an increase was in order, so after 4 days I increased to 1.25 units (yesterday). We finally saw a brief flash of blue yesterday, but today we're bouncing again after +4 in yellow (238).

It's odd - several times now Tigger will drop lower +2 & +4, then bounce up over 300 on +6 & +8, then sometimes go lower again after that. My vet said she thought Tigger's pancreas was 'sputtering', but to me it seems more like he's resisting the lower threshold & throwing out glucagon. If that's the case at least it means his pancreas is working, which is a good thing, yes?

I know I keep re-wording the same few questions in different ways - still grappling with understanding this disease!

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I dont know if its a bounce but you will see in a day or so. Is he still on the steroids?

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

No, Tigger isn't on steroids now. He ONLY had 1 depo shot EVER, on 4/18/13. The vet said at the time it should last him 2-3 months. :cry:

That would be about now till mid-July.

Would the depo shot keep his glucose elevated even with insulin?

Thanks, Wendy

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

That's what I am wondering. His numbers look mainly high with the occasional drop.. Maybe you just haven't found the right dose.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

You're right, Wendy.

I think I'll post that as a general question & see if anyone has had any experience with steroid injections & insulin.

I'm going to do a +10 test tonight & a +6 tomorrow night, but I don't think there's a hypo in there, or even a low number.

Thanks for your insight, if you come up with anything, I'm open.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

It does look to me like something is keeping him unusually high, and given you aren't feeding high carb I suspect its the steroid. Unless there is an infection somewhere, how's his teeth?

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Steroids can elevate glucose levels until they wear off.

They also suppress immune response, which may allow infection to flare up. Check the gums and teeth, check the eyes and nose for mucus discharges/congestion, and watch for signs of UTi (frequent, small urinations or nonproductive attempts to urinate).

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Tigger had a dental 5/15, & most of his teeth are extracted, due to the stomatitis (not a terrible case, but bad enough). He still has his fangs & canines (4 teeth?)

He is eating well, but one of the fangs does have some red around it. The new vet saw it, but didn't say it looked infected.

Maybe I should take him in & have him re-evaluated?

***Just noticed - the vet said I should hold the insulin bottle in my hand & slowly twist my hand from left to right a few times to mix the insulin. I usu. do that about 5-7 times, & then check the bottom of the bottle to make sure everything is mixed. This time when I checked, there were 2 white 'glumps' of stuff on the bottom, 1 about 1/8" or less in diameter, the other about half that. So, I kept mixing, probably 20 times, & checking, & the stuff eventually mixed in. We checked it with a flashlight to make sure. The color is still cloudy white, that's not a problem, but do you think I haven't been mixing it enough? I think I would've noticed the globby stuff on the bottom before, I do check.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

PS - I went ahead & gave the injection at Tigger's current dose of 1.25 units. I'll check him in 2 hours to make sure something isn't horribly wrong & this last shot isn't more concentrated.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I think it should be ok but you don't want to shake the vial.. See this thread with another user with same issue..http://felinediabetes.com/FDMB/viewtopic.php?p=76760

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Have you considered brushing his teeth? See Cat Info for more details.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

The Prozinc does require gentle mixing to distribute the insulin molecules evenly in the suspending liquid. I would keep a close eye on the vial and double check to make sure it is thoroughly mixed before drawing. You do say you have been checking so it is probably ok.

It's also possible, that if this has occurred before without you noticing, that the insulin concentration is a bit more or less than optimal. You may have to increase/decrease the dose if this is the case and you still use this same vial.

Let's see how the numbers fall out over the next few days.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Re. teeth brushing - I've read it's not recommended for stomatitis. My vet recommended C.E.T. dental chews, but they have glycerin, so I use Pro-den, an enzyme made from aspergillus niger, which is the active ingredient in the dental chews. It seems the biotene oral gel is excellent for stomatitis, but it also has glycerin, so I'm reluctant to use it. But - if I can't get that under control, I guess I won't get the FD controlled either.

Re. the insulin, I read some old posts on the Board. & prozinc can have floaters - it may be it was in the solution & I never saw it. I tested Tigger in the PM & it didn't seem to make a huge difference - he's still in the band of mid 200's to mid 300's, but at least he was under 300.

But - Tigger seemed to do better on the glipizide, so maybe it is still a dosing issue.

I'd like to do a phone consult with Dr. Lisa Pierson re. the steroid & stomatitis, but I read she charges $200, more than I can afford now. I think its better to put that money into dental x-rays.

Thanks again for all your help, I do appreciate it.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Are you posting over on the Insulin Support Group PZI forum? It looks to me like you might need another dose increase. Folks there should be able to advise you if you ask.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

EASE AND QUICK WAY TO USE A TEST STRIP that I read about recently:
Buy some aquarium rock/stone; wash them thoroughly first. Let them dry; line a smaller litter pan with the stones. Smaller stones are probably easier for the cat to stand on.
After Kitty urinates in the pan, tip it on its corner to get enough urine for testing, or else put some in a small vial for testing. The rocks will not absorb the urine.
Rinse the stones again, and let dry for your next test time.

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

I REALLY NEED HELP WITH MY DB CAT BEING TREATED BY DIET ALONE:
My 13 year old sweet tabby cat, Sam, was diagnosed with diabetes in April 2013. He presently with glutenous eating and drinking, and very increased urine output. His blood sugar was 340.
He has had enough trauma in his life that going to the vet without being sedated is not possible. I previously had a cat on insulin who died from insulin shock. It was a terrible experience for all of us! This was another reason to try and treat Sam without insulin.
I changed his diet to low carb canned food, with 1/3 cup of Blue Wilderness Holistic No Grain dry food per day to supplement him, and my other male cat who is 11, at nighttime.
I feed them both canned food atleast 3 times per day, with water mixed in. They both look forward to feeding times now. I also give Sam an OTC holistic feline DB liquid called Dia-ionx, 1/4 tsp. 3x daily.
His eating and drinking excess improved immediately with a change in diet. How much the OTC med helps, I do not really know. Recently, however, Sam has started getting weaker and of course I am even more concerned now.
I have no one to get advice from where I live, so I am hoping you can help with opinions you might have, as well as other readers. Or advice as to where on this site I should list my questions.
A Cat-Lover from the age of Nine! (when I got my first kitten from my mother)

 

Re: Any advice to this Newbie re. glipizide greatly apprecia

Lchule, let's set you up on a post of your own.. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=99510