diabetic neuropathy

Hello everyone,

my 17 year-old cat started to fall over on one side about a month ago, one evening as i came home. at first i thought it was a stroke but because he was drinking a lot and and eating a lot the emergency vet i called said it could wait until the morning to bring the cat in. so i brought him to my vet the following morning. he xrayed his spine and found that the leg problem it could be explained by a small spongiosis between two vertebraes. it would be some sort of herniated disc. he was given a cortisone shot.
a week later it was a little better but he was not completely recovered so he got another cortisone shot. in the meantime i thought my cat was having an abnormally big appetite, drinking all the time, having enormous pees and losing weight so i started to suspect diabetes or kidney failure and researching on the internet i discovered that neuropathy was sometimes the first symptom of diabetes. so i told my vet to check for that. he was a little sceptical and said that cortisone could give those side effects but i told him that my cat had started to drink and eat like crazy the night before he received his first cortisone shot. so his blood was tested for general organ functions. his kidneys are fine but his sugar levels indicate diabetes. we tried for 2 weeks to see if the change in diet (RC diabetes) would be sufficient but my cat kept eating like crazy and he was walking in a wobly way. we then started insulin, 2u twice a day. it clearly reduced his food intake and his drinking but he started to refuse eating the diet food. he probably was eating it before because he was constantly hungry. however his blood sugar levels after a week were unchanged (27 when normal should be under 10). he also remains totally lethargic and his hindlegs are now so weak that they don't support him anymore to walk, they keep sliding away under him, it breaks my heart to see his mobility so impaired. so while his appetite and drinking (and urinating) have clearly gone down with the insulin, the sugar levels remain unchanged and his apathy and mobility problems have gotten worse. since Thursday the vet put him on 3u twice a day but his external symptoms is unchanged and i expect that his blood sugar levels with be no different. i am due to call my vet tomorrow to tell him how my cat is doing.
Any thoughts to what we could change to improve my cat's condition?
thank you in advance for your suggestions

 

Aimee...first of all, welcome to the FDMB! There are a lot of members here that are managing our sugarcats at home and doing great, so you've come to the right place!! (One hint though....the candle icon you used on your original post tells us your kitty has died. If you go back to your original post and "edit", you can choose the ? or "None" instead)

There are a lot of facts we'd need to know to fully help out though.

1. Why food are you feeding? Dry is too high in carbs (even "prescription) and changing over to low carb wet can have a profound effect on the numbers (but since you're on insulin, you'd need to learn to home test before just changing over)

2. What insulin do you use?

3. Has your vet ever discussed home testing with you? If not, this isn't surprising and there are lots of us here that can help teach you and support you through it. We all think we can't do it when we first start....Now most of us barely wake up

There's a LOT of information in the "Stickys" at the top of the page here. You can learn an awful lot in them.

We also have a lot of cats with diabetic neuropathy (although mine isn't one of them at this point yet) so I'm sure you'll hear from others as the day goes on.

Good luck!..What's your kitty's name?

(oh yeah...2 weeks is really too soon to expect results, especially since your kitty has recently had steroids...we have quite a few members who's cats developed diabetes due to steroids but are doing well now. ..this dance has lots of steps but if you ask lots of questions, the people here will help you every step of the way

 

Dear Chris and China,

thank you for your reply.

my cat's name is Bärli, it means little bear in swiss german.

diet food is soft royal canin diabetes (i have dry too but since he has diabetes he does not eat kibble anymore, not even his old one). obviously my cat knows that dry food is not good for him. in the past he was given long term royal canin urinary to prevent kidney stones. royal canin veterinary food is of very high quality.

we waited 2 weeks after the second cortisone shot to start with the insulin.
the insulin given is Caninsulin. he asks for food again shortly before it's time for his second shot of the day so no problem of him getting food in between two shots eventhough he has access to it (he really eats less than he used to before he started the neuropathy)

i have asked my vet about home testing and he dismissed it as not being in his experience reliable (e.g. if the blood is not taken properly) and he does not believe in testing at the practice because having worked in a clinic he has seen that stress interferes with the testing.

i have read about the home testing but it is unclear to me how useful it is in treating diabetes. also i have read about the vitamin B supplements and asked my vet but he believes that the right way to get his legs back into shape is getting the diabetes in control...

 

Hi Aimee and sugarcat Barli and welcome to the FDMB. Lot's of experience here with feline diabetes.

1. Caninsulin is good for dogs. Does not last long enough in cats, due to their faster metabolism. Lantus, Levimir, Prozinc are the best insulins for use in cats.

2. Home testing is very reliable. It keeps your cat safe. You test before every shot, to make sure your cat is not too low to give the insulin shot.

3. If you vet does not believe in home testing or blood testing at the vets' how are you monitoring?

 

Hi Aimee,
It sounds like your vet might need to be brought "up to date" on how to manage feline diabetes ;-)

Can you find out how often he gets new diabetic cat patients? And how often they have gone into remission?

