Cat not reacting to any insulin

Discussion in 'Feline Health - (The Main Forum)' started by Maymay, Dec 9, 2018.

  1. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Hi,

    I'm new here and desperately in need of help. I have two diabetic cats, but one is in remission, off his insulin treatment and doing fine. Surprisingly well, according to the vet, since Murphy has food allergies and cannot eat a diabetic diet.

    My second cat, Orlando, was diagnosed exactly two months ago (on his 10th) birthday. He's not doing well and we're losing him, which is why I joined this forum and I hope to draw on your experiences.

    Orlando suddenly started peeing and drinking much more than usual, virtually overnight. I took him to the vet and sure enough his fructosamine levels were 510 mmol/l. All his other vitals were good.

    He was put on 2 units of Caninsulin, but since he was still peeing and drinking too much after 10 days (less than before) and started showing signs of hind leg neuropathy, the vet decided to run an early test, which showed his levels had gone up to 570 mmol/l and his liver values had started going up.

    Vet put him on Prozinc 6.2 units twice daily. I tried measuring his glucose levels, but only managed to get two measurements before he started stressing so much that the numbers went haywire. These showed a drop in glucose levels from around 30 mmol/l to around 16 mmol/l over a four hour period. Another test a few days later said 20 mmol/l right before his injection and then he'd have none of it after that. Vet advised me to stop measuring the glucose levels as not to jeopardize his insulin injection cooperation. He peed slightly less on Prozinc, but otherwise did not improve and the neuropathy in his hindlegs got worse. A test after 3 weeks showed that his fructosamine levels had gone up again to 610 mmol/l.

    My gut instinct was to slowly increase the Prozinc dosage, but vet said it just wasn't effective enough and put him on Lantus for a slower and more steady insulin release, 2 units twice daily (I hate using the pen). It'll be three weeks on Tuesday and he's going in for blood tests again, but I already now know that it's unlikely to have had an effect. His neuropathy has gotten worse still and now also seems to be affecting his front legs. He also pees slightly more on Lantus than he did on Prozinc. I managed to get one glucose measurement on Lantus 4 hours after his morning shot and it said 20 mmol/liter.

    I do know that I do not have enough glucose measurements to conclude anything on and that I desperately need to get more somehow without him stressing over it.

    He's a cat who doesn't like wet food, but through hand-feeding, we're now up to 3/4 of a can daily, which isn't nearly enough since he's a Maine Coon and a big one at that. He was slightly overweight when first diagnosed (10.1 kg), but not so much that the vet thought that was causing the insulin resistance. He's lost weight since, and is of course only otherwise eating diabetic dry food.

    Despite the neuropathy, he doesn't seem to be in any discomfort, he has a good appetite, talks, purrs, uses the litterbox, is interested in playing although it happens lying down, but with his history I believe the vet will tell me this is the end of the road when we go in, and part of me is thinking that she might be right. He's the youngest of our cats and dog, and the thought of losing him breaks my heart, but I don't want him to go on for my sake either if there's already irreversible damage or if it's just a matter of time before he starts suffer.

    Sorry this got so long. I'm just driving myself crazy with worrying and fretting. (It's 1 am where I am right now, so I might not see any answers or be able to answer any questions until tomorrow).

    Thank you for reading. Hugs.
     
  2. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    We have a forum for lantus with protocols for dosing in the yellow stickies at the top.
    Please look through that info.
    Two months is not a long time. This is a marathon, but I know it's hard to wait.
    Which dry food specifically are you feeding?
    Are you giving b12 methylcobalamin supplements for the neuropathy?
     
  3. Carina Josefine

    Carina Josefine Member

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    Nov 9, 2018
    I am a newbie with diabetes, but I don't think I would accept that is is the end of the road before a thorough check of possible causes of insuline restistance has been done. When my kitty was ill with a lung infection (that the vets didnt find for weeks despite of blood tests and x-rays), she didnt react much to insuline either.
     
  4. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Lantus is a good insulin for cats. It could just be that you are not near a good dose yet for your kitty. My girl got up to 8.75 units of Lantus, though she had a couple other conditions that meant she needed more insulin. Once you are able to test more consistently, we can help you get your kitty into better numbers. Each cat is different is a saying here, they all need differing amounts of insulin.

    You don't have to use a Lantus pen, and that's actually not recommended here. You can get syringes with half unit markings (such as the BD Ultrafine), depending where you live, and use those to withdraw the insulin and inject it. Read the Sticky Notes on the top of the Lantus forum for more detail.
     
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Where in the world are you? (I know you're not in the US because you use the metric system)
     
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    @Chris & China She said Denmark in the original post which I just read. The BD Microfine syringes have half unit markings.
     
