Help!! Hyperglycemic Hyperosmolar syndrome

My kitty (Tessa) has been struggling for years with uncontrolled diabetes, and she was just diagnosed with hyperglycemic hyperosmolar syndrome a few days ago. She has been very unsteady and weak in her legs, and is now peeing on pee pads, and when pooping she usually Falls around in the litter box... It is just heartbreaking to watch. I am giving her 100 mls of Sub-Q fluids daily, and she has been on 5 units of Lantus BID for more than a week. I had to have a kitty sitter come over on Friday night to give her her shot, and had her check her BG at that time... Her BG came in at 11.3 so we opted to only give her two units of Lantus that night. When I got home the next morning I realized that the kitty sitter had used the incorrect code on the alphatrak meter, so her BG was probably more in the 16 range. I opted to give her 2.5 units that morning, and did a curve on her throughout the day, with her lowest being 14.9 and her highest 22.4 in the evening, so I gave her 4 units in the evening. This morning she was at 25.2, so I bumped her up to 5 units, as I am now thinking that I shouldn't have reduced her when the kitty sitter was over, as she has had constantly high BGs (20s-30s) until putting her on the five units for the past week, and seeing her lower BGs from the curve I just did yesterday... But she is still awfully weak, and staggers around. I have an appointment tomorrow with the vet, and may consider euthanasia if the vet thinks that there is no hope for quality of life and her gaining back her strength and litter box continence. I suspect that she may have Cushing's Disease, but she has not been checked for that yet... She was tested for acromegaly a couple of years ago, and she was on the high side of normal, but the vet also wonders if that may have been early signs of acromegaly, as well. Any suggestions would be greatly appreciated.

 

I’m sorry Tessa is having such a hard time. I don’t know anything about that condition, but we have several members that have knowledge about Acro and Cushing. What was the number in the acro test? What makes you suspect Cushings? Have you had her potassium levels checked? Also, sometimes the addition of a methyl B12 supplement, such as Zobaline, can help. Do you have a copy of her latest bloodwork?

 

She gets a B12 shot monthly, and I do not have her most recent blood work, but the acromegaly test was a few points off of what would be considered as acromegalic... But that test was also shipped down to the US from Canada, so it could have degredated by the time it got down there, the vet thought. Her potassium was checked, and I believe it was within normal range, but all of the other blood work was off-kilter, which initially made the vet think she was in stage 4 kidney failure, until he checked her urine and found that she was hyperosmolar... she also now has a heart murmur, when she didn't the last time she was in. From what I have researched, she has pretty much all of the markers for Cushing's, including fragile skin and little lesions, weakness, etc. When she walks it is like she is a deer on ice, and her front paw will fold over like she can't feel it.

 

Do you plan to test for cushings? I believe there is a treatment option, I’ll tag @Ana & Frosty (GA) who can tell you more about that. I’ll also tag @Wendy&Neko who may know something about Tessa’s conditions.

 

Thank you... I was thinking to test for Cushing's, but at this stage, I really don't know whether anything can be done for her... She is just so far gone at this point, that I was going to see what the vet says tomorrow when I take her in.

 

Well good luck tomorrow, I’ll keep you both in my prayers for a good report. Hopefully Ana and Wendy will get the tags and may have some info for you to discuss with your vet.

 

Thank you

 

Sorry, don’t know about HHS, but it sounds like fluids are key in treatment. I have heard from IM vets knowledgeable in acromegaly that if your cat’s IGF-1 is close to the edge, they should be retested in three months and could be positive then. Walking gingerly can also be a sign of acromegaly induced arthritis. Kidney and heart conditions are also common in acros, my girl had both.

Good luck with the appointment tomorrow.

If the vet can resolve the HHS, post her again and we’ll see if we can help your kitty get in better blood glucose numbers. We dose Lantus based on the nadir or low points, not the preshot values. In addition, Levemir is often a better choice of insulin for higher dose cats, as the acid base of Lantus can sting at higher doses.

