LONG post, sorry!

Hi all!


Very long post coming, I apologize and thanks for reading! Rufus, 12, was diagnosed late November 17 with diabetes as a secondary issue. He is a big lovable bundle of joy that is having a rough time. We had a certain vet for the first 12 years, but switched when they seemed to be non-chalant with what I’ll call his first issues.


So, Rufus has had pretty severe allergies to who knows what. Kept switching proteins to find a good for for him. Finally, in April 2017 we switched him to RC Selective (rabbit) dry and wet. He was also getting their hydrolyzed treats, 2 cosequins, and a bit of deli turkey everyday (which was very dumb of me for giving him). Seemed to be “better” less scratching and licking. Switched protein in July because of the cost of the food. He liked it for a week or so, then gave up. Switched back to RC and everything was seemingly normal until end of August when I noticed him not eating as much dry food as normal. Then less wet food. Took him to 1st vet. Noticed no physical signs, except he had bad ears (allergies?). Did blood work. High tryglcirides, BUN elevated, and 1.7 for kidneys, and dehydrated. But really no reason not to be eating. I was always concerned that a cat that is not eating would get fatty liver and die, because they kept telling me over the years to get him on a diet, but don’t lose to quick. So a week goes by and no improvement. I read on the internet that prednisone helps with allegies and also with appetite. Awesome! Call vet, she is relucatant, but I ask because I’m worried he’s going to die from not eating. So put him on the pred. No changes. I call new vet to get 2nd opinion.


New vet gives him sub q fluids, covenia antibiotics, and cerenia shot. He’s like a brand new cat! For 10 days. Then its back to not eating again. Give him another round of antibiotics and he’s eating again, but really only wet food. Everything is going ok (except not eating dry food really), so I ween him off the pred. Old vet said sure, he’s not on a big dose anyways, go ahead take him off. Week later, not eating again. Old vet (lady #1) says you shouldn’t have taken him off the pred so quickly. New vet says same thing. So put him back on pred and new cat again. For a week or 2. Like a pattern it seems. Also, at this point some days he’s eating ok, some days not very well. Try different foods and he’ll like it 1 day and not the next.


Now new vet thinks he has pancreatitis from all the food switching and that’s what is causing issues. So at this point he’s super picky, and only eating tempation treats and watered down wet food. I think it’s a tooth issue. She doesn’t think so. He’s lost 2 teeth now in 3 months. She agrees that we should do dental exam, but wants to do bloodwork again.


Test come back. BG is 438. Take him off pred. Lantus 1u am, 1u pm. Do that for a week. BG is 398. Lantus 2u am, 1u pm. Next week BG is 413. 2u am, 2 pm. Next week BG is 4~~. 3 am, 2 pm. Next week BG is 4~~. 3 & 3 daily. Now she says bring him to vet all day, we’ll test every 2 hours. They do and it is always in the 400’s. New dose is 4u am, 4pm. Do that for 2 weeks. Now today go in and we had to wait 45 mins to get in. Stress I’m sure added to this number. BG is 503 and go to 5 and 5.


So anyways, can’t get him regulated and he has so-so days and some bad days. 2 steps forward, 1 back. All this time he’s getting 5mg of pepcid because his stomach is messed up I’m guesing from eating the Fancy Feast. Vet still think pancreatitis is playing a big role in this. I agree and think it’s from food intolerance causing GI issues, causing the pancreatitis which is causing the problem getting regulated. She doesn’t really agree with me how that works. All I know is, if I don’t give him his pepcid he wont eat and it takes DAYS to get back to “normal”


Thanks for reading!


Sean and Rufus

 

And also, I probably left out some things along the way, but really did try to not write so much!

 

Welcome to you and your very complicated kitty! You come to a great place for help and support.

 

Very complicated indeed! Thanks for the welcome!

 

Welcome to the FDMB!
Rufus sure has a lot going on. Because of all the issues and details you've mentioned, one of our members suggested moving your post over to the Lantus & Levemir Insulin Support Group. I think it's probably a good idea. Those well versed in Lantus use tend to hang out in that forum. Please look for the thread over there. I'll also send you the link via private message.

