help plz. my old best friend just diagnosed with diabetes...

hi, nice to meet you all. I wish it was under better circumstances. though I always keep all hope alive for my animal friends, and read and research and ask.. hoping someone somewhere knows things even vets may not know..

here is how it goes for us:

IWAZ is 16 years old. male. not castrated. he was handicapped since around 2 years old. vets never figured out whats wrong. but it can be easily observed it is a one sided (right) paralysis with front right leg being weakest and rear right having enough power to let him move around in strange ways he adopted to over 10-15 years. in time, the front right leg became fused at 90 angle. which it is now. that happned around 10 years ago. its been this way for 10 years around. before he walked on all 4 but with one side weaker and less sensitive at all times.

he adopted fine to everything.. in his own special ways. was a energetic, happy cat.. doing everything on his own.. pee.. poo.. even jupming on sofa..

that's how it was til about 1 month ago.. then:

(1) suddenly, we found him unable to move in his regular ways on the 3 legs (it was bit of a jumping sideway motion for him.. a unique style he developed and mastered over 10 years)

(2) he still had appetite, but we heard him for first time ever do a lot of that grinding noise.. on kibble, but even sometimes on can food only. not sure if that means anyting. but I want to mention as much as I can.

(3) then one day around 2 weeks ago, he had a very bad episode of dirahea.. loads of water... light yellow poo.. and all this was just spraying out of his bum. he did this maybe 2-3 times. over two days. then it stopped. toward end there was some dried/fresh blood.. small quantity.

it's essentially after this diarahea that everythingn went from not so good to worse.. he lost alot of weight and is not just under 5lbs I think... his heaviest ever was maybe 12lbs.. so he was never big heavy cat.. but this is definiley less than his averages.

so dirahea about 2 weeks ago..then weightloss almost instant.. he still had appetite.. and drank but it was obvious he became weak.. lethargic.. and his head was sinking into food bowl and drink after short time of eating.

so we took him to vet around 1 week ago. they kept him for 4 days in emergency.. they ran probabably every possible test out there.. first one was blood.. the results were better than we expected.. but high sugar levels.. around 28 when we took him there.. so they said he's diabetic.. and ketoids were there but low around 0.7

he was also badly dehydrated.. I presume form dirahea.. around 12%

so they gave him IV.. potassiums.. and other things.. while testing urine (no infection)... doing ultra sound (a few things showed up but all minor and they do not suspect cancers etc anywhere)... chest xray fine too.

so essentially we did all test to eliminate anything other than just all that happened to him since he stopped walking (weightloss, lethargy, etc) as being due to only diabetes.. they do not know how long he may have had diabetes.. any thoughts? they say maybe around 1 month.. so I guess this would coincide roughly with when he stopped walking.

while in emergency they tested him on some insuline injections.. different levels.. one time he went quite low into hypoglycemia.. but they catch things quick there.. so all in all, they said he's quite sensritive to insuline.. so when they released him home yesterday, they decided to just have me inject him with 0.5 tiny dose.. one per day.. so its like the very first top line on a thin syringe.. not sure if it gets any smaller for insuline injections? maybe.

I read and learn as much as I can about it of course.. so in advance I apologize for any errors. feel free to ask questions if you feel you can help or comment. I have the whole paper and report from them.. with all info.. numbers etc.. and if something not there, I Can always call and ask for further detils if someone here feels they can offer some insight.

so as it stands now the situation is: he is back home since yesterday. his injections are at noon. once per day. 0.5 unit. sort of like one drop of insuline. I bought a cat reader for glucose.. I tested before first injection yesterday.. it was 18. then tested at midnite was also around there. before 2nd injection this morning it was around 25.

the vet and us, we are most concerned about the big weightloss. and the fact he was handipcapped before, means he cannot just get up and start slowly walking like regular cats.. which is cutting down on his muscle strength and his exercise.. which I read is bad for diabetics. he pees fine.. and we help him. though its still frequent pees. I am told due to glucose etc. poo is fine.