1 - Caninsulin is not a great choice for cats. It's better suited for dogs actually. Cats metabolize insulin about twice as fast as dogs do, so a longer lasting and gentler insulin like Prozinc, Lantus or Levimir have been proven to be the best choice for cats.

2 - I don't understand his logic on testing.... He doesn't support home testing because you might not do it properly? It isn't rocket science. Using a human glucometer, you poke the edge of the ear to get a drop of blood, and test it with the meter. It's no different than a human poking their fingertip to test their blood sugar.
And he doesn't like testing at the clinic because of the stress factor? He's right, to a point. Most cats are stressed at the vet, and stress can raise BG values. But if he doesn't want to test at home, or at the clinic, then when do you get tests? It's impossible to safely manage the diabetes if tests are not done someplace by someone. Daily home-testing, especially before every shot, is the only really safe way to go.

The three keys to "doing this" are-
Home testing.
A low-carb diet.
Logical dosing with a suitable insulin.

And if neuropathy exists, supplementation with methyl-B12 seems to help in most cases.

 

What a beautiful name!!

OK...first, I'm not surprised about your vet's reaction to home testing...Most vets don't know anything about it and although it sounds like yours does understand that testing at the vets office isn't going to give you a really accurate reading due to stress, he's absolutely wrong that you can't get any useful information by home testing.

A human doctor would NEVER suggest that you give your child insulin without testing first! Just because our kids have fur, this doesn't change the fact that it's the only way to make 100% sure that it's safe to give it! You will also learn a LOT about how your kitty responds to treatment so you can adjust his dose as needed. Again using a child as an example, would you expect to just "guess" a dose to start with, and then for the rest of your child's life stay at the same dose? Of course not! Your child's needs change, their response to insulin changes...and our furkids are the same!

There are hundreds of us here that test our cats at home, and if it weren't for that fact, our cats wouldn't be with us anymore...either from going hypo from too much insulin, or from the diabetes itself being uncontrolled and eventually causing the complications that kill them.

On the insulin, Caninsulin is one a lot of vets are familiar with and use...but in cats, it's NOT the best choice!! It was developed for dogs, and a cat's metabolism is much different. Caninsulin is very fast working, and can drop the numbers fast, but it wears off long before it's the next shot time. There are much better choices out there. The 3 used by the members here are Lantus, Levemir or ProZinc/PZI. These are much gentler insulins, and have been proven to work better in cats.

There's even a very good study that was done (in Germany I think) that showed that in the cats that were put on a particular protocol using Lantus, 84% of them went into remission within 6 months of diagnosis...and this study has been published

As for the neuropathy, yes, one of the first things to do is get the diabetes under control! Lots of cats who have progressed to that get much better once their numbers are better!

Now I know you're in another country (I'm in the US), so it's possible the food you're feeding could be a different formula, but the Royal Canin foods we have numbers for are all kind of high in carbs....8-20% depending on the variety (Babycat being the only one less than 10%) so I'm thinking the one you're feeding, although a good quality food, is still going to be too high in carbs. One thing I've learned about the foods...it's not necessarily how much they cost that counts!

I hope you'll continue to research around this message board...and read the Sticky's and posts by others. Those of us that are home testing have a spreadsheet program in our signature line too. You can click on those and see the kind of information you can gain by home testing....and why it's SO important!! My own cat, China, started at 225 yesterday morning before her shot (that's 12.5 for you) and in 7 hours, was at 67 (3.7)..if she'd dropped much lower, she could have gone hypoglycemic on me with all the dangers that brings

I'm hoping some of the other more experienced members will be along soon...I know I'm missing a lot of information for you, but also don't want to overwhelm you all at once.

 

Welcome to FDMB.

We use human glucometers all the time to monitor our diabetics. The number scale is a little different from veterinary lab results, howeve we have reference numbers to use in cats. Think of it as the difference between reading temperature in Celsius or Fahrenheit. Both are correct.

ETA: Updated the following for mmol/L and AlphaTrak estimatesHere are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

thank you all for your helpful responses but it does not seem possible to post a reply under each people's reply so i will try to summerize.

Royal Canin diabetic wet food has only 2.3% starch and 1.3% sugar, plus it has the S/O system which is great against kidney stones (important for my kitty).

i will ask the vet about other insulins.
i don't know how much he is knowledgeable on cat diabetes but this is a modern practice with state of the art equipment in a big city and he is not very old either. am sure he is open to discussion and will ask his collegues for advice if needed. he started with 2u per shot based on this sugar level, not at random.

the reason i am on this forum and was asking about the use of home testing is that there is not a lot of information on european forums but as much as i could tell, testing on a daily basis does not seem so common here as in North America. people seem to bring their cat for monitoring weekly at the begining then monthly.

to avoid hypoglycemia my vet told me to inject as the cat is eating, which i am doing, it sounds also sensible to me. since we started i come home every lunch time to see if the cat is ok, well, not worse and he is just the same. over the weekend i stay home and see no change at all in his daily pattern. if it would not be for his food and drink intake i would think that the insulin is not having any effect.

my Bärli gets tested at the practice after 12h of getting last shot of insulin and last meal. result is the same as after 12h fasting and no insulin (when he was first diagnosed). my vet says the value is not extremely high, 27. he told me some cats are on 60 as a comparison (sorry i don't know what the units are).

has anyone seen the same kind of partial response: drastic effect on appetite, drink and urination but no effect of sugar level and neuropathy?