 

Hi @S&R and welcome to the lanctus support group.
I'm new around here really so I'll tag those far more experienced with lanctus so they can advise you.

One thing I do know is that lanctus should be given twice daily , 12 hours apart, and the dose should be the same each time to start with.
Another thing that is very important is to be able to home test your cat yourself .

@Marje and Gracie
@Wendy&Neko
@Gill & George

 

Yep, he gets hos shots between 7 and 7:15 twice daily. He is at 5 units now. I just ordered an Alpha Trak 2, so I can start home testing. Hopefully it won't bother him too much! Just frustrating that he's off of the pred, eats very low carbs, and his number won't budge. Really hoping his numbers are significantly lower at home and it was stress from the vet!

 

Welcome. First thing that will help us to help you is to start a spreadsheet. Here are the directions:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
It’s also good to add a signature so we don’t keep asking the same questions.
http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

How quickly have you raised the dose? While his other issues and medications can cause high BG, so can raising the dose too quickly or too slowly. That’s where viewing your ss will help. Fill in all the info you have. Since lantus is dosed based upon nadir, the lowest point in the cycle, it’s great that you will be home testing. It will also keep him safe and prevent hypos. Make sure to get a before insulin test for every cycle and to make sure it’s not food influenced, pick up all food two hours before.

I don’t want to overwhelm you so read the stickies and ask lots of questions.

 

His doses were raised once a week. started 1&1, then 1&2, 2&2, 2&3, 3&3, then 4&4 for 2 weeks, and now 5&5 if that makes sense.

 

Just wanted to say Welcome to you and Rufus!

 

Hello and welcome from me too.

Sorry to argue against the vet, but that kind of dosing makes sense for the in and out insulins like Vetsulin, but not for depot based insulins like Lantus. My vet did the same - many vets still aren't familiar with the depot based insulins. Plus with Lantus we increase in much smaller increments. Do you have insulin syringes with 1/2 unit markings on them?

The best thing you can do for Rufus is to start home testing. You don't need an Alphatrak. You can buy a human meter and use that. Bonus - it's quicker and easier to get test strips when you need them, plus they are cheaper. If you are in the US, I'd pop into a Walmart and get a Relion Confirm or Micro and their test strips. Good value for the money. And you won't have to wait for the AT to arrive. I would start testing as soon as you can.

Blood glucose values taken at the vet can be very misleading. Many cats are higher at the vet due to stress, and you don't want to base dosing decisions on those inflated numbers.

Sorry to pile on a lot on you at once, but food may be another issue. Fancy Feast has a lot of fish in it, which many cats are allergic to. There are a lot of good off the shelf low carb products with unique proteins out there. Ziwipeak has a line with rabbit, venison, lamb. Many manufacturers are now coming out with a LID or limited ingredient diet products that are single proteins. But I wouldn't play with food until you are home testing first. Cats on a dry food diet may need a lot higher dose than those on low carb wet. Don't make the transition until you can tell at home that it's safe to do so.

 

I couldn't agree more with what Wendy posted. You might want to take a look at the two dosing methods we use here to give you a feel for how Lantus is dosed. In particular, I'd encourage you to look at the sticky on the Tight Regulation Protocol. This protocol has been published in a leading veterinary journal and has an admirable record for getting cats into remission.

Has Rufus ever had allergy testing? This may be the quickest way to sort out what he's allergic to. One of the members here, @Nicole Z, has a kitty who has allergies and her cat has been tested. She may be able to give you more information about the testing.

 

Hi Sean, and welcome to you and Rufus from me, too.

You've already gotten some good advice and, as Elise said, we don't want to overwhelm you, so I'll just share a couple of links you might find helpful. The first one is to a website created and run by a veterinarian named Dr. Lisa Pierson. It's called catinfo.org. Dr. Lisa tells you everything you ever wanted to know about feline nutrition. She also has a food chart which lists values like protein, phosphorus and carbohydrates for almost all the commercial canned cat foods will find in grocery stores and pet stores. What you want to look for is foods that have less than 10% carbs. She also has a section on how to transition your cat off of dry food, although it sounds like Rufus is already doing that for himself.

