Hello from Margaret and Mackenzie

Discussion in 'Welcome to the Group - Post an Introduction Here' started by plaidabby, May 14, 2016.

  1. plaidabby

    plaidabby New Member

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    May 13, 2016
    Mackenzie is 3 1/2 year old blond kitty. He was diagnosed in Jan 2016 with diabetes. Mackie has been in and out of our emergency/medical clinics in NM over the last 4 months with Insulin resistant diabetes with ketoacidosis as a complication. He is now on Levimir 20 units 2 X dailey plus 5 u of humulin R. Our internal med vets have been working on getting him stabilized but it hasn't happened so far. This is his 3rd insulin. I am not concerned with diabetes as much as the fact that randomly his BG will drop and he gets ketoacidosis almost immediately and ends up in the hospital on IV's. Has anyone out there had this kind of problem?
     
  2. Sharon14

    Sharon14 Well-Known Member

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  3. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    I'm puzzled when you say
    When "drop" what do you mean? Get into lower numbers? Because treating DKA is partially done by getting the cat's blood sugar as much into normal range as possible.

    Here's is some info on DKA: Graphic and three threads where ketones are discussed, plus a discussion of using blood ketone meters.


    What are you using to test for ketones?

    Are you hometesting his blood sugar?

    The "recipe" for DKA includes "not enough insulin + not enough food + infection/systemic inflammation." Has he been identified or treated for any kind of infection?
     
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  4. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Here is some more info on DKA - some of it overlaps the links I just gave you.

    Here is some info on acromegaly and insulin autoantibodies - it's been kept up to date with the latest research that we've seen.

    We have a lot of experience with high dose cats, Margaret. It's good to know what the cause of the insulin resistance is. We encourage people to get their cats tested (blood draw by your vet, blood mailed to Michigan State University). Links for the testing are in the last link above on acro and iaa. We encourage people to get both tests done because we see both conditions - sometimes only one or the other, but it's not uncommon to see both.

    Can you get a spreadsheet going so we can see whatever info you can get into it? The spreadsheet is an essential tool for us. There are directions here on the "Basics: New to the Group?" yellow boxed sticky that is located in the Lantus/Levemir Insulin Support Group.

    Usually people get started on Main Health, learning to test and getting a spreadsheet going, and then move to the support group for their particular insulin. You'll find the most experienced people in the use of Levemir (which is an excellent choice for Mackenzie's situation) in the Lantus/Lev ISG. I think you need to be posting over there as soon as possible. The high dose group has been inactive since about 2011, so cats with high dose conditions have remained in the Lantus/Lev group. There are many. There are also a lot of people with experience with DKA in that group.
     
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  5. plaidabby

    plaidabby New Member

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    May 13, 2016
    I hope I am replying to the correct location as this is getting confusing
     
  6. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    Yes it's a bit confusing at first, but you'll catch on! It sounds like you've gotten great care for Mackie. I've never dealt with DKA, so don't know much about it. He's so young to have had so many problems. I hope you can get to the bottom if it soon. Does Mackie have a good appetite?
     
  7. plaidabby

    plaidabby New Member

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    May 13, 2016
    Okay finally a reply box. It didn't show up at first. I mistakingly wrote that when his BG drop when actually I did mean that they go up. I am using a Abbot meter that is for Ketones as well as BG. Seems to work well. Can't use the strips for Ketones since we have 3 kitties and 3 litter boxes. He is on Hills md dry, Royal Canin moist and dry and Purina propane dm moist. Right now he likes the RC dry and Purina moist. No infections have been seen for a couple of months since first major incident when it was pancreatitis and bladder along with the DKA. We have been keeping a log book of everything since we started which goes with him to vet visits and hospital stays (we live in Los Alamos and 24/7 hospital is 90 miles away in Abq.) I think the spread sheet is a great idea and will be looking at starting that too.
     
  8. plaidabby

    plaidabby New Member

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  9. plaidabby

    plaidabby New Member

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    May 13, 2016
    He is young and was really healthy which is why we are all surprised by this. We also have his litter brother who thankfully hasn't got this problem. When he feeling good (as in no DKA he eats like a horse) but right now he is down 4 lbs. I hope we can get to the bottom of this soon too as it is so hard to have him so far away (plus the costs are like buying a small car)
     
  10. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    Welcome to FDMB.
    Some things you can monitor, in addition to blood glucose, are in my signature link Secondary Monitoring Tools. Dehydration checks, and monitoring food and water intake and output, as best you can with multiple cats, may help alert you when he isn't doing well.
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Hello Margaret and Mackenzie. Sounds like you've both been through a lot. :bighug: IAA (which Neko also has) is insulin auto antibodies - think of it like an allergy to the injected insulin. The antibodies grab onto the injected insulin, leaving less for the blood stream. Could you tell me what his acromegaly blood work (IGF-1) score is? We've seen a number that were lowish but still acrocats. And usually a CT scan is attempted first, before MRI, to detect the pituitary tumor.