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  7. Maymay

    Maymay Member

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    Dec 9, 2018
    Sorry, I've been trying to reply in detail since last night, but I keep getting a spam/inappropriate content error message. I have contacted the admins, so will hopefully be able to get back to you properly soon.
     
  8. Maymay

    Maymay Member

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    Dec 9, 2018
    Okay, I still don't have a resolution for the posting issue, rewriting again to see if third time's lucky.

    It was a relief to hear that it's still early days. It breaks my heart seeing Orlando wobble around, but we'll keep fighting as long as there's still hope for a good quality of life. The vet could not see us this week, so we're going on Monday instead.

    He's getting Hills M/D and RC Diabetic dry food. Kattovit wet food (He does not like Hills wet food). I'm ordering from Germany, but I suspect I still have very limited options compared to the U.S. This is some of the only diabetic food for cats I've been able to find. He's not getting b12 methylcobalamin supplements, but I'll mention it to the vet when we go.

    I have mentioned underlying conditions to the vet and she assures me it's something they have in mind when running tests. How did you discover the infection, Carina Josephine?

    Right when starting on Lantus I asked about using the BD microfine syringes which I've been using for both cats without any problems, but the vet advised against it. I've been reading the Lantus information here and have mentioned it again, though. I also hadn't thought about only being able to give whole units with the pen, that is a valid concern when/if we have to increase the dosage.

    In other news we're making progress with the glucose measurement training. Hopefully I can start measuring for real soon.
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    The RC “diabetic” dry food is not a good choice. It is higher in carbs than is good for diabetics and will keep the numbers higher. We suggest feeding low carb wet or raw food. However, I wouldn’t switch food until you have more practice with home testing as going to low carb food can make a huge difference in amout of insulin needed.
     
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  10. Maymay

    Maymay Member

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    Dec 9, 2018
    Aha, that would explain why he loves the RC so much, which I guess has inadvertently been a good thing, since I've been using them mainly as treats because of that. Now that I know, I can cut down even further. Thank you. Good to know.

    I don't think I'll ever get him to eat raw food, anything not dry food and he's not interested. While our other cats will happily eat eggs, fish, chicken etc, he'll pass. I'm hoping to switch him to wet food only, though. We started out with half a teaspoonful to almost a can a day (the goal is 2 1/2 cans a day), but it does involve hand-feeding him. It's a good thing I mainly work from home.

    When feeding wet food or raw food, what do you do during the night?
     
  11. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi May,
    I think you have a Zooplus in Denmark? If so there are many foods there that are fine for diabetics. ...If you look at the UK food list in the Google link below you'll see quite a few Zooplus foods toward the top of the list, and many of these are likely to available in Denmark also.
    https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml
    https://www.zooplus.dk/

    However, it is not really safe to reduce the carb content of the diet until you are OK with testing Orlando's blood glucose. That is because reducing the carb content of the diet can reduce blood glucose, and the insulin may need to be reduced also so as to avoid hypoglycemia.

    Regarding the insulin dose, sometimes cats look like they need more insulin when in fact they need less... I know this sounds strange, but if the dose is too high it can cause the blood glucose to drop too low or too fast for the cat's comfort. The cat's body may then release its own stored glucose (mainly from the liver) to try to raise the blood glucose level. It can also release counter-regulatory hormones which cause temporary insulin resistance. The net result is that you may see high blood glucose levels that don't respond to insulin. At some point though the blood glucose would drop low/fast again. And the cycle can repeat.

    It may well be that your cat does need a high dose of insulin. Some certainly do. But it would be really good to be sure that the dose isn't actually too high at the moment. The best way to do that (sorry!) is through testing blood glucose at home more. And I do realise that you have found this difficult to do...
    My own cat was difficult to test at first, and I found I had to get him to associate the test process with tasty cat treats. I started by holding his ear for a few seconds, or clicking the lancing device near his ear, and then giving him a treat. I did this multiple times a day. He only ever got treats when the test kit was around. Then he soon got used to it all, and testing him 'for real' was not a problem any more. I'd crumble a few treats for him and then test him while he was hoovering up the crumbs. Before long I could test him while he was dozing in his basket and he didn't mind at all.
    Here's a little video on 'desensitization and counter-conditioning' that you might find helpful. In the video the vet is trying to get a cat used to injections, but the principles also apply to testing blood glucose.
    .