 

Hello there

I will let BJ or someone address the kidney stone issue - we can recommend other foods that will help with that but are also low carb. Low carb will help regulate Barli.

This board mainly has North Americans on it but there are also quite a few UK and other european members so you arent alone.

Are you still giving the steroids now? If not, Barlis blood sugar could start to drop back to normal levels so home testing becomes more important ( and saves you money at the vets)

yes - the insulin will help Barli process the food better and so reduce his appetite, drinking and urinating. However if it isnt the right dose Barli could be bouncing up and down from low to high. The highs will cause continued neuropathy and depending how long he spends high, the blood sugar average could stay high too. Thats again where home testing comes in. you can see if he is bouncing up and down.

Wendy

 

Testing 12 hours after a shot of insulin is only showing you how high Barli is. By testing him 12 hours after the insulin, the only thing you are learning is that the insulin has run out by that time. That is normal with the Caninsulin, as it usually lasts only 6-8 hours in a cat.

We also need to know how low the insulin drops him. To do that, you need to test somewhere in the +4 to +7 hour range after the insulin is given.

That 27 mmol/L multiplied by 18 gives us 486 mg/dL. Yes. that is very high. You want Barli to be under 15 mmol/L (270 mg/dL), even better is if he is under 11 mmol /L (200 mg/dL) most of the time.

What country do you live in? I know that for many in Europe, Caninsulin must be used first to treat dogs and cats. I know this is the situation in the UK.

I know most of our UK members home test. Maybe they can suggest a glucometer for you to buy.

 

Hello Wendy, he only has had two shots of steroids one week apart and the last one was three and half weeks ago...he was last tested for sugar 3 weeks after the last cortisone shot. i don't understand what you mean by "normal levels"? are you suggesting that he does not have diabetes but that the cortisone induced the high sugar level?

 

Steroid shots can induce diabetes. If that is the case with Barli, he has a better chance of going into remission. As the steroid shot leaves his system, the pancreas can heal and start producing insulin. As his pancreas heals and produces insulin, his needs less insulin given by injection.

Only testing will show you if his pancreas is healing and he needs less insulin.

 

i live in Switzerland and yes i was given caninsulin.

 

I've sent a PM (private message) to one of our other members that lives in Switzerland. I was hoping she might be able to help you with suggestions on a good glucometer to choose, maybe some food suggestions for your cat, things like that.

She isn't on here a lot, but she may get the PM and come and respond.

You said your cat did not want to eat the diabetic cat food. He needs to eat something. These are some possible food choices from a website that says these are available in Germany. No sure if they would be available in Switzerland. Would any of these tempt him to eat?

Some canned foods to get started with:
Almo Nature Bio Pate Huhn, Kalb oder Lamm,
Almo Nature Bio Pate Schweinefleisch, Truthahn oder Rind
Amora vom Besten Kalb + Pute oder Geflügel + Leber
Animonda Rafiné Petit mit Herz oder mit Kaninchen
Bozita mit Hühnchen, mit Lachs oder mit Rind
Cosma Hühnchen oder Lamm in Jelly
Gimpet Shiny Cat Hühnchen mit Garnelen
Miamor Bio mit Putenherz, mit Geflügelleber, mit Kalb, mit Truthahn
Ziwi-Peak Wild oder Lamm

There are some other foods which may be appropriate for FD cats, please make sure to check the dry matter carbs before feeding these;

Felix by Purina, surprisingly different from US Purina. The Gelee variety - Fish - salmon cod, trout; turkey, beef, chicken.

Kitekat in Gelee.

 

thank you for the food suggestions. at the moment i mix his diet food with 100% tuna+shrimp so no carbohydrates from a brand similar to Almo. what is a good carbohydrate range to look for generally? Almo often mixes its food with rice so that would not be good...

 

We like to keep the carb percent under 10% if we can. Some cats are more carb sensitive than others, so some people strive for even lower, under 8%.

A little bit of rice might be ok. Friskies adds rice to their pate style foods here in the USA. That ingredient is down low on the ingredients list, so most of their pates are under 10% carbs. I do need to watch how much of that I give to my diabetic cat Wink. They can elevate his BG levels and since he is off insulin for now, I try to keep feeding him mostly the lower carb 4-7% varieties of the Fancy Feast foods with only a little bit of the Friskies. He seems to have lower BG's on those lower carb foods and I'd like to keep it that way.

ECID. Every Cat is Different. You need to find what foods work better for your own cat.