    We have another member in Los Alamos @rhiannon and shadow (GA) .

    I see Maceknzie is on dry food. That is part of the problem. Diabetic cats do best on low carb wet or raw food. It does not have to be veterinary food, and in fact there is a lot of better quality food available on the pet food store shelves.

    I look forward to seeing your spreadsheet. That's a great tool that can help us help you and Mackenzie to get to a good dose where he is in better blood sugar numbers.

    And I can relate to the costs of a small car. I've taken Neko to Colorado State University for treatment for her acromegaly twice, and my vet jokes I could have bought a car with that. Of course, it wouldn't purr and cuddle like Neko does. :kiss:
     
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  12. Sharon14

    Sharon14 Well-Known Member

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    Both the dry foods you are feeding are high in carbs and not really good for diabetic cats. Have you tried putting him on a strictly canned food diet? I'm sure that won't solve all your problems, but it is much better for him and may help lower his numbers some.
     
  13. plaidabby

    plaidabby New Member

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    May 13, 2016
    Hi Wendy &Neko, I don't know the number for the IGF-1 but I will get it from his doctor to add to the spread sheet and I will ask about the IAA too. I think that the endrocrinologist in ABQ suggested it. He didn't do well on the anaestiasia for the MRI and I didn't know you could do a cat scan for that. He really likes the purina pro food and we have a place here in town that sells " holistic" cat food that is low carb and high protein which I also use. I also need to find out what insulins he has been on, for how long and how much too. What I really want is for him to be able to come home stabile where we can monitor his BG and Ketones, Give him love, his injections, food and water and not have the ups and downs we have been having. If he has Acro or hyperthyroidism or Cushings or just won't work on regular insulins levels, will we able be able to have him at home, are there solutions to any of the above diseases, medicines he can take (in addition to the insulin).
     
  14. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    For treatments it varies depending on the secondary condition, but usually the best thing you can do for them is get them to an insulin dose where they spend most of their time under renal threshold. We've had people with all the above conditions treat their cat's insulin needs at home.
     
  15. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    Hi Margaret,
    sorry to be late.... I wasn't online yesterday much.
    I'm so glad you found us.... I'm here in Los Alamos. I am guessing your vet is Ridgeview.
    I used the other vet and taught them a lot about FD. I think Ridgeview is the better vet for an FD cat.

    Wendy and the others are better at advising you for acrocat , special conditions....so keep posting.
    But I can certainly help you with the food lists and daily management.

    I am sending you my phone number in a private message ...
    I live over behind the golf course near Arizona and Woodland.
     
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  16. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Was the IGF-1 test sent to Michigan State? I believe they are the only lab in N. America that does that particular test. If it went elsewhere, it may have been a different test. If the IGF-1 test from Michigan State for acro was less than 92, then it's considered negative. I don't think that hyperthyroid alone would account for this dose. It can raise the dose, but I haven't seen a cat over 6u per shot that wasn't either acro (most commonly seen here on FDMB), iaa (probably next most commonly seen) or Cushing's (least common.)

    The dry food would cause a need for a higher dose, but if you change to the low carb canned, you need to do it gradually over several days to a week while you are hometesting. That change will reduce the amount of insulin Mackenzie will need.

    The iaa test would be the most important step for you to take next, in my opinion. We've had iaa tests return as high as over 80%. It's normal for a diabetic cat to have some level of iaa because injecting insulin in the body is putting a foreign object there. Cats can develop some autobodies to it. Punkin's level was 7%, which is negative. Under 20% is considered normal.

    In the lower part of the "Basics: New to the Group?" sticky that I linked above is also another link with info on high dose conditions:
    • 2014 ~ 39th Congress of the World Small Animal Veterinary Association (WSAVA)
      • Which Insulin in Cats - p 156
      • Management and Monitoring of the Diabetic Cat - p 160
      • Feline Diabetes - p 229
      • Diabetes Mellitus and Quality of Life - p 730
      • Acromegaly in Cats – p 733
      • Insulin Resistance – p 737 (description of mechanisms of resistance on p 738 under heading Pet)
      • Medical and Nutritional Management of Diabetes Mellitus – p 739 (description on p 741 of glucose toxicity and lipotoxicity)

    Thanks for answering the onslaught of questions. The spreadsheet will help us as well as the dates/doses on the different insulins that you've tried so far. Any test data will be helpful, including blood sugar tests, endocrine tests like the acro or MRI results - just put things like that in the comments cell of the appropriate date.

    By the way, you don't necessarily have to quote to respond. Lots of people do, but you can also just answer all the questions in the reply box and sometimes that's easier to do. It's up to you.
     
  17. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    I heard from Margaret ....

    I want to ask @julie & punkin (ga) @Wendy&Neko

    Margaret said
    and

    I am wondering out loud...
    isn't that a lot of R ...dosagewise...

    couldn't that be why he's having these fluctuations....

    and I will nudge her to get the ss started....
    i know you all need that dearly to help Mackie do better....

