Disco Update 11/6 (and this group is such a comfort!)

It's Wednesday 11/6 and Disco's 4th dose of Vetsulin at 1.5U. Thanks to members for helping me through his lowest reading of 110, which wasn't an emergency after all, but sure made me realize how much I now depend on guidance (and how fast a response I got, too!). I let his vet know of the value of FelineDiabetes.com and the forums (in case she didn't know about you), especially as she was out of the office for a few days and how much I am learning from your info and 'handouts'

I sent his SS to his vet on Monday and this was her reply:
The ReliOn monitor is ok to use. I completely understand wanting a more cost effective means of measuring Disco's glucose. It should work ok, as long as we consistently use that monitor for his trends. That way we do not have to worry about variation due to the type of glucometer.

His Saturday readings were great, with a low of 158; However, the remainder of the readings were still variable. I would agree most of his values are still higher than desirable. He also appears symptomatic (PU/PD/PP and ++ Glucosuria).

You are doing an amazing job. Diabetes is a difficult condition to understand all the ins/outs and to get patients regulated. At this point, we do not want to alter his food due to his IBD. We also have to keep in mind he is on steroids and those can make regulation more difficult.

Lets go ahead and increase his insulin to 1.5 units BID (if you can measure that reliably on the syringes).
Monitor him through the week. If his values still stay high, we will either need to increase to 2 units BID or change insulin type. We should see a response within 2-3 days after increasing his insulin. At this time, he does not have ketones and he is still doing well otherwise, so I do not worry about development of DKA.

It can be frustrating, but again you are doing an amazing job! I would not be concerned that some values are higher than his initial glucose level (on his biochem) as this was only a spot check and there could have been variability. For now we will monitor him on 1.5 units BID and then adjust from there (i.e. increase insulin or change type), but I think we are getting closer!

I am not sure when I should just start using the ReliOn 'full-time' and just use the AlphaTRAK2 when I'm getting a concerning result and since I think we'll eventually change over to Lantus. I'm still doing both I guess for my own education. I've been following the Lantus group, too so I can try and learn in advance, and hope that when I finally can move into my new home with the cats (hopefully by Dec 1st at the latest) that I can get a routine down without interruption (it's hard living with my 89 year old mom and her constant questions, needs and negativity, but am grateful I had a place to land when I moved and all my stuff is here so didn't have to get a storage unit). Disco had his labs done in June right before I left Virginia and I wonder if the stress of the move brought on his Diabetes, although the cats are very used to traveling with me and as long as their blankie, heated wool beds and bonita flakes are with them, they are happy and have seemed to settle in at my mom's since I arrived Sept 1st. I think his diabetes might be related to his IBD and damaged pancreas though and know there are a number of members with cats that have both diseases also and wondered if their vets ever brought up a possible connection.

 

Oh my god that pic of him is too adorable

 

Hi Teri, my name is Chloe and I'm new to the board here too. My cat Oscar was just diagnosed on Oct 24th. I just wanted to respond because your last point about the IBD/Diabetes connection really intrigued me. I too have noticed quite a few other IBD affected cats on here during the short time I've been on this board. Oscar has IBD as well, and his diabetic symptoms appeared very shortly after a bad bout that arose from us switching his food. By the time we switched his food back and realized our mistake, he was losing weight and other symptoms started appearing. For a little while we had assumed that his symptoms were due to the food change/his IBD, and that he would bounce back like he usually did. But they just kept persisting and the less usual symptoms of excessive urination and thirst is what got us to bring him in. That's when we got his diabetes dx. It was just so coincidental that even my vet considered that this may shortly resolve. Well, we've had no luck with that so far at least and it appears the diabetes is here to stay, but I think you're on to something here. It was just way too coincidental. Anyways, just my totally anecdotal input.

 

Hi Chloe, Thanks for taking the time to reply to my thoughts! Is Oscar on any meds for his IBD? (not noted in his 'signature' so I'm assuming not). Disco when initially diagnosed in 2012 was on prednisolone but quickly had high BG numbers so we switched him to budesonide which is only 'easier' on their 'systems' and he did fine on that. Starting in about Jan 2016, I weaned him off all meds as he was symptom free on a raw diet which I began in 2014 I think. Before diagnosis, he had 'paint-the-walls' diarrrhea, no vomiting or weight loss.

As I knew I would be retiring in 2019, in Dec 2018 I had an abdominal ultrasound done (his first 'specialist one--the one done before his exploratory/biopsies was done where I worked with a new machine and inexperienced doctor) just so I knew if anything bad was inside like lymphoma etc. His labs were normal then. The ultrasound showed more thickening than my other cats who is still on low-dose budesonide, so we decided to put him back on meds and repeated his labs in June 2019 and again normal, so I started him back on budesonide around the time I moved (August) and when I took him to the new vet here in Oct, that's when the dx of Diabetes was confirmed. So this time, it may have been the steroid that pushed him over the edge.

I need to talk with his vet again about taking him off it and seeing if that makes a difference as after 2 weeks he is still not regulated. He is only on budesonide 3 x a week, so a pretty low dose though. It's a tough spot to be in as the chronic inflammation of IBD can turn into lymphoma, but as his outward symptoms were normal (only the ultrasound confirmed that despite that, he still had intestinal changes).