How else may we help you?

 

i just talked to my vet about caninsulin versus levimir and he said that the endocrinology specialist of the Zurich Animal Hospital has better results with caninsulin over other types of insulin. he is not happy that my cat is not doing better and is starting to tell me that i should think of terminating my cat's life. to which i replied that we should try different treatment protocols before we give up.

 

I think you should terminate your vet's contract

I think we can work on getting him better if you are willing to work with us. The steroid shot was fairly recently and still may be in his system and he hasnt been on insulin long. and you really dont know whats going on without home testing.. os its still early days. Your vet just seems inexperienced.

So heres my suggestions

1. try and find another vet that will give you a better insulin. Start calling round.
2. Get testing at home - go get a human meter asap. We will help advise you on how to test - and we will get you set up with a spreadsheet so we can see how things are going.
3. Work on moving to a lower carb food as suggested

Wendy

 

I would definitely try a different insulin than the Caninsulin before you euthanize your cat. How can your vet even suggest that without trying something else?

Levimir is a good insulin and so is lantus/glargine. We have many cats here go into remission in the first 6 months when using glargine, a low carb diet and home monitoring.

If your vet is not willing to try another insulin, I'd recommend finding another vet that will.

 

i am a biologist so i don't give up that easily :- ) thanks for your offers of help

there is a telephone line at the Zürich animal university hospital so i will try and get advice there. maybe they can refer me to a diabetes specialist in my city. my vet will do what i suggest him to do but i would feel more confident with a vet that comes with some ideas himself other than just increasing the dose of caninsulin.

 

Wow Aimee!! Terminate your baby after only about a month of trying? That just leaves me speechless!! I totally agree with Wendy...what needs to be terminated is your vet's contract!

You've been getting some excellent advice from others, to which I just want to add one thing about the steroid/diabetes connection.

We just recently had a member who gave 2 (yes, two!) injections of Lantus insulin, and then went OTJ (Off the juice...off insulin completely) and continues to be regulated. We all thought that was a real miracle, but I just learned that before getting the diagnoses of diabetes, she had also had a couple of steroid shots.

Once the steroid had a chance to leave her cats body, it's most likely the cat never DID have diabetes! Steroids can raise that BG level high and keep it there until it totally leaves. I think it's totally possible that the 2 shots your kitty has had may be what is causing the diabetes...Now it's also possible you're dealing with BOTH...effects of steroid and clinical diabetes, but until the steroids clear, we can't know for sure.

I would look for a different vet who'll at least try another one of the insulins...ones that work better on CATS, start home testing, and changing food over to the Low Carb varieties.

One of the first things people will tell you here, is that diabetes is not a death sentence. I'm dismayed that your vet would even propose such a thing :evil:

 

Wow. Why would a person who thinks like that even become a vet? For the humans in his life, I hope they never become diabetic with that sort of attitude around.

 

Bärli is already on low carb food since 3 weeks. i take your point that the steroids could be interfering with the insulin and the first response of my vet when i suggested diabetes was that cortisone could be giving these same symptoms (appetite and drink). however, as i said before he did show the diabetes signs before he received the first shot, increased appetite + increased drinking and urinating + neuropathy. now i cannot rule out that these were symptoms caused by some other disease but which one then? do you know what the cat you mentionned got cortison shots for in the first place? we will test my kitty's sugar levels on Friday so i will ask him whether it's possible that cortison could still be interfering with insulin after 4 weeks. at least when he was under cortison his legs were better...

 

If you think The vet might be open to learning more, print and share these 2010 AAHA Feline diabetes Guidleines as well as this link to, or a printout of, the online Merck Veterinary Reference Manual on Diabetes Mellitus

 

Ok I wasnt sure on the low carb as I dont know those foods. Any idea of % calories from carbs?

Even though he was showing symptoms before the steroids, they didnt help and I wouldnt give up yet. Its still early. Plus if you cant find a vet that will give you a good insulin we can certainly work with what you have , it will just need more work.. and testing.. (Sorry to harp on about testing)

He may need insulin for a while to support his pancreas

Wendy

 

I'm not sure if Missy ever said. She was diagnosed with diabetes on 7/14/13 and after getting her on low carb wet (she had been eating all dry food) and 1 shot of insulin came down into normal numbers and was considered OTJ (off the juice) on 8/3/13. We don't consider our cats in remission unless they go for 2 weeks without insulin and the numbers are all within normal ranges for a diet controlled diabetic.

She'd had a shot of cortisone 6 weeks prior to her diagnosis, and after only changing diet and 1 shot, came back down so quickly their vet thinks that the only reason she'd been "diabetic" was because of the cortisone and it had just taken that long to clear her body. The diet change most likely helped a lot too though!!

