AT MY WITS END! DON'T KNOW WHAT TO DO NOW!

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Julie Schropp, Jan 7, 2018.

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  1. Julie Schropp

    Julie Schropp New Member

    Joined:
    Aug 21, 2017
    New to this forum and hoping for advice. Our kitty (Corona AKA "Roanie", "Bit", "BayBay", "ABAY") was diagnosed diabetic last summer. He also had always been on Science diet C/D dry food for urinary issues and was also recently diagnosed with thyroid disease but had a severe allergic reaction to the thyroid meds, so we are dealing with multiple issues here. We switched him to C/D wet food when he was diagnosed but since he couldn't take the thyroid meds we had to treat that with diet so now he's on Science Diet Y/D. Vet started him on Prozinc. Got frustrated with that vet and switched vets. He was all over the place with his levels so I started him on some herbal drops as well, Pet Wellbeing Blood Sugar GOLD drops He went into remission BRIEFLY so the new vet had us stop insulin, then he REVERTED BACK! Since then it's been a rollercoaster and we don't seem to be getting any where with getting him under control! So we started back on the Prozinc but his level kept climbing so the vet switched him to NPH with no improvement. (We were up to 7 units twice a day) She kept pushing Lantus but I hesitated, due to cost ($270/bottle!) but finally gave in. Had him up to 10.5 units twice a day and he has STILL been in the 400 and 500's. Finished that bottle and told the vet that we COULD NOT CONTINUE LANTUS d/t cost and the fact that it was not proving any better than the other insulins. So we're back on NPH (because we still had 3/4 of a bottle) currently at 8 units and his blood sugar was 530 tonight before feeding him. Oh, he's also on Pet Wellbeing Thyroid Support drops and Urinary Gold drops. I asked the vet about Vetsulin but was told Vetsulin is more for dogs, even though their website says its for BOTH dogs AND CATS! So I don't know what to do now. Considered changing vets (my husband not happy with this vet) but didn't really want to start over AGAIN! I questioned what would be considered and acceptable blood sugar level and she said she would be happy to see him in the 200's. We've done many "curves" on him but he hasn't had a fructosamine level in a while. He's due to go in for rabies at the end of the month. So I don't know if I'm doing him more harm than good at this point. Any advise would be appreciated. THANKS
     
  2. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Wow – the two of you have been through the wringer. I'm tagging @Kris & Teasel @JanetNJ and @Critter Mom all of whom have had personal experience with multiple insulins.

    If you could set up a spreadsheet of the blood glucose tests and insulins, that would help tremendously.
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
    If the task is daunting, there are spreadsheet gurus here that can help.

    Has your cat been tested for acromelagy or IAA (high dose conditions)?
     
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  3. Julie Schropp

    Julie Schropp New Member

    Joined:
    Aug 21, 2017
    I created my own sheet to monitor his blood sugars not sure it would be what you refer to as a "spreadsheet" but a weekly page that has columns to record his BS BID with meals, the insulin he received, the dose and a column for "notes". If we curve him I record it separately. No he hasn't been tested for those that I know of.
     
  4. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Can you post the log of his readings?
     
  5. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    What thyroid med did you use and what was the allergic reaction? If we can figure a way to get him off the high carb food that would help a lot, but if he needs the special food then you’ll have to dose around it. Lantus is a great insulin, and it is much cheaper if you buy it from Canada like most of us do.
     
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  6. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    We'll try hard to help as much as we can. :)

    I'm aware of this thyroid diet. Is it helping Corona's thyroid levels? If it is then he has to eat that and insulin dosing has to work around that.

    So - about 6 months ago, correct? You've been through a lot of vet and insulin changes in a short time by feline diabetes standards. There are very few vets that are really well informed about FD treatment. If you have a vet now that you like and is helpful in treating Corona's other issues I recommend you stick with him/her. We can help with the diabetes treatment. Having said that, it is trickier to treat a cat that is hyperthyroid because that can affect BG regulation. There are other members on FDMB who have hyperthyroid diabetic kitties. I suggest you post about that specifically on the main health forum and say something about thyroid meds allergy.

    ProZinc is actually a good insulin for many cats. It can take a diabetic cat quite a long time to settle down on any insulin, though, and the general advice here on FDMB is to stick with one for at least a couple of months unless there's an obvious problem.

    Unfortunately, once a diabetic, always a diabetic. Kitties in remission are actually diet-controlled diabetics. If you have to feed him the (likely higher carb) thyroid food Corona will probably need insulin to keep his BG down.

    These are very high insulin doses. There are some medical conditions that can make a kitty a high doser but it's also possible that you got caught in an upward spiral of dosing for another quite common reason. What can happen is that kitty has high BG at the vet's (often caused by vet stress) and vet doses based on that number. The kitty's BG calms down at home, owner gives the vet prescribed dose that's actually too high and kitty responds by "bouncing". It's a protective reaction to an insulin dose that's too high and it causes rebound hyperglycemia. As we often say here, too high a dose can look like too little insulin.

    There are many members who use Vetsulin. It tends not to last as long in cats as ProZinc, Lantus, etc. It can also produce dramatic drops in BG and high rebounds. Some cats, though, do well on it and it's quite economical to use.

    Are these curves done by the vet clinic? That can become very expensive. Another problem with curves is that they capture only a day's data and if it happens to be a "bounce" day the BGs will be inflated and that can lead to a dose increase that compounds the problem.

    Here's what we would recommend, recognizing that Corona's hyperthyroidism is a complicating factor:
    • If you aren't already doing it, learn to test his BG at home (I'll post our suggested routine below)
    • log your data in the spreadsheet we use here (link below - techie help available) because we need to see it to advise properly
    • stick with the NPH insulin for now while you build up his dose-response profile according to the two steps above
    • post here to ask questions any time - out on the main health forum if they aren't seen in this forum (it's less busy)
    • try hard to test Corona at home for urine ketones using human ketone test strips from a human pharmacy - high BGs put him at risk for ketosis (testing tips below).
    Suggested BG testing routine:
    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    Explanation of bouncing:

    Here's how it works:
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    How to test for urine ketones:
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light

    Link to FDMB spreadsheet:
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    This is a start. I hope it helps. We truly understand the anxiety and frustration. :):bighug:



     
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