    I would think she may also need to learn to do squids herself.... and I can help her learn that... from Marje's video.
     
  18. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    I feel very unqualified to comment on the size of the dose for both the Levemir and the R. We don't have enough information about how he got to these doses or if he has a high dose condition. If he's currently in the vet's hospital, which I thought he was, I'd assume the vets are on top of things.

    When a cat has DKA, that is an indicator that it isn't getting enough insulin, so it could very well be that he needs more. I can't see that we know enough to suggest anything about his dose at this point.
     
  19. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    i know he needs more insulin....
    no talk of less from me....

    i just called her... no answer so I left a message....

    I know we really need to see a ss.....
     
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  20. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I've been watching this thread out of interest as I have a high dose cat with IAA. Just curious @rhiannon and shadow (GA) , you have quoted Margaret indicating Mackenzie was getting 14u of Lev 2X daily and 4u R 1X daily and then she says the Lev has been raised to "21u as of last night". Do you know if she means a 7u increase of Levemir all at once?
     
  21. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    he is at the vet's...
    and apparently they did that....

    i guess they are working it to get an actual response from the insulin?
    but i don't know....

    the quote was from her describing to me what has been going on...
    i'll post the whole thing....
    something might be clearer from writing it all a second time.... or mentioned that wasn't before....

    except for her address and phone...
     
  22. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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  23. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    i will....
    especially on dosing....

    i can be of most help with learning how to manage it on her own...after they get some normalcy. ( whatever that's going to be)
    and foods... and fluids... and testing...
    and support...

    she's going to need those experienced eyes....
     
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Thanks @rhiannon and shadow (GA) . This poor little guy and Margaret are really having a hard time. I certainly hope they get some answers soon.
     
  25. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    I can't speak for Libby because she has some other things going on right now, but I'm willing to help out. I'm not sure much can be done until we can see some dosing history in a spreadsheet and have replies to the specific questions Wendy asked about acromegaly/tests for high dose conditions.
    I agree with Julie.
    I'm extremely hesitant to suggest anything about dose at this point because we just don't know enough to make any determinations or come to any conclusions... yet.
    Exactly. A spreadsheet will be a big help. :)



    Edited to add: It would be best to start a new thread on Feline Health - (The Main Forum). You'll get more eyes on your thread if you post over there.






     
    Last edited: May 15, 2016
  26. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    i spoke with Margaret a few minutes ago...
    she is on her way to Albuquerque to visit Mackie....

    so she and i will talk tomorrow as she says she will be home late....
    i'll be encouraging her for that ss...

    wanted everyone to know she's just otherwise engaged today....
     
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  27. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    Hi Margaret. Just stopping by to see how things are going.
    Hope Mackenzie is showing signs of improvement. :)
     
  28. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    i spoke with Margaret today....
    Mackie was good and happy to see her.... doing fine at the vets....still in Albuquerque.

    don't remember if her long intro spoke about him having a bladder infection but they've treated that and think it's gone.

    She is really really really ( did I say Really) busy this weekend...
    got a dance recital... sewing costumes... and about to go on a trip and I can't remember it all...

    Mackie will be staying with the vet while they are gone just to be safe.

    She does intend to get here and share more info... answer questions...
    she's just so darn busy for the next few days...
    and all her charts are at the vet with Mackie so she couldn't fill in a ss right now if she could stand still.
     
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  29. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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  30. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    I have not....
    i'll text her today and see. She said something about a trip so she may be gone.
     
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  31. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    here's what Margaret texted me.....
    " We leave Monday am (5/30) Fort Lauderdale then on to abaco next am. We miss the connections to abacos no matter which airline, bummer. Went down to visit Mackie on monday, have some cuddles and love, grooming and playtime altho' he was ready to nap which he did on my lap.
    Saw Dr. Hale his doctor there. She said he is up to 28 units of levemir so going up by 1 unit every other day.
    Bg just won't regulate and staying there, but he is off iv's and subc fluids, no ketones, eating well, complaining to them when he wants food/attention.... gained some weight back. He is a medical fragile boarder there for next 2 weeks at $60 /day instead of $300! His doctors both internal med docs are going to a big international conference in Denver next week ( 4 days) . Both have all of Mackies stats, bg graphs, test results hoping one of these endocrinologists has some other ideas or suggestions. I am interested in the lady who teaches at u of Queensland in Australia. The papers she has written are dealing with cats with difficult to treat diabetes.
    Well, that sure is Macster Caterer ( another nickname)
    Here is a photo of our baby.
    [​IMG]
    [​IMG]
    [​IMG]

    [​IMG]
     
  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Thanks for the update Rhiannon. Glad to hear Mackie is ok and improving somewhat (no ketones, no subq flds etc.) When you "talk" to Margaret, tell her thanks for the pics. He is a very handsome little guy. Hope they can get him sorted out. He's such a young cat!
     
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