This may not be what's going on with your kitty at all...it may be a contributing factor though. I just wanted to mention that 3 weeks isn't all that long for cortisone to clear the body...it's effects can last much longer

I'm sorry Bärli's legs don't seem to be doing as well without the cortisone, but diabetes can also cause the neuropathy (as you know). If getting his blood sugars under control doesn't help and Bärli is still having trouble, he may need to go back on it. If he does, then we can help deal with that too.

If you have a primary diagnosis of something else that requires a different approach to the diabetes, that primary diagnosis comes first...the people here will help you the best they can to also get the best results from insulin even if cortisone is required

 

the royal canin wet food was 2.3% starch + 1.3 "sugars" but i don't know in terms of calory. he clearly is on strike for that food since he is on insulin (before he got on insulin he was constantly hungy and eating it greedily) so i am now giving him tuna+shrimp (cat food) . the tuna/shrimp food composition states that it's pure fish with pure fish broth so there should not be any carbs in there. today i will get some canned meat, i have been looking at the composition of canned food and not all of them state how much carohydrates they have. for those that do list it, the most i found was 5 to 7% of total wet matter. when you say carbohydrate levels should be below 10% do you mean wet matter or dry matter?

last night for the first time in many days he has been able to wobble on his back legs which is better than the back legs sliding under him when he tries to walk and he is gaining appetite again (but not like when he was constantly craving for food) and looking more alert. he even visisted a room he had not been in ages and is purring at least a little when i stroke him. he also sits on his favorite cushion, which i laid next to the water bowl (his anchor since he fell sick) under the table, something he had not done for a while. his main position was lying on the side on the floor under the table or in the carboard house i built him. this morning the same trend was kept and he even cleaned himself a little, something i have not seen him doing in ages (i had to remove the clumping litter because of this, the poor sweetie).

this is good to know that the cortisone can take that long to clear off because as you rightly pointed out corticoids interfer with insulin.

a question about the different types of insulins: which of caninsulin or levimir is the one most likely to cause hypoglycemia? is levimir also to be given twice a day? and how long does it take for a cat to go into hypogycemia after an insulin shot depending on the type of insulin?
if there is a hypothetical effect of the corticoids wearing off, we may see a decrease in the BG. if this would be the case would it not be wise to decrease the insulin to avoid hypoglycemia risk?

 

Again, this is where this whole thing is terribly confusing...animal food labels aren't required (in any country I know of anyway) to put the percentage of carbs on their label...that's why we rely so much on the Dr. Pierson food charts (which unfortunately don't do you much good in Switzerland)

Deb posted a list of foods we DO have a good idea that are 10% carb or less available in Germany. Can you get any of them in Switzerland? The 10% we're looking for is a total percentage of carbs "as fed"...or "ask tested"...Guaranteed analysis is pretty useless, but that's all most company's give us.

I just found this...I'm not sure if you've seen it or not or how up to date it is:

_______________________________________________________________________________________________________________________________________

Hopefully you'll be available to find some of those choices or at least get some information on brands so you can check websites and even call manufacturers and see if they'll give you as "As Fed" carb percentage.

ANY insulin can cause hypoglycemia which is why we keep going back to home testing!! The only way you should give any insulin is to first test to see if it's safe to give ANY at all! Canisulin works very quickly to drop BG, but doesn't last a full 12 hours. It's not the best choice for cats since it was developed for dogs. If it's the ONLY thing you can get, there are members here who will do their best to help you with it

Levemir and Lantus are both what's called "depot" insulins...they can also cause hypoglycemia but they work more gradually and gently, but still require home testing to be safe. I'm sorry, but the ONLY way to know for sure what any insulin is doing inside your cat is to test! With Lantus and Levemir, we generally start at a very low dose and keep the same dose for at least 5-7 days (10-14 cycles) and during that time, you're gathering data from home testing to see how your cat reacts.
1. you always test before shooting any insulin
2. get as many tests during the cycle as you can...a "full curve" is every 2 hours for one entire 12hr cycle, and a "mini curve" is at +3, +6 and +9 hours after shot (so if you gave shot at 0700, you'd test every 2 hours until 1900 for a "full curve" and at 1000, 1300, and 1600 for a "mini curve". We suggest doing one curve per week.
3. Even if you can't do THIS much testing, (or on other days of the week) if you can get a +2 or +3, another test sometime between +4 and +8 (during the AM cycle) and a +2 or 3 and then one test before you go to bed at night (during the PM cycle) that data is invaluable in helping to see how your cat reacts to insulin and how to keep him in safe and healing numbers without going into hypoglycemia.

Lantus and levemir are both given at 12 hr intervals, so yes, twice/day...but they need to be as close to 12hrs apart as possible. They work best when tightly controlled

This depends on too many factors to be able to give one set answer. It can take an hour, it can take 10 hours..it can never happen..it can happen so fast it's too late by the time you catch it....it all depends on how your cat reacts to insulin, how much they've eaten, what kind of food, and a myriad of other things (again, home testing is how to keep your kitty safe)

IF the corticoids are pushing his BG up, then yes, it makes sense that as they wear off, there'd be a decrease in the BG...but, since we don't know for 100% sure how much his numbers are effected by the steroids, this isn't something I can comfortably answer. Again, home testing would be the best and fastest way to alert you to ANY changes in BG levels...whether effected by food, steroids or anything else

We know we keep saying the same thing over and over again...Home Test!!, but it really is the BEST way to take the BEST care of your kitty....no matter why his BG readings are high.

