BGs too high for so long... long post

Discussion in 'Feline Health - (The Main Forum)' started by Carol & Orlando, Nov 25, 2017.

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  1. Carol & Orlando

    Carol & Orlando Member

    Joined:
    Nov 19, 2017
    Hey everyone!

    I'm pretty new to this forum, but I've already got so many great tips here! I decided I'd post Orlando's (my diabetic cat) story here and see if anyone has any idea of what to do to drop his BGs (it's been over 400 for around 3 weeks now).

    Orlando is my all white 12 year old kitty, I adopted him from a friend whose cat (a stray cat) had a litter and he couldn't keep the kitties. He came to my place when he was 3 months old. He's extremely attached to me but a very shy cat with anyone else (aside from my mom and my boyfriend). And he's adoooorable!
    He's been diagnosed diabetic back in July, he almost died then from not eating, losing too much weight too fast (he was 6 kilos a few months earlier, then he dropped to 4.8 kilos very quickly). He had problems with ketone as well. He had to go stay at a clinic for two days so they could balance out his BG and a bunch of other problems (stomach, liver and kidneys were all inflamed). After he came back home, I started giving him Lantus twice a day, 1 unit each time. He took a while to get better because of the other problems, but started getting better after a month or so.
    I started taking him to an endocrinologist, aside from his regular vet. Nothing much was explained to me, just that I had to give him his insulin twice a day and that I "should measure his BGs sometimes" (they told me which meter to buy but not how to use it. There's a manual that came with the meter, though). Oh, and that I should change his food to a diabetic food (Purina Proplan Overweight Management).
    For the first time in my life I thought "ok, Carol, do what the vet tells you, trust her, don't go googling everything and thinking you might know better than someone who studied animals for a long time." What a dumb thing to do....
    Things were going well, I measured him from time to time and started seeing his BGs going back to normal. When he was at the clinic, it measured for 48h at around 350-400, now it was around 90-120. I told the endocrinologist and she told me start giving him his insulin only once a day for a week and then get back to her. Which I did. Still with the good numbers. Then she told me to stop the insulin, and that made me sooo happy! I was thrilled he was in remission already, which I imagine everyone would be! That was in October (exactly three months after starting the insulin).

    No one had told me I should keep measuring him (I know I should have known, again I was extremely dumb!!! :banghead:), so I only measured him twice in two weeks (both numbers were good, 106 and 90) and we didn't test his blood to see if everything was a-ok after he stopped the insulin (that I thought was kinda weird). So, 3 weeks later he started drinking lots of water and peeing too much again... but this time I knew right away what that meant. I measured him and it was 446! I measured him three more times that day, every time it was in the 400s (once was 482).
    Back to the insulin we went. Once a day, 1 unit. That was November 5th.
    I started measuring him three times a day. The day after the first insulin shot I got a High (my meter only measures up until 500, after that it shows "Hi" as in high, it's a Freestyle Optium Neo human meter), after that it was between 380-470. After a couple of days he went back to 1 unit twice a day. Then a couple days more 2 units in the am, 1 unit pm. From Nov 16th on he's been measuring High several times a day, aside from his nadir which is usually around 470 (way too high as well!). Last Monday (the 20th) we took a blood test, everything was actually pretty good, aside from fructosamine which was 7,22 (on the blood test result it says it should be from 2.19 to 3.4 - no idea if that's the same in every country) and a few things related to his kidneys (he's already at the beginning of kidney failure). Cholesterol was acceptable.
    At the moment, his insulin is at 2 units in the am, 3 units pm. He's been reading High (over 500) since Tuesday night, nothing changes... I upped his insulin last Sunday and a little more today, so 3 units am, 3 units pm. I've read here (and his vet told me the same) that I should wait between 5 or 7 days to increase his insulin. He uses Lantus (I think I said this already, sorry), that pen thingie that only lets me choose 1 by 1 unit (I see sometimes people talking about 0.25 or 0.5 here, is this from a different kind of insulin or pen?).

    The thing is, he's been reading High non-stop, and since a couple of days I saw that his hind paws are shaky, he's much quieter than usual, today I saw his front paws are kinda weak as well. His fur isn't pretty and shiny anymore, he had diarrhea a couple of days back (took me a while to find out it was actually him, I woke up one day and saw it, it could have been any of my cats, this happens occasionally with my black cat Johnny, but not that bad).

    Do you guys think he became insulin resistant? That's what his vet thought, back when he was at 2 units twice a day (many things happened since then and I haven't checked back much with her, I don't trust her much anymore and she plays it way too safe with the insulin but my boy's BGs has been through the roof for way too long!).
    Should I keep increasing his insulin until something changes? How long should I wait to increase again? I'm afraid I'm taking too long between increases...
    And what exactly happens when a diabetic cat becomes insulin resistant? There's nothing else to do, leave him alone (stop poking him all the time) to enjoy his final days/months?