 

Thank you... fingers crossed that the vet can help. Will update tomorrow.

 

Hi Tanya, I am so sorry to hear your kitty isn’t doing well. My kitty had Cushing’s and he did really well on a medication called Vetoryl. He had poor coat condition and skin tears down to his muscle, and very poorly controlled blood sugar. On Vetoryl, his wounds healed, coat and skin condition improved, blood sugar became better controlled, and he was finally able to walk more than 2 steps.

Since my kitty was a stray and adopted as an 8-10 year old, we dont know how long he had Cushing’s and diabetes, and unfortunately he also had other medical problems and passed away earlier this year. However, I do believe if he had been treated earlier, he could have lived longer (most, if not all of his issues were likely related to long term Cushing’s disease).

I definitely understand your concern about life quality and I commend you for your strength and compassion. If you and the vet determine that there is a chance your kitty could turn around, I would be happy to answer any questions you may have about the disease. Another member here, @Tuxedo Mom also had a Cushing’s kitty who lived a few years after his diagnosis.

Fingers crossed that the appointment tomorrow goes well. Either way, we are here if you need anything. ❤️

 

Thank you, and sorry to hear about your kitty passing. If I can get some type of assurance from the vet that she can turn around, I will get the Cushing's test... But would neuropathy and incontinence ever get better? She is lagging in her back legs, but also one of her front paws keeps folding over.

Thanks again for the support, and will update tomorrow ❤

 

It definitely can. If it’s due to sugar being poorly controlled, then once it’s under control, the neuropathy will improve.

If your kitty does indeed have cushing’s, the extra cortisol causes muscle wasting and will make the weakness in the legs even worse. With treatment with Vetoryl, that can also be reversed (And was in Frosty’s case). Once the weakness is better, a lot of litter box issues will likely improve.

The goal, of course, is to figure out what is going on first, and take into consideration how much the kitty is suffering, to decide on the best next step.

Hope this helps. ❤️

 

Thank you very much, Ana & Frosty ❤

 

I meant to ask what type of test is it for Cushing's, and does it take long to get results? And if it is Cushing's, and start treatment, how quickly do you notice results?

 

Ana has several threads in the Acro/IAA/Cushings forum. This is the first and has a lot of info. http://www.felinediabetes.com/FDMB/threads/possible-cushings-disease.195542/

 

Thank you, I will check this out.

 

Vetty vines for Tessa today

Please keep us updated

 

The test for Cushing’s is a blood test that is taken a few hours apart, so the kitty has to stay at the vet for most of the day.

It took Frosty about a month to heal his wound and show significant improvement in all his symptoms. Slow improvement was seen throughout the duration of that month. Then he maintained it for 5 months until he had other organ issues, most likely from long standing Cushing’s before I even got him.

 

Thanks Ana... Unfortunately now Tessa is not eating at all this morning... And won't get out of her bed. She had a couple of licks, and I tried to spoon-feed her, but she wasn't having any part of it. Her BG was at 18.5 just now, and not sure whether to give her her insulin shot this morning

 

Will you be home to test?

I don’t know the conversion for 18.5 into the American system unfortunately but I believe that’s pretty high. If you’re home to monitor her i would give her insulin and check her levels. If you don’t want to give the full dose u can give half. That’s what I did when I couldn’t feed frosty before some of his tests.

Hope this helps. Keep us posted

 

I was able to get in touch with the vet, so I gave her one unit... Unfortunately she has taken more of a downward turn (crying while pooping in her bed)... she is sleeping right now, and taking her in at 2:40pst... I don't want her to suffer. Tessa and I thank you all for the support ❤

 

Thinking of you.

 

Totally understand. Whatever you decide, we are behind you. Sending hugs

 

Thoughts and prayers are with you & Tessa

 

Many thoughts and prayers for you and your girl.