he has good appetite.. and we were told to feed before insuline (12pm) then at 4pm then at 8pm.
but after a while his head does go into bowl and gets a bit lethargic and tired.. same with drink.
we do give subcutanous... 50ml per 2 days.

they also gave him:
clavaseptin
baytril

those antiobiotics were give cause initially they thought there was urinaty infection.. but the lab was analyzing the bacteria today to pinpoint which antiobiotic best.. instead, they call me today to say there wa sample contamination.. and the whole UTI is negative. which I suppose is good news.

they told me to go back for reevaluation in a week.. curves etc.. its such stress for him that I am freaking out about going.. plus they are not really too excited to treat him because they'd prefer he wasn't handicapped and think this makes his chances much lower. at least I have this feeling from them.

all along in hospital he was fed the purina diabetic formula can food only. which he loved and they all said he was always hungry (which I read can also be a sign of sugar levels being high and diabetic condtion, so go figure.. hard to say if appetite is good or not I guess! I even read appetite goes up in hypoglycemia state too!)... so they told me to continue only on this at home.

so far I followed all they told me and its only his 2nd day back home... but after much reading, I did decide to feed him also some portioons of purely raw diet.. mostly turkey legs.. which he loves and does not need to get from a bowl.. as I just put them in his mouth.. also a few raw chicken hearts..
any thoughts at all about raw in this case here???

oddly, today, I talked to one of vets there (there are many there.. its emergency clinic) and she said that at this stage its not about numbers anymore really.. after I told her the numbers I measured at home.. she said they just want him to get better overall.. weight... energy etc.. to which of course I said: well yes I know.. but isn't him getting better still all about his diabetes and therefore all about the numbers too????

I have no idea why she said that.

if any soul here has comments or help to offer, we'll have no words to express our gratitude for them.

thank you

p.s. I do not remember for sure, but I think they said they managed to rehydrated him quite well. and he was maybe 4-5% dehydrated when left hospital. so I do not presume dyhadration is an issue now. they even disconnected him from IV I think a day before he came home.

 

Welcome! You and your kitty have been through a lot recently. I'll address those things that are diabetes related. Did the vet talk about diabetic ketoacidosis when your cat was in the hospital? Was the main reason for his stay there to treat the dehydration and start him on insulin?

What insulin are you giving him? The dose is low (0.5 unit) and that's the best way to start. However, cats need insulin twice a day because they metabolize it quickly. If you give it only once a day they can spend 12 of every 24 hours with uncontrolled blood glucose. It's really good that you're testing at home. Those two test numbers of 18 and 25 are high but we need more results to see what's going on. You're measuring blood glucose in mmol/L. Are you in Europe?

Regarding food: if it's the Purina ProPlan DM pate food it's low enough in carbs (6%) but can be expensive. Depending on where you live the might be other members who can suggest different low carb wet foods to buy. Raw food can be good for cats but you must add a vitamin/mineral supplement to it so that it's nutritionally balanced.

Here's what I suggest you do right now to start helping your kitty feel better and making it easier for us to help you:
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Set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

thanks for taking the time to talk!
appreciate it! yes, we've been through a lot. 16 years taking care of a handicapped cat friend... like caring for a handicapped human.. has many challenges.. but as you know, also creates bonds which can be that much more powerful.

when we got there to clinic they first ran blood test. on the results it said something around 28 for the glucose levels. which they said is high.. mind you, the visit stress didn't help for sure.. and they said ketoids were around 0.7

I later learned and was told by them that it is not good when ketoids are present.. but that this is a relatively low number. so low in fact that subsequently they did not even bother to recheck if it went down.. form what they told me.

truly, he was there for anything and everything. first off, we had no clue he had diabetes. so I presume once they discovered it, they concentrated on treating diabetes.. curves.. insuline.. etc.. but the dehydration was serious so it had to be taken care of.