The second thing I want to share with you is a post we put together for new members to help them get comfortable using this forum: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/.

Just read everything you can in the stickies at the top of the Lantus and Levemir page and ask lots of questions. We love to help.

 

I'm an impatient person, but I also think we are increasing too fast. I think the reason why she keeps going up is because the number are always the same, and the fructosamine came back as "poor". I really don't want to rock the boast with her as We switched to her in September and have been going almost weekly to see her because of his "first" problems of not eating and only eating wet liquified food. I will have a chat with her, though. I'd realy like to calm his pancrese and see what happens.

As far as food, yeah we've been there done that with almost everything out there. The hard part is right now. Normally, or before this all happened he'd eat anything. Now he's super picky. Likes it only for a couple days. Has to be super liquified and the right texture! Life will be a lot easier once his pancreatitis goes away and/or I can get his teeth looked at. The dental vet doesn't think that is the issue, but she won't do anything until his fructosamine test comes back as at least "fair".

 

I've pushed and asked for testing from both my original vet and my new vet, and they both said pretty much same thing. Hard to test for the proteins. A lot of inconclusives and not worth the $ spent.

 

Thanks! Yes, I've looked over that list since November. We landed on fancy feast because of the carbs and he actually ate it. It really is not easy to find a good LID food, and with the requirments he needs. The dry food I now have is the LID zero carb young again. He seems to like it, when he attempts to eat it. Honestly hoping that will be his main food source once things come around.

 

Young Again is fine. Be aware, though, it's not really zero carbs. It's about 5% so it's a lot better than the other dry foods and fine for a diabetic kitty. Make sure you follow their instructions about the quantity of food. It's high in calories and can cause a tummy ache if Rufus eats too much.

What are the requirements that Rufus needs?

 

As of right now, requirements are super liquified food, limited ingredient (rabbit, venison, ?) and low carb. A lot of the limitid ingredient foods have a high carb AND it's hard to liquify them and get him to accept the flavor and texture! Ugh.

 

If pancreatitis is suspected, why haven't they tested for it? There's a SNAP fPL test that a lot of vets run in their office that gives a "yes or no" answer and a Spec fPL test that's sent out and gives a better answer on how bad it is.

There's a lot of information on pancreatitis in this Primer on Pancreatitis

 

Sorry, not sure where I wrote that or why or the context. But yes, he did have a test and it was a yes.

 

So let’s talk pancreatitis. My Max had chronic pancreatitis for several years that likely was a cause for him becoming diabetic. It doesn’t sound like you have it under control. For Max he became inappetent when it hit. Since it comes and goes andfor him stress like a vet trip brought it on I learned through trial and error tgat ondansetron for his nausea got him eating. At first he got an appetite stimulant, cyproheptadine in addition. Later I learned when he got tge right amount of ondansetron he didn’t need the cyproheptadine. There were periods where he got ondansetron twice a day for a month or more. Some cats do better with cerenia for nausea and others need both. For Max diet was not the problem.

Here’s an article with a good overview of pancreatitis.

http://www.idexx.de/pdf/de_de/small...ancreatitis_roundtable_discussion_2006_us.pdf

 

A good nausea medicine really can help a lot with pancreatitis. For some reason a lot of vets push Pepcid for this, but that is actually only addressing the acid in his tummy. Cerenia is the anti-nausea that medicine that most vets prescribe because it's intended for animals. Ondansetron, or Zofran, which is actually human medicine, works better than Cerenia for some. It worked better for mine. But later in life, when other issues besides pancreatitis were affecting them, I sometimes had to use both Cerenia and Ondansetron at the same time. It is perfectly safe to do so.

 

Sorry for the hijack, but I have been trying to find out what's the best dosage to start with for Cerenia. I was told 1/4 of a 16 mg tablet.