It might be nice to have a IBD/Diabetes kitty support group here, like there is for insulin type etc, to toss ideas and experiences around. IBD is such a varied symptom disease, my personal opinion is that depending on the type and where it's located, the symptoms vary a lot. My three cats all have IBD, two confirmed with biopsies (lymphocytic plasmacytic IBD) and one treated empirically--just on symptoms (his was vomiting and weight loss). Coco's symptoms were vomiting and repeated pancreatitis flares, and Disco's were diarrhea and pancreatitis flares. Many people are reluctant to do exploratories and biopsies (the gold standard) and opt for endoscopy as it's less invasive and less expensive, but the 'pinch' biopsies of an endoscopy can miss the area where the inflammation is. And some just opt to treat on symptoms without any diagnostics other than just lab work (TLI/PLI/Cobalamin/Folate). And it's surprising to me how many vets don't run that GI Profile for any tummy issue cat with symptoms of frequent vomiting/frequent hairballs.

 

Take a look at @MrWorfMen's Mom spreadsheet for 2015. She tested the AlphaTrak against a FreeStyle Lite meter, starting in July. The FreeStyle Lite numbers are in the remarks column. For US numbers, multiply x 18. Comparing the two meters is like comparing apples tohttps://docs.google.com/spreadsheets/d/1XffvXPEkvvIYkoRyykvnR51nJwaObZDkJ9FLzEmdSwc/pubhtml#

Feline diabetes is a marathon, not a sprint. I'm hoping you start to see better regulation when/if you move to Lantus. Also, if you could get a few PM tests in, it will help fill in the pattern. If you get up in the night to use the facilities, take a test.

 

Thanks for reminding me of that and putting this in perspective!

 

I tend to think you will drive yourself a but nutty if you try to use two different meters. Your vet's point about sticking with one meter in order to avoid the variability between different meters is well taken.

 

I will get a few PM tests in over the weekend, did 2 last night, updated SS. I have about 5 AlphaTRAK strips left in the current container, so will stop using it when I run out and save the unopened tube to put in his emergency kit.

Here's a cute pix of Disco warming his front paw pad this morning.

 

Ah, I see, our situations are actually quite different. Oscar was diagnosed much more casually, I actually had to call around for a vet to even really seem interested in looking at him when I explained the IBD symptoms he was having (which were apparent from when he was about 4 years old, he's 11 now). They all made it seem like it was an unnecessary thing to bring him in for, and that further testing would be very expensive. At the time I was only about 18 and couldn't afford the types of things they were talking about, and they made it seem like I was silly for investigating this. I let the symptoms go on for about 6 months longer until I couldn't bear watching him in pain anymore (he had awful liquid diarrhea, and had a certain cry he would get when his stomach hurt, and he would roll over onto his back and go between me wanting to rub his belly, and him biting me because he was in pain). Still as I said, the eventual dx was very casual, this vet took it seriously (or so I thought at the time) but was nonetheless diagnosed based off his physical symptoms only. He was put on Prednisolone at that time and we changed his diet to grain free only, and not knowing any better, took wet food out of the equation.

He got better so quickly it was insane. I'm talking within a couple days his feces were solid and he was no longer going outside the litterbox (which was a huge problem beforehand....diarrhea everywhere), his painful meows were gone. His energy though went way down, and he was gaining a lot of weight and when that started happening he came off the prednisolone. But his symptoms didn't come back, it seemed as though the grain free food is what he actually needed. Anyways around 6 months prior to diagnosis we brought him back into a vet because our last one lost his records and we needed the appropriate records to move into a new condo. We decided to update him on his vaccinations, microchip him as its something we never had done, and we did a blood test while we were there because why not? We were also given a speech about how awful grain free food is for cats, how it's completely a marketing strategy and we should switch him to something else asap. I tried to explain why I thought Oscar was likely a rare exception to this rule, but they weren't having it. I left feeling like I was an idiot for keeping him on grain free, and changed his diet. By the way, his blood results were fine. We switched his dry food back to grain, and he immediately had symptoms again so we put him back on grain free and things were better within a few days again, and started him on grain wet food instead which weirdly didn't bother his IBD. But in these next six months we slowly progressed down the road of increased thirst, increased urination, weight loss etc. We brought him to a different vet thinking our last was wrong and it was just the food change, but he was then diagnosed with diabetes.

It just felt really coincidental to both myself and the vet that this happened after an abrupt food change, but maybe it is just that, a coincidence. He is a senior male orange tabby after all, and they seem to have a high risk for diabetes. He was also overweight for a couple years. It's been a couple weeks now and he's doing well with his IBD but no sign of the diabetes going away.

Your situation seems to be very likely that it was steroid induced for Disco. Oscar hasn't been on steroids in 7 years so that isn't the case for him, but I still can't help but wonder if there is some type of link there. I've definitely been considering getting him properly evaluated for his IBD now that all of this is going on, and I'm also keen to find out if this is actually IBD or rather just a food/grain intolerance. Anyways sorry for the long reply lol, I haven't really gotten any of these thoughts out prior to right now haha. I do think an IBD support group would be super helpful, it seems to be prevalent around here and I think even just anecdotal experiences would be helpful to read.