? Inappropriate elimination isn't ending - help?

Hi there! New to posting, not to lurking here...have two brothers, age 8 and both diabetic. They're on vetsulin and it's been pretty good thus far. One brother, Fred is managed and easy to catch is something is "off" with him. His brother, Barney is slightly unmanaged and hard to catch when something is "off" with him.

Right now, Barney is the issue. He's on 4 cc's of vetsulin 2x day (U-40 syringes) which seems to be a good dose for him; but, he's still eliminating inappropriately. In my bedroom! We rent, I've cleaned that area with GALLONS of vinegar, baking soda, peroxide...Nature's Miracle...and if not in my bedroom, in my teen's bedroom, the bathroom, the hallway or our office space - anywhere on the second floor where there is carpet. We've put extra boxes around the house, but really don't have space upstairs for a permanent box. There is a one box on the first floor in an old buffet that was refinished for boxes (Barney won't use it though) and 5 more boxes in the basement via a pet door; which he does use. He almost always has his pee accident about 4 am - I get up and feed them about 6:30 am every day. I clean boxes every other day. I do plan to rent a rug cleaner and really have it on the rugs in the next month or so too to see if that helps.

I am more than willing to set up a temporary box again in our upstairs bathroom, but hate to get all of them used to a box on the second floor when we won't be able to keep it there long term. We've been keeping him locked out of all the rooms, but it kind of punishes our other cats and the dogs too...and they whine at the door and wake me up. I'd love to get back to being able to keep the doors open again; and of course, get Barney back to feeling well too!

I can ask my husband to do an updated blood curve on Barney because it hasn't been done in about a month; since we had to up Barney from 2 to 4 cc's; he's not putting on much weight and still remains skinny. We can bring him in for a vet visit, but I'd love to try to exhaust any common sense home remedies and such first.

So, all you experienced folks out there, please let me know your thoughts....if you need more info I'll provide what I can. Thank you!

 

I'll get started:

1. When was Barney diagnosed?
2. What dose (in units) was he started on?
3. How often was the dose raised and by how much each time?
4. Do you test blood glucose daily or only for a curve?
5. What meter are you using?
6. What foods do your diabetic kitties eat?
7. Would you be willing to change your routine to get your kitty feeling and doing better?

I'm asking all these questions because your description is of an unregulated diabetic - the inappropriate peeing, skinniness, etc. Just to clarify: when you say doses of 2 cc's and 4 cc's, I take it you mean drawn up to the 2 or 4 mark on your syringe? Those are insulin unit marks so we would say the doses are 2 units or 4 units. I mention this so there's no confusion when others read your post.

 

Ok..
1. Recently - within the past 6 months (February?) - maybe a little earlier but definitely the beginning of the year
2. Started on 2 cc's initially; that's 2 marks on a U40 needle
3. Raised a month ago to 4 cc's because of continued high blood sugar and inappropriate elimination
4. No - just a curve, my husband tests - I can't do it!
5. A people meter, Freestyle - have worked with vet to make the adjustment to account for cat blood sugar
6. Walmart brand, Special Kitty, wet food - pate type, each cat gets 1/2 of a 5.5 oz. can three times/day (6:30 am; 3pm; 7:30pm) - they are big, orange tabbies - male
7. We will do whatever we can - and are able to do - to get Barney back to himself, of course! We didn't have this much difficulty regulating Fred, Barney has been tough...we have tried Evo wet (they won't touch it!) and Fancy Feast seemed to be pretty good but it gets costly.

Yes - the cc's are the marks on the needles, we use the U40 needles, 1/2 ml (?) per mark.

His last results (including the adjustment for the meter) were:
AMPS: 409
2 units + 1 hour: 406
+2 hours: 252
+4 hours: 257
+6 hours: 326

Those numbers led to the increase in insulin, but we haven't tested him since so I will have to get my husband on that. Maybe the 4 units isn't enough...anyways, thank you and I'll patiently await suggestions.

 

The vet might have started at this dose because he's a big boy. Many people start at 1 unit twice a day , regardless of kitty's size. It's not a given that a big kitty will need more insulin.
It's easier to start low and raise the dose in small increments of 0.25 u (that's what we recommend) so you don't zoom past a good dose.

That a 100% increase in dose if it went from 2 to 4 units twice a day. There are many, many doses in between that might be better. It's even possible that the good dose is between 1 and 2 units. It's impossible to know at this point.

A curve is almost always what a vet will suggest but they're of limited usefulness. If it's done on a day when your kitty's BG happens to be running higher then you can be mislead into thinking to dose is too low. They can be doing what we call "bouncing" because a dose is actually too high. I'll add info on this further down.

Most of us use a human meter because a pet meter's strips are too darn expensive. What sort of adjustment did your vet make? Human meters will read lower than a pet meter but the difference is larger at higher BGs (300+) and much less at lower BG (below 100). All of us here know how to interpret human meter BG numbers with no adjustment. The most important thing to know is that 50 and lower on a human meter is far too low. Too low is about 68 and lower on a pet meter.

Some cats become regulated quite easily but most don't. It can take a long time. Food-wise, many of us feed Friskies pates (not the gravy types - high carb) and they're very economical. I'm sure the Walmart brand pates are fine too. It seems you've got the food front covered!

