HCM with new Diabetes

Discussion in 'Feline Health - (The Main Forum)' started by Teresa & Cricket, Nov 10, 2018.

  1. Teresa & Cricket

    Teresa & Cricket New Member

    Joined:
    Nov 5, 2018
    Hi everyone,
    I'm new here and new to my Cricket Cakes having diabetes.

    Specifically looking for anyone who has experience with a cat friend who has/had both diabetes and Hypertrophic Cardiomyopathy with Congestive Heart Failure.
    She went into CHF back in February, with no previous signs of HCM. It was a shock, but she stabilized within a month on her diuretics and has no signs of clotting. She's doing very good on the heart side for someone in CHF.

    Hyperglycemia showed up 1 month ago.

    We've been having a hard time getting her BSL down (I didn't know about 1/2 and 1/4 slow increases yet, vet increased 1U per week)
    I did some looking and saw references to Furosemide (Lasix), her diuretic, potentially interfering with insulin.

    Has anyone here had this experience in real life?

    Out of concern, I altered the timing of her diuretic over the past few days.
    I used to give it 2-4 hours after food mixed in a tblsp of TikiCat mousse (no carbs) which also meant 2-4 hrs after insulin.
    I'm now giving it to her either 10 min before food or within 1 hour of eating and taking insulin. Hoping it will help.
    Vet says if it doesn't help, he wants to raise insulin more.

    Bright side: today I got my first <300 reading at her afternoon nadir: 285.

    Anyway, if anyone has knowledge about diabetic cats concurrently on diuretics, I would love to hear what you have to say.
    Thank you!
    Teresa
     
  2. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

    Joined:
    Jan 19, 2018
    My cat was on lasix and Lantus and I did not notice significant changes in his sugars due to it.

    Although loop diuretics may theoretically cause sugars to go up a little, human patients are on both all the time and i haven’t heard of it making a significant difference (I’m a PA). Either way, lasix is a very important medication for heart failure, so if insulin requirements are slightly higher, it’s better to just adjust insulin and continue the diuretic. So I wouldn’t worry about it too much and would give both medicine at whatever time is more convenient for you and your schedule.

    Hope this helps. ❤️
     
  3. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
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  4. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Neko only had a very tiny dose of Lasix, because she also had stage 3-4 kidney disease at the time. It was a balance between the two conditions. I didn't notice any difference with her blood sugars. I think @Doodles & Karen however, did notice an impact with one form of Lasix.

    As Ana said, if there is a medicine that raises the blood sugar, and it's an essential medicine, we just raise the insulin dose to compensate.
     
  5. Teresa & Cricket

    Teresa & Cricket New Member

    Joined:
    Nov 5, 2018
    Thanks Wendy and Ana,
    (I haven't figured out how to tag yet)

    I know not to discontinue the Lasix--it is literally keeping her breathing and alive and I'm so grateful for it.
    Sounds like it might affect some, but not all... which is what the various warnings I saw alluded to.
    xo
     
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  6. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    @Teresa & Cricket My previous kitty was diabetic, hcm, chf. And had a heart attack some time in the previous 3 months before the hcm was diagnosed. He had an ultrasound for pancreatitis and an extremely enlarged heart was noted which lead to doing an echo.

    He was on lasix liquid 5 mg every 12 hrs. Also benazepril/spironolactone/Pimobendan compounded suspension every 12 hrs. And aspirin liquid on Mondays and Thursday.

    I gave the lasix at the same the insulin was given and the other meds 1 hr later. The aspirin I gave much later in the day.

    I did not notice any spike in glucose.

    At his 3 month echo follow up. Cardiologist was super surprised how much Smokey improved. The fluid had resolved, his heart was back to normal size, no murmur and pulses normal.I

    Hope Cricket is feeling better soon.
     
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  7. Teresa & Cricket

    Teresa & Cricket New Member

    Joined:
    Nov 5, 2018
    @Olive & Paula Wow, his heart went back to normal?! That is impressive.
    Sadly, I doubt that'll happen with Cricket. I was basically told" "The diuretics will work, until they don't"
    I was happy to see her finally dip below 300 today, not sure if changing the timing to the same as insulin/meals helps or not.
    I've had to change the time of the clopidegrel (Plavix) though, because it upsets her tummy to take with Lasix... but also she needs it with food. Luckily I give her a small meal before bed- she still has increased appetite.

    If it doesn't keep going down, I will start increasing her dose as my vet suggested, but likely slower now.
     
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  8. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015

    His heart size went back to normal and the fluid was gone. He still had the wall thickness and left side defect. A thrombosis took him despite the aspirin.
     
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  9. Doodles & Karen

    Doodles & Karen Well-Known Member

    Joined:
    Jun 2, 2015
    Unfortunately this was true for my Doodles but we did manage the HCM/ CHF for about a year. He was diabetic before the HCM/ CHF dx. In the beginning we used the injectable form of Lasix which did absolutely raise his sugar levels but he also had another condition called IAA which was insulin resistance. Doodles Lasix dose grew to 30mg twice a day and sometimes 3 times a day hitting 90mg Lasik a day. There can be a moderate interaction with Lasix and insulin like Lantus/ Levemir that could contribute to hyperglycemia. Heart conditions alone can cause a bit of insulin resistance. We just have to follow their numbers and the protocol here and do the best we can to get them into good BG ranges. It can take time for any newly diabetic without other health issues.

    I will mention that it's essential to start testing before every shot and a mid cycle test at the very least. It could be that Cricket is actually on too high of an insulin dose causing high numbers or dropping to low sometime in the cycle. Please read the stickies at the top of the page and continue to ask as many questions....people here are very willing to help and we were all new at one time.
     
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  10. Teresa & Cricket

    Teresa & Cricket New Member

    Joined:
    Nov 5, 2018
    Thanks for your input.
    I keep hearing this info about higher insulin causing the numbers to be high, but how do you know which is which?
    The lowest mid-cycle number I have seen is 284 (I haven't checked in the middle of the night yet tho)
    I'm currently low on test strips, so the intensive testing will have to wait a bit.


    Is there a thread that already discusses this?
     
  11. Ana & Frosty (GA)

    Ana & Frosty (GA) Member

    Joined:
    Jan 19, 2018
    Once you replenish your strips, I suggest doing a glucose curve - where you check your kitty’s sugar every 2 hours for a 12 hour span - from time of am shot to time of pm shot. The lowest number in the cycle is usually around 6 hours after a shot, but can be any time, so a 12 hour curve will help you catch the lowest number. Depending on what protocol you decide to follow (there are 2 different ounces in the stickies section), it recommends doing a curve either once per week or more frequently.

    Take a look at that section to see which protocol would work better for you. :)
     

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