I hope I've been helpful.

 

thank you for your detailed answers.

i have not come across most of these brands except for the Bozita which i have used in the past and stopped because Bärli was throwing it up (it looks as if he was not chewing it enough) and my other cat did not like it (she prefers dry food generally except for tuna). cats are like humans, they don't necessarily like health food

Bärli has not had any symptoms of obvious hypoglycemia but in case the insulin starts to be more effective or if we change insulin i want to be prepared.

 

I didn't try looking at all the websites listed in that long list of foods I added, but it may be helpful to do some internet searching for those brands/manufacturers. You may be able to find more choices than just the Bozita that you can get...either locally or shipped from online sellers

Unfortunately, our kitties don't always show us any symptoms, and by the time they do, it CAN be too late to reverse. My own cat, China, dropped to 21 (that's 1.1) without showing any signs or symptoms. I just happened to catch it on a spot check while testing. If I hadn't caught it and brought her back up by giving her a little syrup and high carb food, it's totally possible she may not be with me today.

You should always have a hypo kit in the house in case your cat does show symptoms...I'm just (again) urging you to home test so you can know how your cat reacts and will be better able to keep from having to try to "save her life", instead of "manage her diabetes"

Good luck to you!

 

the thing is, i work all day and long hours and if my cat goes hypoglycemic during that time i won't see it happen. i sometimes can come home for lunch but not always. just wonder how people manage their cat's diabetes while having busy professional lives, i have not seen much of that mentioned so far on internet sites (maybe this forum has a section).

 

We do have quite a few members who have full time busy jobs and still manage, but of course, it's more of a challenge for them.

I think that if their schedule allows it, they get up early enough in the morning to test/shoot/feed, and then get ready for work, do their morning things, and get a +2 before they have to leave. That +2 is an important test since it can give you an idea of how active the cycle is going to be. If the number is about the same as the PS number, it's probably going to be a quiet cycle. If it's much lower, depending on how well they know their own cat, they'll adjust...either leave down some extra LC food, or even give a little MC or HC just to make sure they stay safe during the day while they can't test.

Some are able to run home at lunchtime and grab a mid-cycle test occasionally too. It all depends on each person's schedule and ability to be flexible with it. Not everyone can!

They get as much data as possible during PM cycles as well as weekends when they're not working so they have more confidence in how their cat reacts to the insulin and the food. Some cats are really carb sensitive and a little goes a long way..others can eat more and their numbers can be gently nudged into the safe numbers without bouncing through the roof. ECID!! KNOW THY CAT is especially important

Are you going to go ahead and try home testing? ANY data is better than NO data and will help everyone here help you.

Have you found out if you're going to be able to switch over to Lantus or Levemir?

I can try to get some attention over here to your questions about work, but they're going to want to know if you're going to be home testing, the insulin you'll be using, and all the other things we've been talking about here too (and they're at work, so may not be able to respond until later)

What might be even better is to post a new question, and ask something like "how do working members handle testing?"....but in the body of your message, you need to add the information about testing, insulin, etc (and it's also very helpful to "link" this thread to a new post so others can quickly go back and see what has already been discussed)

 

You deal with it the best you can. In the beginning, it was a bit of a panicky nightmare for me and I was constantly calling my brother at home to "check on Michelangelo" and I was running home at every lunch. The longer we've been at it, the more confident I became in the data I'd gathered and I was no longer too worried that he'd drop low while I was gone. I still get a little overprotective when I'm increasing his dose, so I time increases to days I'm working from home, PMSs, and weekends so I'll be around in case it's too much of an increase.

The more tests you can get in when first starting out, the easier it gets later on because you've gathered enough data. "Okay, his pre-shot is 300. He should be fine while I'm gone till his next shot." "Okay, his pre-shot is 150. I'll need to run home and check him on my lunch." "Okay, his pre-shot is 99. I'm skipping it this morning even though I know he'll most likely be fine simply because I'm not home to monitor."

 

i will not embark on home testing on my own because i don't feel confident enough to interpret this correctly even with your help. depending on how things go with my vet tomorrow about switching to Levemir i will call up the vets in my city to find one with a less sloppy approach to diabetic treatment and take it from there. i have to wait a few days though because not everyone is back from summer vacation here.
i will give you news when i have some, thank you for all your suggestions, this is really nice of you.