given that we ran all tests including ultrasound and others.. to determine if other things could be behind dehydration.. lethargy.. or even in his case (and despite the handicap) motor skill issues... other than diabetes... and it seems the tests did not reveal other potential causes ... so they concluded, and so did we, that diabetes is indeed behind it all. which I suppose is always good to have a fairly accurate culprit and diagnosis.. so we can know what to concentrate on... but if this is true.. then I wonder why they are not too excited to know for example the readings I get at home.. the glucose numbers..

what am I missing here? I mean if there is a cat patient who was determined to be diabetic with no tumor or other things behind it to cause all symtptoms.. then isn't the logical and obvious way to reverse symptoms (at least most of them) via concentrating 100% on handling the diabetes?

thanks.

 

I use alpha track-2 reader
I am in canada.
I listed 18 and 25.. as those are the default numbers that appear on the screen.

yes indeed it is the red label.. purina-dmproplan cans. they told me to give 1 per day. 12pm (with injection.. which clearly contradicts what you said .. not to feed less than 2 hours before injecting).. then 4pm.. then 8pm.. and to keep things regular.

I am personally huge fan of raw diets for cats in general. there is just something beautiful about the juicy little chunk of a turkey's leg... the color is beautiful.. the smell is right... plus it has the perfect humidity and water levels.. taking care of most drinking needs after for our cats.. I guess it is no secret to anyone here that our cats are paying with diabetes for the years we spent feedin them kibbles.

 

How wonderful of you to be taking care of a handicapped kitty !

Welcome!! You've arrived at the right place there are lots of very experienced people here that can help you

What insulin are you using?

Some times diabetic cats develop a nephropathy that causes them to loose strength in their back legs with your baby it would be hard to detect but that could also be complicating his mobility issues, it gets better as the diabetes gets controlled but most of the people give zobaline and it helps a lot too, it may be worth to take a look at it and if you can get it where you live it may help him or you could maybe get the components (b12 and folic acid) ask around here about it if you would like to give it to him

If you can get the hang of testing at home , it appears you have already started which is great, you could then do the curve at home and just sent it to your vet instead of having to take him,.

If you set up the spreadsheet there's a tab in it for the lab results put yours in there, and ask for people to take a look at them maybe they can give you some extra input

 

I agree that starting with a low dose is a good idea, but it is important to do two injections 12 hours apart, esp since your cat had a history of ketones.

Is he on canisilun, ProZinc, lantus?

 

Thank you for the info.. everyone.

the bottle says: lantus/giangrine

so I presume this means Lantus.

I obviously do not want to argue this with vet, so do you think I should contradict his direction and do it twice a day then?

new development since I wrote this thread:

this morning when I woke up he was breathing a bit heavier.. more restless too, due to breathing I guess.. first time ever in his life, that I saw him breathe with open mouth.. he kept doing this, we paniced a bit... and decided to call vet. it ended up in emergency visit.. they checked him out... his pressure is fine... his temp upon arrival was low.. around 34... though even before his emergency visit last time (2 weeks ago as I described above) he was a bit lower than the 37 normal range.. back first time to emergency he was around 36... maybe today it was the drive in cold air.. who knows. before we left office he warmed up and was back to 36... which is lower than should be.. but acceptable I think... I should be taking his temp readings at home now. I hope its not too invasive for him and I do not mess up.

clearly, he has some body temp issues. I'll try to keep him extra warm and put heating up... any ideas how temp relates to diabetes? or it does not? or diabetes can literally mess everything up.. pressure.. temp.. etc.

all in all aside from the lower body temp, the vet did not find more issues since he left them 2 days ago. however, he did loose some more weight since going home. I do not quite get it as he ate considerable amounts of chicken hearts.. and turkey leg.. as well as bit of chicken liver. and it was so nutritious too. more so than cans etc. he is now just under 5lbs... he was never in his life big or heavy.. I'd say 10lbs average.