    Because your cat's blood glucose is high, I would strongly recommend that you monitor his urine for ketones. Ketones can be very dangerous for diabetics, and can build up in the body to create a serious condition called DKA (diabetic ketoacidosis).
    Testing is simple and involves dipping the end of a ketone test strip into a drop of urine. Then you time it for a given number of seconds and read off the result. Anything above a 'trace' reading is a reason to contact your vet ASAP.
    Crumpling plastic food wrap in the litter tray is often an easy way to catch a sample. But if you use clumping litter you may just be able (if you can time it right!) to stick the test strip into a fresh urine clump while it's still really wet.
    Ketone test strips should be available from most pharmacies. And if you can get the ones that test for both ketones and urine glucose that would be even better until you've become more comfortable with testing blood glucose.
    There is more info on testing cats' urine on the Sugarpet website here:
    http://www.sugarpet.net/urine.html

    Be aware that not all ketones are registered by the strips, so also note how your cat's breath smells. It should smell like normal cat breath (!). If it smells fruity or like acetone that can also indicate ketones.

    Your kitty was only diagnosed 2 months ago; it's still very 'early days'. There is every chance that he will recover.
    (((Reassuring hugs))) to you.

    Eliz
     
    Last edited: Dec 12, 2018
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  12. Maymay

    Maymay Member

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    Dec 9, 2018
    Hi Elizabeth,

    Thank you for your very detailed answer and links.

    Yes, this is more or less exactly how I'm training him. My dog is clicker trained and the cats as well to some degree (Well, they can all "sit" when asked to, "Even Orlando" as my husband says).

    We started with "touch ear with lancet" = treat. Now we're at the point where we have all the equipment out and he gets a treat if he sits quietly while I "poke" his ear with the blunt side of the lancet. My problem was that the vet really wanted a 3 x 20 hour glucose measurement every two hours (also to check for rebound hyperglycemia). He handled the first test like a champ, and seeing how he's generally a very cooperative kitty, I thought we were good to go, but then he did NOT like the second one, and after that he was on to me. So I need to "undo" this.

    I'll definitely try the plastic food wrap. The one time I managed to get a urine test, I had to use three bags of special test cat litter before he'd use the litter box and even then he was holding it for ages. That cost a small fortune. The cat litter I use is really clumping, but maybe I can stick a strip under him when he goes. I can see I can get glucose test strips and ketone test strips (no two in one, unfortunately) at my regular online pharmacy. Do I need special test strips for cats or can I just use the ones for humans?

    And thank you for the reassurance! I've been a total wreck, thinking we were running out of time until I found this forum.
     
  13. Maymay

    Maymay Member

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    Dec 9, 2018
    Oh! I know Zooplus, I used to buy from there until I found Bitiba, which is generally cheaper. I can see Zooplus has one diabetes wet food that Bitiba doesn't have (Integra), and that it comes in different flavours. Will be getting some of that! Thanks for the reminder.
     
  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    The ones for humans work fine
     
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  15. Maymay

    Maymay Member

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    Dec 9, 2018
    Great. Will order some. Thank you.
     
  16. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Hi!

    I'm not shure if someone has mentioned it but if you can get Zobaline that will help him a lot with his neuropathy (weakness of his back legs ) I don't know if it is available for you but if not you could also give him B12 vitamins and folic acid
     
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  17. Maymay

    Maymay Member

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    Dec 9, 2018
    Thank you, Veronica. I've just ordered Zobaline from the U.S.
     
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  18. Maymay

    Maymay Member

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    Dec 9, 2018
    A small update. We just came back from the vet. She assured me that she was nowhere ready to give up yet. However, if it turns out that Lantus hasn't worked either (which I'm pretty sure it hasn't), she's referring us to a specialist.

    We've made progress with the glucose measurement training and I'm beginning to be able to do a real test here and then without too much fuss. The main problem now is more my lack of practise, but we're getting there!

    I've also done a urine ketone measurement which came back normal.
     
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  19. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Don't give up on the insolin so quickly. It can take months to find the right dose. It took me three months and three units before cc was below 300 on any test! 6 weeks after that she was in remission! Stick with it, follow one of our lantus dosing protocols, and just keep at it until you find the breakthrough dose. Then it will start making progress. Switching and staying over every month isn't a good plan.
     
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  20. Maymay

    Maymay Member

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    Dec 9, 2018
    We're not giving up on the insulin. He's still on Lantus. The specialist will do further tests to see if there are any underlying conditions that the other tests failed to pick up on and also to help determine the right insulin, dosage etc.

    I had also thought there would be more dosage adjustments, but according to my vet, they follow a standard protocol of switching insulin if they cannot see any effects of the one given. If none work, then they refer to a specialist. She took a course on cat diabetes after diagnosing Orlando and she's been doing a lot of extra reading in the evenings, so I do feel we're in good hands. The "problem" here is that there aren't a lot of diabetic cats. Most vet clinics will only have one single patient, if any at all. At the course our vet was the only one with two (both mine).