 

Is it the blood glucose numbers that you don't feel comfortable enough interpreting? There are a few other options besides home testing that you can use to help you monitor him. Home testing is of course the safest route since you can immediately see what is going on vs. having to guess. It does seem intimidating and overwhelming at first, but it eventually becomes second nature. Take your time and ask as many questions as you need. We've all been in your shoes at one point and can sympathize with what you're going through right now. That's what this board is for: to help each other. :YMHUG:

 

The chart I posted previously on this page gives you the reference numbers when testing with a human glucometer. You might find it helpful to print it out. And print out the hypo protocol linked for the < 40 ml/dL (<70 mg/dl for AlphaTrak)

Also, you can post your spreadsheet for review. Folks will be more than happy to give you feedback

 

this morning Bärli tested 10 on his BG, which is a perfect value and made me look weak when i told him caninsulin is not good for him. he could see that the cat was weak and lethargic and he thought that was not normal with this BG value. he has lost more even more weight, which does not surprise me as he is eating much less since he started insulin and when i mean much less, less than when he was healthy. he is also drinking much less so i was not surprised when the wet thought he is a little dehydrated. the vet will keep him there for the day to rehydrate him, see if he eats and how his BG levels develop during the day (he won't give him insulin). i think that yesterday his BG dropped a lot from the way he was behaving and i was worried he might go hypo. maybe this is why his levels look "normal" today.
i gave him documents showing what the protocol should be to start treating diabetes (testing a whole day with insulin intake at the hospital then home testing) and showing why caninsulin is not good. he said that caninsulin was the only insulin they had experience with here and that at the animal hospital they may have well experience with other kinds as lantus, levimir or prozinc (the last one seems the best but harder to get) but i told him i found on forums that in Switzerland cats were treated by the local vet with levemir for example.
the vet thinks there could be something wrong in addition to diabetic symptoms because he does not understand why he is not feeling better with 10 of BG but my kitty is more lethargic and is eating very little since he is on insulin (drinking is variable, sometimes more, sometimes less) so i think his state is related to the insulin.
the good news was that he does not have ketoacidosis so we are fine on this issue for the moment.
i get my kitty at 5 pm so we'll see what the vet decides but i think that he may suggest that we keep him off insulin for a few days to see if he recovers his appetite.

 

a 10 (our 180 equivalent) is better, but still NOT a normal or healing BG number. Most vets (this seems to be world-wide) seem to think that anywhere between 150-200 is "controlled enough" (8.3-11.1) This thinking does not take into consideration that by home testing, we caregivers can get much more reliable numbers, as well as not getting "inflated" numbers due to stress from being taken to the vet

To get the pancreas to heal (and hopefully start working correctly again), it needs time (sometimes weeks, months or years) at what are REAL normal ranges for diabetic cats. These numbers should be between 50-130 (2.8 to 7.2)

Now since you're using Canisulin, and I have absolutely no experience with using it, the BG numbers are going to swing much quicker than they would on a depot insulin like Lantus/Levemir. Cansulin is a harsher insulin that Lantus or Levemir, so what looks like a decent number at one minute, could actually be the lowest number he's going to....and the rest of the cycle is much higher (or lower).

Since we don't know your schedule, as far as when you feed, test, shoot, that 10 could be a pretty good number to actually GIVE insulin (with the hope to get into those lower numbers where the pancreas can actually heal), or if 10 is a nadir number (where the insulin is working it's BEST), then the other numbers could have been much higher.

As for the appetite, as you do get the BG numbers under better control (you've come down from 27 to 10 {486 to 180}), it's normal for their appetite to go down too...their bodies are more capable of using the calories it's taking in

BUT..if he's also acting like he's not feeling well, you need to be looking for other things that might explain it other than that...like needing a dental, a urinary track infection, kidney issues...all kind of things, so getting a good checkup with blood/urine work up at the vet is probably a good idea.

Some days, they just don't feel so good too....Just like people have days when they're not really sick, just feel kind of yucky/tired/down.

Since you're not giving the cortisone anymore (that I know of), it's also possible that now that it's clearing his body, the BG numbers are falling because of that and due to your change to some of the lower carb foods.

I'd strongly suggest that you start a new topic, with a subject line like "Using Cansulin, Need advice!!" so anyone who HAS used it in the past might be able to advise you better. Put the link to this thread (which will bring all the information already discussed) to the new one so other members will be able to learn what's already going on

 

he was checked for general organ functions when i asked him to check for diabetes and that included kidney. everything was perfect except for the BG.
i will change topic but one last question, is is better to take a cat off insulin slowly i.e. by lowering unit numbers or is it ok to remove in completely (we are talking of a few days to see if appetite comes back)?

 

Aimee

I updated my previous post with the reference numbers to include mmol/L.

 

If a cat needs insulin, then it's better to not take a cat off insulin period. The only logical reason I could see doing this is if maybe the vet is thinking that Bärli is dropping too low on the insulin and the vet suspects that Bärli might not need insulin any longer. Even still, it's usually recommended to decrease the dose first before removing insulin altogether to make sure it's really remission. Otherwise, if you take him off insulin and he "gets his appetite back," all that's really happening is that he's starving again because his body isn't able to process nutrients properly.