they told me today when I visited vet that they could keep him again. like last time. redo all blood tests. give him IV again. maybe do another chest xray to see if something changed since last one few days ago.. and maybe some water in lungs or such, to cause the heavy breathing. all in all they've no clue about the breathing. but they did say not related to diabetes. thoughts??

as he was breathing heavier this morning, right at that time I took reading.. it showed 24.. so essentially what he was yesterday.

now his breathing has stabilized. but he is weak.. less alert a bit.. etc... I gave him a bit (30ml) of subcutaneous injection. yesterday he was drinking fine..from syringe or bowl (though I prefer use syringe cause his head goes into bowl when he eats and drink and I Do not want water in his nose etc)... when I gave water yesterday he was sticking out tongue to drink it.. however today he is not. nor is he interested in food since return from vet (30 mins ago) .. so maybe stressed maybe not hungry... not sure. however, when I flashed small piece turkey by his nose he snapped at it like a day ago, and did eat it.

I hope I did not make some terrible error to essentially put him all on raw yesterday (2nd day since return from vet)... he loved the pieces I gave.. plus I did do my reading on net before doing it.. and countless folk are praising raw diet on diabetes.. however, some of those people were not so sure about doing it if cat is already started on insuline.. recent as this is for my guy.

well, I am out of turkey.. chicken hearts now.. and its the only thing he even considers opening his mouth for.. so I will go buy some more now.

we decided not to leave him at vet again today. to essentially redo all the tests and process they did last time.. we can always return I guess..... but we decided to continue protocol of returning home (insuline etc) as if the breathing episode did not happen.

I am also not a fan of vets who give up on animals easily. and frankly, with his preexisting handicap condition which will make it hard for him to get back on his feet even once diabetes stabilizes.. as well as what the vet saw today with the breathing, the lower temp, the reduced weight.. she did not give me a good prognostic for future.

it's a good clinic but problem is its 24/7 and there are like 10 vets there.. so everytime I talked to somoene when he was there, it was different vet. and everyone has different views and opinions about future.. recovery chances.. etc.

also he pees just fine.. but he tried passing stool last nite and had hard time.. maybe conspitation. I gave him a tiny bit of omega 3 fish oil... do not want to overdo it.. and make stools watery again.

if anyone can comment on any above we'd appreciate it.

 

My worry is that he's not getting the insulin he needs, his BGs are too high, he's very underweight, has had dehydration from diarrhea recently, etc. This is a recipe for the development of ketones and possibly full blown diabetic ketoacidosis. That can be life threatening and is very expensive to treat.

I strongly encourage you to set up the spreadsheet we use here and follow the testing routine I outlined in my long post (#2 above). Enter all the BG data you get. I definitely think your vet is wrong about dosing only once a day but I'm not asking you to change it. I want you to get data on that spreadsheet so you can see for yourself what's happening.

We try very hard to help but we need that spreadsheet and BG numbers to do so.

 

There's a special forum here for users of Lantus: http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
This is where you should post to get really good help. They will say the same things as I've said about testing, getting a spreadsheet set up and giving insulin twice a day. Please trust their expertise.

Here's good information about how Lantus works. It's very important that you read and understand this. Ask a lot of questions on the Lantus forum. http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

Here are the detailed instructions for a Lantus dosing method called SLGS (Start Low Go Slow):
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/
Read it, make notes and ask questions to see if it's the best method for you.

Here are the detailed instructions for a Lantus dosing protocol called TR (Tight Regulation):
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

As you can see there's a lot of information here on FDMB for how to use Lantus effectively. Please think hard about taking advantage of it.

 

The breathing is worrisome. That sometimes indicates heart problems or lungs.

24 is very high. Yes I think you need to dose twice a day. And it probably should be 1 unit twice a day with it that high and ketones. Normal is around 3-8. Sounds like your vet is more familiar with canine diabetes. Dogs can take lantus 1 time a day. Cats have a faster metabolism... It doesn't last 24 hours in a cat.

If constipation is an issue try adding a little plain canned pumpkin to his food. Like a teaspoon each feeding.