 

Hi Sean and Rufus,
I'm sorry that you are having so many problems all at the same time. But you have gotten a lot of great advice already. Rusty has food allergies (fish; beef) and I have found that you really have to read the ingredients on the cans very carefully. Lots of foods that are "chicken" have fish in them. Rusty has always been a picky eater. I have recently found a food that he will eat readily: RAWZ Chicken & Chicken Liver, RAWZ Turkey& Turkey Liver. It's a paté, healthy (it is steamed, not rendered), and it is expensive, but for us it is worth it. It is relatively new and is not in Dr. Lisa's list yet. Also it is only sold through independent petfood stores (not the big chains). If you can find it, buy a couple of cans to try. It also comes in beef, and in salmon.
Pancreatitis is a bummer. The IDEXX round table, a link to which Tiffmaxie gives, above, is excellent.

Do get a human meter. You will save hundreds of dollars on strips. The Walmart Relion Confirm and Micro are excellent.

Best of luck, and I hope that Rufus will be doing well soon. It sounds like he has had an awful lot of meds, all at once!

 

That's correct.

 

Good info! He has tried cerenia twice as an injectable and once for a 3 day course and didn't seem to help. His pepcid now seems to help quite a bit. Just crossing my fingers that the food intolerance is causing the pancreatitis. I will ask my vet about the ondansetron though!

 

Interesting. So maybe his big problem is an acid tummy.

 

Yeah, I really need to get him on a single protein, and one he has never had. He seems to be liking the wysong rabbit so far. As far home testing, I ordered the alpha trak today, but maybe I can return it and get the walmart branded 1? Does seem a lot less expensive!

 

Not only that, but you'll find it much easier to follow the protocols here as they are written based on the use of the human meter.

 

Yeah, his stomach is always gurgling and he has gas, and even sometimes burps! I think it is the food intolerance. Food intolerance causes GI issues, which causes pancreatitis, which causes, pancreas scarring, which causes diabetes. I asked my vet if I'm on to something and this is why we cant get him regulated, but kinda got a shoulder shrug.

 

I haven't checked yet, but is there a conversion chart to show the numbers to the vet then?

 

Sorry no. The meters are closer in lower numbers and higher in the high numbers. Some people will use the human meter most of the time and do a curve for the vet with the AT.

The Wysong Epigen diets by themselves are not a complete cat food diet. Are you adding a supplement? Another option is raw food. Much easier to get single proteins with no additives. And it often works wonders for allergies.

 

I just bought some taurine from amazon. He also gets lysine and probiotics so hopefully that'll suffice. Goal is really to get him eating the dry food. Raw food is pretty spendy and as soon as his fructosamine comes back "fair" or better, he's going to the dentist which will be between 1500 and $2000. And I've already spent about $1500 on him since September. Oh, and I'm unemployed right now. But really I'd do anything for him, and if it comes to raw food then that will be the deal.

 

I made my own raw food using the EZComplete premix. It was much cheaper per day than canned. And any wet or raw food is better than dry. Dr. Lisa has a recipe for making home made on her catinfo site too.

 

I don't disagree about wet food and raw food. Definitely would be ideal. Problem is my other cat refuses to eat anything wet, and I doubt he'd eat the raw. I could be wrong though. So issue would be when Rufus is feeling better he'll eat anything and everything out there!

 

I had to give Max 6-8 mg cerenia but he was 15-16 pounds. He got 2-3 mg of ondan.

 

I am in the process of transitioning my two kittens to Dr. Lisa's raw food. They LOVE it. She recommends using either chicken or rabbit. It can end up being more economical than buying commercial food, and so much better for them.

 

Just wanted to say hello and Welcome.

You've had some great advice and tips from others.

Just wondered what probiotics you are using? A lot of vets recommend fortiflora, there are better options.

 

OK. Tanner is just under 7 pounds. Is 4 mg too much?

 

I too transitioned my kitties to Dr. Lisa's recipe , not exactly the one on her web page because of the CKD one that she was very kind to prepare for them , but has the same philosophy and they LOVE it

 

I think it’s tge right starting dose. The oral doesn’t get absorbed as well as injected. But injected stings.

I’m feeding Primal and Balanced Blends to my year olds. This was just posted on the CRF list though.

https://www.theguardian.com/science...-meat-pet-food-after-analysis-finds-pathogens

 

Primal just had a recall. I had a bag and a half, and even though the batch numbers didn't match, I don't think I'll use it.

This is why Dr. Lisa discourages buying raw food, and why with her recipe you partially cook the chicken and don't keep it in the fridge for more than 72 hours.