It's hard to evaluate fully because we'd need to know if the first test at 2 u +1 hour was after feeding or not. A vet will usually say test before feeding and dosing on curve day. Let me know. All that aside and taking the numbers at face value I see the following:

• He dropped quickly by +2 and that can be quite typical of Vetsulin. It hits harder and faster than some other insulins.
• He held his BG nicely for a few hours and his low point (nadir) was around +4 or maybe a bit later but there's no dats for +5. That again is a typical nadir time for Vetsuln. Most kitties will be lowest between +4 and +6 on Vetsulin.
• Overall you got a nice drop in BG so that says the dose is having an effect.
• The whole curve sits in higher than ideal numbers so the goal is to shift it downward with careful dose increases. If you were following the dosing method we use here, you'd increase to 2.25 u next (eyeballed to the best of your ability on the syringe). However, with the BG numbers here, you could try 2.5 u (not more than that) eyeballed half way between the 2 and 3 marks on your syringe.

Here's the link from elsewhere on FDMB to dosing info for Vetsulin:
http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/
Notice the testing routine we promote. It might look like a lot but it'll quickly become routine and daily testing will tell you A LOT more about how your kitty is doing than a monthly curve will. You were lucky getting Barney's brother regulated without all this. A more difficult diabetic needs a different approach. Ask me how I know!

Here's something I wrote for someone else about bouncing that can make too high a high dose look like it's not enough insulin:

Here's how it works:

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.
7. Many vets have little/no understanding of the bouncing phenomenon.

I hope I've given you food for thought ...

 

I used the spreadsheet from here (thank you all for that!) to track the mini curve I noted; strangely the AMPS was pre-shot, the 2 units plus 1 hour was after shot. My husband is going to curve him today or tomorrow again to see what's going on. I have limited time in the morning and a long commute so I have no clue if I can fit in testing - they're really wiggly for my husband and I have no confidence trying it - but will ask him to teach me. It took me a year to try to give Fred his shots...thank goodness for my husband! He has been so great at just getting the testing and shooting done...

I'll review all the bouncing info - maybe that is it...we shall see? Barney does NOT like to get his shots (hard to get his rear quarters without getting bitten; he's better at the scruff area - but not in the scruff) and he really hates the ear pricks for testing. He's new to it all though, which might be part of it. Fred doesn't care...he just sits there!

For the meter another poster mentioned the adjustment. We bought a brand new Freestyle (I don't have the model # on me) and brought it to the vet's office. They used their pet meter and we used the freestyle and then determined the adjustment. We need to add 58 to the number the meter gives us. If we have to somehow re-calibrate that please let me know and we can do a return trip to the vet just to be sure.

So, just to make sure I'm framing this right...improper elimination can occur when a cat is unregulated - period. Whether sugar is high or low? I always thought it was the result of high sugars, but I'm only 2 years into this now. I assumed that his sugars are still high and that's why the peeing...

Thanks again - I really appreciate the info as our pets can't talk to us and say what's wrong - they can only show us and I know this baby is still not feeling well.

 

Yes, because they don't feel well. They have to pee a lot because they often drink a lot and so on. As you know cats often use their toilet habits to tell us when they don't feel well, are stressed , upset, etc.

 

The Freestyle meter is fine to use for testing your cats, but you can't just add 58 to any result and have it be equal to a result from a pet meter. There is no way to compare the numbers between a human meter and a pet meter. There is no basis for comparison, it's the old apples and oranges thing. Kris is right, the difference is larger at higher numbers and less at smaller ones, and 50 on a human meter is your "Take Action" number.

 

When your husband tests, he knows not to prick the vein, right? Some vets mistakenly tell people to aim for the vein. It hurts a lot more there. You should aim for the sweet spot.

Where is he getting injected? Typically folks inject in the scruff /shoulder area.

 

Oh! Wanted to add.... My favorite accident cleaner is Anti Icky Poo Unscented which I get on amazon

 

Another recommendation for clean up- Pet Select, Pee Pee (yes that's really the name). It takes away odors and stains. Does a very good job, even on cat diarrhea.

 

Can you add a link to your spreadsheet in your signature so we can see?

 

So, what we thought was unmanaged diabetes in one of my boys...is likely pancreatitis. It has to be confirmed by another set of blood tests and we won't know for sure for a week. That said, this vet hasn't been wrong before.

I have to say that I am heart broken. It's a serious diagnosis alone, but add in the diabetes and it's just not a good prognosis. I have a chronic illness and limited budget and I don't foresee me being able to afford a lengthy and expensive treatment. If I could, I would.

Has anyone gone through something like this? If you have/had a diabetic and then got a pancreatitis diagnosis - what was your experience with it?

 

Hi,
sorry about the p-titis!

A lot of members of this forum deal with it and with diabetes successfully. I have no experience with it (my cat was suspect to have p-titis but it turned out to be false alarm) but if you start new thread making your question: "if you have/had a diabetic and then got a pancreatitis diagnosis - what was your experience with it?" its subject line I am sure you'll get many posters sharing their knowledge.

P-titis is never a good thing but it is manageable.

Best wishes to you and Barney!

 

The only odor/pee cleaner that has worked for me is Zero Odor. I get it from Amazon. The cats actually react to it like catnip! Go figure...