    I will of course also be home testing and be involved with treatment choices etc. Funny thing, I was just watching your YouTube video just yesterday and thinking it was one of the best I'd seen. I love the way you're "no big deal" about it and your sense of humour when you whispered "It doesn't matter" (regarding poking through the ear). I've been having problems drawing blood, despite ear warming/massages, but good to know it will get easier (and yes, I've poked through a couple of times). Great video!
     
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  21. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    Yes it gets better and the more you test the easier it gets for to get the drop of blood

    It takes a very long time to get a cat regulated you will need a lot of patience (it can be months sometimes ) and there's no exact dose like with medicines there are a lot of variables that afect blood glucose levels so you will need to be adjusting the dose more o less frecuently, with Lantus usually the first 8-10 are just for his body to get used to getting the insulin and form the depot, and after that you start adjusting the dose.

    It would help to see what's going on if we could see the results you are getting from the test, if you could use the spreasheet we use here in the fourm it would be great ( this is the link on how to use it http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/) this spreasheet will help you a lot, if you have any trouble using it let us know and there's people here that can help you. In the mean time if you could post the results you are getting so that we can take a look it would be nice
     
  22. Maymay

    Maymay Member

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    Good to know. We'll just keep trying.

    I studied Janet's spreadsheet earlier today and I think I've got it. The only thing I need to do is to convert our mmol/l to mg/dl for you, but I can see there are online converters for that. Orlando's still not at a stage where I can get enough results to be of much help yet, but he's become more relaxed about it just this past week. I'll post as soon as I have more. I am looking forward to seeing what's happening with his blood glucose levels, instead of just "shooting blindly".

    Unfortunately, I suddenly have another very sick cat (Greedy), so I'm not at the top of my game right now. I took her in together with Orlando this morning and we'll be getting her blood test results as well first thing tomorrow, but it looks like renal failure which she's probably had for a while. She's not exhibiting many of the usual symptoms, though, which might be how we missed it. It is hard when pets start to get old. We lost our oldest cat a year ago and the rest of the gang (four cats and one dog) are all between 10-12 years old with Orlando being the youngest.
     
  23. majandra

    majandra Well-Known Member

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    Oct 11, 2018
    If you use the "world" spreadsheet, any value you enter in mmol will convert automatically to the us sheet that is included.

    Eta- take a peek at mine
     
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  24. Maymay

    Maymay Member

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    Oh, that's brilliant. Thank you.
     
  25. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I'm glad you found it helpful! If you are having trouble it could be your lancets. Make sure they are 26 or 28 gauge. 30+ guage are too thin in the beginning.
     
  26. Maymay

    Maymay Member

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    Dec 9, 2018
    They're 28 gauge. He's probably just a tough cookie, plus my technique might not be the best yet. If it doesn't get better, I'll order 26 gauge next time.
     
  27. Maymay

    Maymay Member

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    Dec 9, 2018
    I've managed to do a rough 12 hour curve. I know there might be a hidden rebound hyperglycemia in there, but I'm thinking it's rather unlikely to be the problem since he usually eats right before and right after each injection, then then again around 2 hours later (yesterday it was closer to 3 hours later, though). Plus I've been getting up at night to get an idea of when he eats and he seems to be nibbling throughout.

    He's also a big boy, heavier built than Murphy (both Maine Coons), so what I'd really like to do is to increase the dosage with 0.25 units to start with. Thoughts? Should I wait until I can get more measurements?

    Update: I spoke to the vet and she agreed with increasing the dosage, so we start with 2.25 units tonight. And I'm shattered, we had to say goodbye to Greedy today. Her numbers and the fact that she went downhill so rapidly all pointed towards liver cancer.
     
    Last edited: Dec 19, 2018
    Reason for edit: Update
  28. JanetNJ

    JanetNJ Well-Known Member

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    I'm so sorry you lost your Greedy. :(
     
  29. Maymay

    Maymay Member

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    Thank you, Janet. It's so hard, she was only 11 years old, I never thought we'd lose her so soon. I held her in my hands just days after she was born and then held her today as she slipped away. When we bought the old farmhouse we're living in, it came with a farm cat. A very pregnant farm cat and one of these kittens was Greedy. The only girl, the smallest of the bunch and the most ferocious around food.

    Here she is giving Orlando the evil eye for trying to play with her tail while she was eating (he was a total Greedy fanboy, always at her beck and call), back before either got sick:

    [​IMG]
     
  30. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Lol Greedy fan boy! Lol. I know what youre going through. I lost my Nikki at only 6 years old to cancer. It was terrible.
     
  31. Maymay

    Maymay Member

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    Dec 9, 2018
    I'm sorry to hear about Nikki, it is terrible to lose a young pet. I've actually been thinking for a very long time that I won't be getting any more pets. Few seem to believe me, though, I've had pets almost non-stop since I was five years old. Even my husband looks doubtful.
     