    We live in Brazil, a country where most people have dogs, all vets know a lot about dogs but not much about cats. Some can't even treat cats because they're afraid of them. Diabetic cats seem like not very common here (growing more and more lately, though). I've free fed dry food to all my cats my whole life. I've changed brands, I'm always looking for the best quality possible (it's impossible to find all the same varieties you guys have in the USA or Canada or Europe, but there are some. Some are way too expensive for me to afford, let alone having three cats to feed and take care of). Orlando and Johnny also eat wet food, we have the sachets (pouches) kind here, not much liquid in it. They eat a bit of it twice a day. The rest of the day they nibbled on dry food. The canned food I can find here doesn't seem very good, as in healthy and I can't find information on calories on those cans (weird, right?).
    But I've been buying some to try out, Orlando eats a little bit and leaves the rest for later (Johnny looks at it as if he's g0nna gag), but I live in a tropical country and it's spring already, way too hot most days. Canned food goes bad in a matter of half an hour here. The sachets are okay because they eat at once, because I leave just a little bit and they really love it.

    I'm not sure if changing his diet (he and the other cats are eating Hill's Science Diet Senior plus the sachets and Orlando every other day gets a bit of carpaccio beef, which he adores. He loves red meat) now is gonna do much good. If the insulin doesn't help lowering his BGs to an acceptable number (hell, I'd be jumping up and down with happiness if I ever saw him go down to 350!), is food really what's gonna work?
    He's already quiet and seems kinda sad (of course, he can't be feeling any good), I don't wanna take away from him the foods he likes and then he dies and I see that he didn't even enjoy that in his final days/weeks/months, you know?

    I'm afraid my boy's body is just tired of all of this. He's been so strong for 4 months, but now it seems like his body is giving up. I wanna do whatever it is there is to do to make him feel good again, but then again, I don't wanna put him through hell (I don't mean that with just changing food, but also taking to vets, which he absolutely hates, poking him all day long, his ears are looking so rough from so many tests already, etc...). I wanna be able to realize when the time comes to let him be free of annoying stuff and also the time to stop his suffering (which, at least with animals, we can do here in this country). I've read that dying from complications of diabetes, especially neuropathys (which he seems to already have), is very painful and awful. He doesn't need to go through all that. He can die peacefully in my arms, when the time comes.
    But I don't wanna look back on all of this and regret to not have tried harder, or something different.
    I'm so lost. I'm keeping myself as strong as I can because I know he needs me to be, and he can't see me suffering. He's too sensitive with this kind of stuff, poor thing.

    Soooo sorry for such a long post. Really! I'm just so lost and feeling so alone in all this... I needed to get all this out with people that understand what I'm saying and maybe get some good tips on what to do.
    Thanks in advance to anyone brave enough to read all of this :cat:
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! We can help. You need to get a strict routine of BG testing and data logging going so we can give you the best advice. I'll summarize some important points:
    • Lantus is a very good insulin for cats but they metabolize it quickly so twice a day dosing on a fairly strict 12/12 schedule is best
    • it's best to give the same dose AM and PM and a good starting dose is 1 unit
    • dose increases are best done in 0.25 unit increments.. You can take the cartridge out of the pen and use it like a mini vial by inserting a U100 insulin syringe into the rubber end to draw a dose. Get syringes with half unit marking and learn to eyeball between the half units to give yourself a wide variety of possible doses.
    • his clinical signs will improve once his BG is better regulated but that takes time and a good action plan
    • the ups and downs of dosing early on are ancient history now so you'd do best to start from scratch by having a good testing routine set up to learn where he is now
    • yes, he might have built up a degree of insulin resistance due to glucose toxicity (high BGs over a long period can impair the body's ability to respond to insulin. That generally responds to careful dose increases every 6 cycles or so. Eventually you'll start to see a distinct response to a dose.
    • low carb wet food is best for diabetic cats, whatever you can find where you live. All dry food is too high in carbs except for a few types available in the US.
    • the yellow info stickies at the top of the Lantus forum are where you should start reading to learn more about how this insulin works
    • read about the two dosing guidelines TR and SLGS to see what might suit you going forward. You can change from one to the other any time as long as your kitty gets no dry food (no dry allowed in TR).
    • please consider setting up a spreadsheet like the one we use here. It's viewable by all members and is the first thing we look at before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ If you need help with it there are people who will do it for you.
     
  3. Carol & Orlando

    Carol & Orlando Member

    Joined:
    Nov 19, 2017
    Thank you SO much, Kris (I'm assuming I'm talking to Kris here haha)!
    These tips are very helpful! Especially the ones about the spreadsheet and how to handle everything so you guys can give me good advice :)

    I finally found a canned food (wet) that Orlando seems to like. Actually, all the cats liked it. I'm gonna transition from dry fo wet carefully so Orlando doesn't stop eating suddenly (he's done that before with changing foods).
    Good to know that any kind of wet food is already a step up from dry food! I didn't know that (I thought it had to be a specific kind).

    Also great to know how you guys measure 0.25, 0.5! I'll get that syringe tomorrow!

    I'll come back once I have the spreadsheet and have read all the yellow stickies at the top of Lantus forum (I've read some but not all) <3
     
  4. Amanda and a Loudogg

    Amanda and a Loudogg Well-Known Member

    Joined:
    Jun 16, 2017
    Hiya Carol! Kris has already given you great starting advice, and I'm not at all familiar with Lantus. I just wanted to stop by and give you a hug and Orlando some scritches. You are definitely in the right place! :bighug::bighug::bighug:
     
  5. Carol & Orlando

    Carol & Orlando Member

    Joined:
    Nov 19, 2017
    Thank you so much! :bighug:
     
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