 

ok at 9 am Bärli's BG was at 10 (a week ago at the same time, before the increase of 2 to 3U per shot he was at 27), at 10.30 am BG of 7.5 and tonight at 5 pm he was at 5 so vet decided that we should not be giving him insulin for a few days. he considers that it's more important at this stage that he gets his appetite and drink back because he has lost a lot of weight since he is on insulin and is getting more and more dehydrated (and constipated). in fact he was perfused during the day to get rehydrated and tonight he was much more alert.
i will call back on Tuesday to let him know how Bärli is doing and we will measure his BG again at the end of next week and his ketoacidosis if the BG is high again. if his BG goes high up again, we will start properly with a different insulin and a protocol (he said he would call up a collegue who is specialised on diabetes to ask him for advice). he told me again he has been treating diabetic cats like this and has not seen a response like Bärli has (lethargy).

he also did a blood spectrum analysis and there is no sign of infection.

thank you again for all your help. if my cat gets better miraculously i will keep you posted here. otherwise i will create a new thread more centered on insulin treatment to let you know how the story continues.
have all a nice kitty weekend <3

 

Okay, that makes a bit more sense if he's planning on switching insulin (if he even still needs insulin). It's called a "detox."

Are you testing his urine for ketones?

 

Thats good news his bloodwork is ok!

So the vet said he gave a 3 unit dose and then got these results?
9.30am - 10
10.30am - 7.5
5pm- 5

?? where are the mid cycle tests between 10.30am and 5pm? - the insulin would have brought Barli down lower between the 10.30 and 5pm as that insulin would have hit its peak around early afternoon! and that low number is key to knowing whether a dose change is needed. If he went too low, lethargy is expected.

It will be interesting to see how he does without insulin but he might need a dose thats somewhere between zero and 3 units if 2 units is too much but zero isnt enough.

Is he planning to switch insulin or just try different dosing? are you going to try the animal hospital instead?

Wendy

 

yes he was tested yesterday and it was all fine

 

the animal hospital is more than an hour and half away, this is not pratical. i made it clear than we should switch insulin rather than fiddle with the one and he is prepared to ask a collegue for advice so i am not worried about that. for now we need to see if and when his BG goes high again.
the perfusion to rehydrate him was a brilliant idea because since we are back from the vet Bärli has been pooing quite a few times so the constipation was really due to dehydration. my priority right now it to keep Bärli eating and drinking properly again for the next few days. he is not his own self because he is quiet and his back legs aren't good but he does not look drowsy like when he was under the insulin and his gaze is not blurry. we'll measure the BG again either next week or the week after depending on whether i see the pre-insulin symptoms of polyphagy and excessive drinking and a worsening of the neuropathy. what is fundementally lacking is his pre-cortisone BG but since diabetes was not suspected at the time it was not measured.

 

Please urine test for ketones and glucose to keep him safe.

If ketones are present in more than trace levels, [{]it is an emergency[/u].

If glucose is spilling in the urine, the blood glucose hhas exceeded the renal thyreshold and he needs insulin.

Also watch for yellowing of the skin and the whites of the eyes which may happen with fat breakdosn for calories due to insufficient insulin. This is called hepatic lipidosis.

Waiting on any of those puts your cat at risk of severe (as in potentially fatal), expensive, complications from untreated diabetes.

 

i would like to thank you for all your advice. i did take him in the end to the right place for treatment but my Bärli died shortly after, not from ketoacidosis but from severe anemia. i will change vet because he failed to diagnose the diabetes and then the anemia and i don't know if he could have been saved had he been diagnosed in time but he should have referred me to this clinic himself and much earlier (you can only go there if you are referred by a vet).

my advice to anyone who comes to this site with a diabetic cat: don't try and figure out the treatment by yourself but find ASAP a clinic where they will do it right: a full check-up on the cat to exclude additional sources of disease which might hamper the treatment for diabetes (this was the case for Bärli and explains why the insulin treatment did not work) and following a protocol where the cat is tested for the right dose of the right insulin with full curves and you get to be taught how you to do home testing during the stabilization phase.

yes my cat was old and was maybe too ill to survive but he was also seen by the wrong person and i have learnt my lesson. i never had any illness with any of my cats so i just saw the vet for vaccinations and now i know he is not competent.

thank you again and long live your diabetic cats

 

Oh Aimee,

This is so sad. I am so sorry. My heart goes out to you.

Bärli was so lucky to have such a caring Mum throughout his life.

Juliet

 

Requiem aeternum, Bärli.

{{hugs}}

 

Lighting a ring of candles in memory of your sweet Barli.

 

So sorry to hear this news about your sweet Bärli

I know you tried your best to help, but with the restrictions put on you by your veterinary system, you didn't get the help you needed soon enough. We all wish there was something we could have done to help more.

Fly free sweet Bärli ...there are lots of kitties at the Rainbow Bridge to greet you rb_icon wings_cat