  32. Maymay

    Maymay Member

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    Dec 9, 2018
    Argh. Just had to give up on another evening BG measurement because Orlando's ears are just not bleeding (the lancets are working just FINE on me, though. Managed to poke through his ear, through the cotton wad and into my finger. The good news is that I'm not diabetic).

    So, we're switching lancets to a 26 gauge. He's become pretty good about the whole thing, but his cooperation rapidly goes down the drain the more times I poke him, and who can blame him? Now, if I can manage to draw blood (and a large enough sample at that) during the first or second poke, we'll be BG measuring champions.

    His numbers are unfortunately still horrible, but I don't want to set up his dosage until I know exactly what's happening with his BG levels.

    Anyway, just had to went a little. Hope you all had a lovely Christmas and wishing you a Happy New Year tomorrow. Here's to a great 2019.
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm sorry you lost your kitty. :(:bighug:
     
  34. Maymay

    Maymay Member

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    Dec 9, 2018
    Thank you, Kris. :bighug: It's been really hard. We're all missing her terribly.
     
  35. Maymay

    Maymay Member

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    Dec 9, 2018
    We just came back from the specialist. The blood test results won't come in before next week, but it's not looking good. She said she'd never seen such bad neuropathy before, that he'd basically lost all muscle mass, and she was doubtful if he could recover from it.

    She also set his dosage up to 4 units twice daily and said he should have started out at much higher dosages than what he'd been given. I literally felt faint and had to sit down when I heard that. To think that had I gone to see her right at the beginning, we might not have reached this point. I feel like the worst cat owner ever. While he doesn't seem to be in any discomfort or pain, he is currently so disabled by the neuropathy on all four paws that this is not a quality of life that would be fair to him for more than a limited period of time. He used to be a pain-in-the-butt, drive-everyone crazy (including our other cat and dog) kind of cat, and now he can only stagger a couple of wobbly steps at a time.

    Right now all we can do is wait for the results. The specialist will call next week when she gets them and after she confers with her colleague and their physiotherapist.
     
  36. majandra

    majandra Well-Known Member

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    Oct 11, 2018
    Don't lose hope yet- but definitely try the methylcobalamin. There are many cats who had severe neuropathy that had complete or near complete reduction in symptoms from using that vitamin. Also, with his sugars so high, his body is not able to use the glucose properly, which in itself causes weakness. I found with Rhubarb that her strength had improved once her sugars came down, and that was before ever starting the methylcobalamin. She still has the neuropathy, but it doesn't affect her abilities much now. She even regained a bit of muscle mass.
     
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  37. Maymay

    Maymay Member

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    Dec 9, 2018
    Hi,

    Thank you for the reassurance. I'm still waiting for the tablets to arrive and am worried they might have been lost.

    How bad was Rhubarb? Orlando is can only take a couple of wobbly steps at a time, and he's walking on both his "heels" and his "wrists".
     
  38. majandra

    majandra Well-Known Member

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    She wasn't quite that bad. What had us rushing to the vet when she got diagnosed, was we thought she had been stepped on, or had a box fall on her during our move. She walked like her hip was broken or something, and her back legs moved funny. She would lose her footing going up her scratching post, and couldn't jump onto couch. Turns out she was diabetic, and that was neuropathy. It didn't instantly get better when her sugars lowered. It happened slowly over a couple months, with the most progress being since she was on insulin. My belief is that lowering sugars allowed her the strength to redevelop a little muscle mass, so she no longer had to sit every 10 steps or so. she still sorta walks on front wrists, and definitely does on back, but not the rabbit walk. But she can walk, and she doesn't look quite like she has a twig butt with a gigantic ribcage anymore.

    ETA: ECID, there are no absolutes with biology. And maybe my girl is a bit of exception. Rhubarb is off insulin, when I never expected her to be, given that she had already developed neuropathy. I wanted to make sure to say this, so you could see that there is hope. Rhubarb is a good example of how much *can* improve just from sugars coming under control. It won't fix everything, but it helps.
     
    Last edited: Jan 11, 2019
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  39. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    I am glad to hear you got into see the specialist. Did you remember which special blood tests are being done?

    Good job getting in more tests at home. I would definitely keep trying. You do eventually want to test at least before every shot to make sure it’s safe to give insulin. Jumping up to 4 units is a bigger jump than we would do here. However, if you were giving six units of Prozinc, I expect you will get up there in Lantus too. When people switch insulins here, we usually go close to the dose of the previous insulin type.
     