 

The recall was because the bones weren’t small enough. It was tge fd chicken and turkey only. I use the frozen and remove from the freezer to the fridge no more than 24 hours before using. The article talks about home made as well as store purchased. It has to do with the actual protein.

I’ve given mine gently cooked as well. How long are you cooking it?

Sorry for hyjacking this condo.

 

I was using fortiflora, but switched to Young Again Immune & Digestive Support. A lot less money and seems to be working.

 

Welcome to FDMB!

Dr. Dodds, a renowned expert in thyroid and blood testing, has developed Nutriscan to identify food sensitivities via a saliva test.

Since he has tested positive for pancreatitis, you might want to read the Primer on Pancreatitis.

 

Thanks! I started a topic in the main forum asking if anyone has used NutriScan, but looks like no one here has. 2 different vets have told me not to get testing, as most often they are inconclusive and a waste of money. I might go ahead and do it in hopes that it does give back good info.

 

Nutriscan is different. There are other allergy tests out there that are worthless.

 

Hi just chiming in here to offer my feedback on allergies. My other kitty Mulan has severe allergies. Like severe. She was licking herself and making sores on her knees. We were desperate to help her and tried everything, most steroid pills didn’t help and we had to try the depo metrol injection which is a long acting steroid. We finally took her to a specialty dermo who did blood work and determined she was allergic to dust mites, storage mites ( found in flour, cereal, dry foods ). We did do a much longer course of oral steroids to get her itching under control and also had to put her on atopica which is an immune suppressant to help calm her body’s response to the allergies. Once the atopica kicked in we stopped the steroids. We also went ahead and did full inter dermal allergy testing which included putting her under and doing a full skin test. This confirmed conclusively the dust mites and storage mite allergy in addition to many trees. It’s been a long road. She is also now on allergy shots weekly for life. I even go as far as to steam with a professional clothing streamer all carpeted cat trees to kill off the dust mites 1x per week. I haven’t fully figured this out but in other cat boards that I’m part of, allergies seem to be a mass issue. What is in the foods, or litters, or something that is causing allergies? I have cats my entire life and years ago I never had a cat with allergies and how all I seem to see are posts about allergies and itching to the point of making sores. If you can take your kitty to a dermo for testing that’s helpful, my dermo was pretty convinced Mulans issues were environmental and not food. I do feed rad cat raw in addition to canned grain free wild calling which just declared bankruptcy.....ugh ugh ugh.
I’d ditch all dry food since I took my diabetic cat Aurora off kibble she’s almost at normal levels I have her in .5 of a unit which I’m comfortable with. I had a renal kitty and I swore I’d never feed dry kibble ever again. Depending in the allergy I guess you could ask your vet about trying Zyrtec regular never give d that’s toxic. A side effect of Zyrtec is it’s an appetite stimulant and that might help keep allergies at bay. Mulan is a severe case but Claritin or Zyrtec has been proven helpful for allergies. Worth a shot if your vet agrees. I was giving 1/4 pill 1x per day. Razor blade makes it easy to cut up and they eat if youput in a pill pocket treat. I agree the food testing for allergies in cats isn’t very reliable. Seems to work better in dogs than cats. The interdermal test is more comprehensive for environmental allergens. I hope this is helpful! I’m sorry I’m late replying I’m not here on the board often.

 

Hi Nicole! Thanks for replying. I'm almost 100% it's a food allergy that turned into a food intolerance. I could be wrong. He was on Zyrtec for about 3 months and it didn't do anything for him. Could try a different brand I suppose. I do know that turkey is a huge thing for him. I learned that slowly in that last couple months. I was feeding it to him daily as treat in the form of deli turkey. I now know that when he doesn't have it, his tummy is much better and not as much licking. Problem is he is eating Fancy Feast and it contains meat byproducts and who knows if turkey is there. He has been improving greatly since removing any turkey though. He could be allergic to chicken though too. I think I'm going to go ahead and do the NutriScan test. It's spendy and might be inconclusive but who knows. Worth a try for my guy. I just wish he'd eat his Young Again LID zero or his rabbit food, but he's not digging them right now

 

Keep trying!