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  40. Bear & Lora

    Bear & Lora Member

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    Sep 24, 2018
    My Kitty Bear had neuropathy like you described with your Maymay. We started Zobaline for diabetic cats two months ago and I have seen improvement. He used to wobble quite a bit and would have to take a break and lay down after walking about 5 feet. Both front and back feet have neuropathy. He used to walk flat on his back hocks and his front wrists would touch the floor, so that his dew claw would catch the rugs.

    These are his improvements so far:
    He can jump down off the bed and couch.
    He can push himself up with his back legs to try to climb in my lap.
    He will chase (some) for freeze dried chicken treats when I throw them.
    He doesn't wobble anymore.
    He doesn't take breaks from walking to and from his litter box.
    He rolls his back feet to his paws more often and his front wrists are higher from the floor, so his dew claws rarely catch on the rugs now.

    I know it is distressing and hurts your heart to see a once graceful cat with neuropathy but they can improve.
    Bear has vastly improved in attitude and health since he is better regulated and his neuropathy has improved. Grumpy cat has turned into a lover boy.
    I know that Bear will improve more with time.
     
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  41. Maymay

    Maymay Member

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    Dec 9, 2018
    Thank you for elaborating Majandra, sounds like it was quite a sudden onset for Rhubarb as well. I hope she continues to improve.

    Wendy, for now she's running a full blood screen, plus a separate pancreas test. Based on the results there, she might decide to run some more tests, which she didn't specify. Just informed us that she'd be sending an extra bill if she did that. She told me not to worry about hypoglycemia the first few days, but to run a PS and a +2 or +3 approx. three to four days in to make sure he doesn't dip too low. Then run a 0, 2, 4, 6, 8 curve a few days later to see if we need to put up the dosage. I took a +7 just now out of curiosity and I see no changes with the higher dosage, in fact it was higher than previous measurements around this time. I'll try to take some more measurements tonight without stressing him too much.

    Lora, so good to hear about Bear. I would be satisfied about a good quality of life if Orlando could reach that level of mobility.

    He hasn't had much appetite since returning from the specialist yesterday, and it's a bit of a struggle with hand-feeding and treats to make sure he eats enough. He's often like that if he's been messed with too much, though. After vet visits, after a day with several BG measurements, or if I've had to clean him up, so hopefully it's just that and he'll be eating well again by this evening. He does seem comfy enough, though, and he's been playing with my husband on the couch.
     
  42. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I would try to get a ketone test, if he's off his feed.
     
  43. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Right, will do one next time he pees. Thank you.

    He still has no appetite, not even his beloved RC diabetic had any great appeal. I had to resort to also giving him a little of Murphy's cat food before giving him his evening injection.
     
  44. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Eating is important. I was hoping you ordered the blood ketone test strips you mentioned earlier.
     
  45. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Yes, I'm trying to get as much food in him as possible. He completely spurned the Hills kibble he usually eats the most. It took 45 minutes of hand-feeding, but I managed to get him to eat a few mouthfuls of wet food (two different types), some RC diabetic kibble and some of Murphy's hypoallergenic kibble, which obviously isn't ideal, but better than nothing.

    I ordered urine ketone strips, and have been measuring him regularly. I'm not familiar with the blood ketone test strips, maybe I missed something earlier? I will google them now.
     
  46. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I thought these were the blood ketone test strips you mentioned.
    I'm in the US, but I was able to buy the blood ketone meter at the regular pharmacy but they all said they do not carry the ketone test strips, and I had to call and specifically ask (a little forcefully? and had to ask more than once) for them to order the blood ketone test strips (sold for humans) for me, and each one said they could order them and get them within 24 hours. Diabetic humans use them, and I guess humans who are on the keto diet.
     
  47. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Ahaa, no I mean the urine ones. I had never heard about the blood ketone meter. I did a quick search and found the blood ketone strips, but not meter. But obviously if I can buy the strips here, I should be able to buy the meter as well.

    (And managed to get him to eat a bit more)
     
  48. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Hi, I know your vet said not to worry about hypo right now, but still testing before shooting is very important, seriously cats really don't exactly behave as one would expect so, specially when it comes to insulin so I think is better safe than sorry, also getting a few more tests mid cycle when ever you can even though they come out high is helpful to try and figure out what's going on.

    Since you are using lantus I suggest you post on the Lantus forum so that the Lantus experts can take a look at Orlando's numbers and see what they think
     
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  49. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Yeah... I did run a few test anyway Saturday, as I wanted to see what was going on. Numbers were unfortunately unchanged. He's been walking better these past two days, though. The neuropathy is the same, but he seems stronger, walks more steps at a time, and no longer "wobbles". He took a small tumble yesterday as he decided to walk down the stairs for the first time since the neuropathy set in almost three months ago. So the stairs are now blocked!

    I just tried to test him half an hour ago, but unfortunately with no luck. We're still struggling with the "no blood" issue, despite bigger lancets. The problem is also that he becomes uncooperative and goes off his food when messed with too much, so it's always about weighing pros and cons. Today is the first day he's had a normal appetite since the specialist visit Friday, so my main goal has been to get some food in him. I'll try again later.
     
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  50. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    Last edited: Jan 14, 2019
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  51. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Good to know he's a bit better, not sure if this has been mentioned before but are you warming up his ear before poking it? gettin it warmed helps the blood flow a bit, they do tend to have their ears cold and that doesn't help. I use a piece of wet cloth that I warm in the microwave (just a few seconds) and put in a plastic bag that I put under his ear, it helps also just in case I go through ( it happens sometimes ).
     
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  52. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Zobaline (methyl cobalamin) is for neuropathy, B12 shots (cyano cobalamin) are for B12 deficiencies and given for several conditions. You can buy Zobaline on line.
     
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  53. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Specialist said to try with the Zobaline pills once they arrive (I'm afraid they've been lost. Have contacted ilifelink, but they haven't gotten back to me), but I can ask her about B-12 shots when she calls, hopefully with good news.

    Regarding the BG measurements. I've read all the articles and watched all the videos I could find online, and I think I'm using every trick in the book:

    What I do is that I:
    1. Warm up kitty's ear (I either use small Pinewood heat pads or heat up my own hands on the radiator) and massage it. Don't poke until ear is nice and toasty
    2. Rub on a bit of Vaseline for droplet to form
    3. Switched to 25 G lancets
    4. Poke in the sweet spot
    5. Try to massage a droplet out
    6. Do the double poke thing if the first poke doesn't bring results, which often doesn't bring any results either, same thing also often happens with subsequent pokes - and at some point he's just had enough of all that. Plus I don't want to turn him into a pin cushion.
    7. Put pressure on ear afterwards

    Today I did all of the above. Four pokes, not a hint of blood, and then he was done. It's always a hit and miss if he bleeds, sometimes if there's a tiny drop of blood I can massage enough out for a measurement, but not always. Once in a blue moon, a poke will produce enough blood for a measurement. I have a feeling that the evening measurements are more likely to fail for some reason.

    I'll post in the Lantus section tomorrow. Thank you for all your help and advice.
     
  54. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    For neuropathy you need as Wendy mentioned the form of B12 methylcobalamin because this is the form that the nerves use best and the B-12 shoots are usually cyanocobalamin

    Keep trying with the poke the more you test the easier becomes for the ears to bleed
     
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  55. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Thank you, we'll definitely keep at it.
     
  56. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Sometimes, I've had to poke 6 or so times in practically the same spot. Sometimes, one ear bleeds more readily than the other. Always give a special treat or extra loves and praise after every test whether it worked or not. You'll get this.
     
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  57. Giomax

    Giomax Member

    Joined:
    Dec 29, 2018
    When you test, are you using a lancet device? When I first started testing Max I thought it would be better to just use the lancets--wrong! I couldn't get any blood that way, and Max hated it. The lancet device is my best friend. One tiny poke and I can almost always get blood. Sometimes it does take more than one try, sometimes about four pokes--poor guy. I feel so bad poking his ears all the time but it's definitely important and I'm less stressed since I started home testing.

    All of the stress isn't gone though. I'm stressed out of my mind about him usually, haha. He's developing hind leg neuropathy and I'm hoping so hard we can reverse it. I've been making no progress with his numbers since diagnosis. I work full time and nobody is there to watch him while I'm gone, so I'm terrified of overdosing him. I'm so happy for this forum and all of you guys. I can't say I'm happy others are struggling, but it is good to know I'm not alone!
     
  58. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Try a different ear or the other side of the ear... Try moving up or down along the side as well.
     
  59. Giomax

    Giomax Member

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    Dec 29, 2018
    Yes, there are definitely spots where I get better bloodage.
     
  60. majandra

    majandra Well-Known Member

    Joined:
    Oct 11, 2018
    Do you know for a fact that you are breaking the skin? I found I wasn't breaking skin to start.
     
  61. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Good morning all. Thank you for all the suggestions and feedback. It is really great to be in here, like Giomax, I find it good to know that I'm not alone.

    To answer your questions:

    Yes, I have poked multiple times in the same spot. I think our record is seven. I do both ears and I have tried other spots along the edge other than the sweet spot. I know that I'm breaking the skin, have poked through a few times as well (usually without drawing any blood, except my own once). And yes, I've tried using a lancet device, but never managed to draw any blood with that.

    I did manage to get three measurements since I last posted, but I'm sorry to say that the two were because he jerked while I was poking him and the third required a double poke. His numbers were horrible as always.
     
  62. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    It took me a couple weeks in the beginning to consistently get readings. Your cat probably just had few capillaries along the edge. The more you try the more that start to grow. Keep at it.
     
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  63. Maymay

    Maymay Member

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    Dec 9, 2018
    Thanks for your encouragement Janet, you are one of the BG testing masters in my eyes. :)
     
  64. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    After 2.5 years and thousands of tests I have plenty of experience. Lol.
     
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  65. Giomax

    Giomax Member

    Joined:
    Dec 29, 2018
    What did your lancet device look like?
     
  66. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    I have this one:
    [​IMG]
     
  67. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Aaaand we seemed to have cracked the blood sampling code! Sheer coincidence. It started this morning where I went through the usual: warm up kitty's ear, massage kitty's ear etc. Did a double poke with no blood whatsoever. Then I thought, "let's just warm his ear a little more before poke three". I put the heating pad back on the inside of his ear, and behold! A droplet formed on the outside from one of the previous pokes. I've done two tests after that and each time was a hole in one with very little fuss from kitty.

    I'm so chuffed. Now if only his numbers were good.

    I've spoken to the specialist. All his numbers were fine. They found nothing that could explain why he isn't reacting to the insulin. His pancreas levels were slightly elevated, but insignificantly so. There were no signs of infection. She's convinced it's a matter of dosage and told me to go up one unit tonight. Again, he should be completely safe, but if I was worried, I should measure his BG later. I know these rapid increases goes against the Lantus protocols in here, but I have decided to follow her instructions - at least for now. According to her, considering his numbers and weight, we are still going "slow". She couldn't explain why he's less wobbly on his feet, but said neuropathy is often unpredictable. So far it hasn't been the bad news, I was fearing. We'll speak again next week for a follow up on the higher dosage and after she's spoken to her colleague and the physiotherapist.

    And the Zobaline I ordered was stopped in customs, hence the delay. They're holding it until I pay duty and handling fees (35 USD), which is almost as much as the Zobaline + shipping, but so be it. Hopefully, I'll have the tablets sometime this week.
     
  68. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Congratulations on the successful testing!!

    I do suggest you ask about the dosing in the Lantus forum and ask for the group to take a look at your SS, and really do give it a thought about raising the dose in one whole unit, is important that you consider that too much insulin can look as too little especially since you were seeing some pinks (between 300-400) on a 2.25 dose
     
  69. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Thank you Veronica. :) Four tests today and all but the first required just one poke. I'll do one right before bedtime to make sure he's not dropping too low, so fingers crossed that it will be as smooth as the others.

    I have gotten feedback in the Lantus forum, and they weren't keen on the high increases either. The specialist has been following Orlando's spreadsheet as well, though, and she's also seen the pink numbers. I spoke to her about this today, and she's confident about her approach. I do like the Lantus protocol used here, which is why I decided to follow it initially. And I wish that I'd found this forum earlier so I could have started on the Start Low Go Slow method earlier as well.

    But for now, at least, I'm going with the specialist's advice. She's seen him, his spreadsheet, and his lab results. Together with the veterinary university, the AniCura hospitals get the hard-to-crack and complicated cases, so I'm going to trust that she knows what she's doing.

    There's of course no guarantee, but she seems pretty confident that she can get him in the 5-15.5 mmol/l (90-280 mg/dl) range. Considering his sky-high numbers the past three months and his neuropathy, I'll take that. Although ideally, Orlando's spreadsheet would look like your Babu-chiri's.
     
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  70. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Hopefully you will get there but do have a look at his numbers on 2016 and a good part of 2017 when we started with all of this and they weren't as different as Orlando's so hang in there
     
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  71. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Yes, I could see he had some bad numbers a few years ago. Must have been such a relief when you consistently started hitting blues and greens. Right now a yellow would get me pretty excited.

    The Zobaline arrived today (it had been stopped in customs and been around the Danish Medicines Agency, which is why it's taken so long). I've given him his first tablet, so fingers crossed that we'll start seeing more progress.
     
  72. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    I'm really tired and half asleep already, but I just had to share that we hit our first blue number today! :)

    Yesterday was the worst day we've had in a week and I went to bed feeling pretty dejected, and then today we've had three breakthroughs:

    - a blue number
    - a cat who for the first time in weeks (months?) ate all on his own throughout the day without having to be hand fed a single time
    - and not only did he get up during play time, he tried to run. The result was a few awkward bunny hops, but it's the fastest distance he's covered in months
     
  73. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Great news! We celebrate every positive development! :smuggrin:
     
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  74. Maymay

    Maymay Member

    Joined:
    Dec 9, 2018
    Thank you! :)
     
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