My cat just went completely blind... Help

Good morning and Happy 2020.

This is my first post (but I put it under the "Think Tank" category by mistake).

This is the "Reader's Digest" version of the story, because there are too many details to remember and post.

My (approx) 11 year-old cat Mama was diagnosed with diabetes about 3 years ago. She has been on Vetsulin and now on Lantus. I was giving her insulin per vet recommendation, and brought her in for insuling curves when I could afford to. I took her off the "prescription food" after visiting catinfo.org, and switched her to high protein, low carb wet food only (except for a small dry snack at night). Mostly she stayed stable until the last 2-3 months.

She started peeing outside of the litter box, so I took her to the vet. They said she had a UTI, and gave her antibiotics. They suggested we reduce the insulin to 2units, twice daily after eating. Around the same time, I also started home testing with the Alphatrak 2 kit. I noticed that her blood sugar was quite unstable, and when I did a curve I saw it range from the low 200's to the low 400's randomly throughout the day. Otherwise she was eating and drinking, and toileting normally.

Flash forward to last week, when i noticed an increase in her urinating outside of the box, poor apetite, a bout of vomiting, and lethargy. We took her to the vet, and they said she now is completely blind. He was conservative with testing, but did give her a shot for nausea, checked her blood pressure (which was normal), and she did not have a UTI. He also said to try to increase her insulin incrementally to see if we can get it stabilized to 100-200.

I'm thinking she is struggling with being blind, which may be related to the peeing in wrong places (though she usually hits a part of the pee pee pad at least). Yesterday, I put her in the litter box a few times and she did pee, but seems to be a bit disoriented (which is understable). She has found the litter box by chance a few times, but mostly it's on the floor or pee pads.

I'm trying to make this work because she has perked up in terms of eating, drinking and alertness. I don't want to euthanize her just because she's peeing all over my floors, but I also don't want to keep her alive for me if she's suffering. I've had to let go of pets before and it's not easy but it was clearly appropriate in those occasions.

I'm sad, confused and overwhelmed. Just wanted some feedback..thank you.

 

Hello there, welcome to FDMB.

I personally do not have experience with blindness caused by diabetes; experienced users should be along shortly to help you out.

It's wonderful you've started to home test, that is the biggest thing here you can do and help us to help you and Mama. While we wait on more direct answers, if you have time you could create a spreadsheet and make a signature. The spreadsheet (info on making one here) is used to input blood glucose data as you test, so we can monitor how high/low Mama is going on a daily basis. We use our signatures (info on making one here) to record insulin type and dose, food, age, diagnosis date, all the typical stuff we need to know about your cat and so you don't have to repeat yourself every time you have a question for Mama. ^-^ Insulin type, dosage, food, and blood glucose checks play a big role in how we can guide you in the right direction to getting Mama feeling better. If you have trouble making a spreadsheet, many of our mods are more than happy to make it for you.

 

Thank you so much. I am at work, but I will set up the spreadsheet as you requested. How often do most people test blood sugar and give insulin daily? I test her right after eating, and then dose the insulin.

 

Thank you, that will be a big help to everyone once it's set up! If you have time now, could you also let us know what her current dosage is of Lantus?

Most people give insulin twice daily. Some lucky cats only need once a day but personally I've yet to meet someone here in that case. With Lantus, the protocol is to test (in case you need to stall feeding if the test reads low, to see if it will rise on its own without food), feed, and shoot. As far as testing, it depends on who you ask! Aside from pre-shots tests (tests just before insulin) which we all do, some people only get 1-2 mid-cycle tests, where others poke 5-10 times a day. It's good to at least get a couple mid-cycle tests each day to paint a better picture of what's happening, though some people work long hours and don't always get the luxury, they try to catch up on the weekends and such.

 

Hello again!

For Lantus, we always test before each shot, and then ideally at least one test between shots to see how low a dose is taking the cat (Lantus should be dosed based on the lowest number of the cycle, not the pre-shots). Some people test a lot more than that, some people aren't able to get mid-day tests most days due to work or other schedule constraints and due a "curve" (testing every two hours) on weekends. Curves can be really useful information, but they can also be misleading, because if you catch them on the wrong day, you could see high numbers all day but it's because the cat's body is reacting to a really low number the previous day. So it looks like the cat needs more insulin when really she needs less.

To answer a question you asked in Think Tank, yes, a lot of us use human meters, largely because of the costs involved in the AT meter strips! A favorite brand is the Relion brand at Walmart, because the strips are cheap and it's easy for most people to get a new batch in an emergency (no having to wait for a vet or ordering online).

I think @JeffJ had an experience with hypo-induced blindness. And to be clear, we don't know if that's what it is for Mama, but just in case. Your report of lethargy and vomiting at the time of the onset last week really makes me wonder, but it's not the only possibility.

 

Right now I'm giving her 2.5-3 units depending upon her reading. I think I have totally screwed this up for her trying to figure out things on my own through research. I don't have a ton of faith in the doctors. There are 3 at my vet, and in hindsight they've told me different things. So much information rumbling around in my head in trying to make this work medically and financially.

 

I opened up a spreadsheet but I realize I don't understand a lot of what it's asking for.

 

@Marje and Gracie could you help her out with a spreadsheet?

 

I think I just need a "key" of some sort to understand every column. I have been tracking using the little booklet that came with the Alphatrak, and that just asks for time, reading, apetite and insulin given I think.

 

How do you calibrate it for cats? With the Alphatrak there is a number on the strip container that has to match with my meter.

 

U=number of units of insulin given
AMPS=morning pre-shot BG reading
PMPS=evening pre-shot BG reading

After the shot, we measure time relative to that-- +1 is one hour post-shot, +2 two hours, etc. We do this because we are in all kinds of different time zones here, so nobody will know what you mean when you talk clock times.

When you fill in BG numbers in the cells, they will automatically color-code for you. Then, anyone looking at your spreadsheet will be able to see at a glance the kinds of patterns that are there (well, ok, not necessarily always "at a glance" but you can tell a lot that way!).

Click on some of the examples in people's signatures to see how it works...

 

Don't sweat it, if all of us here just listened to our vets we wouldn't have so many cats doing so well and on the road to remission! I harbor no ill will to my vet; she, like most vets it seems, just doesn't have a thorough understanding of feline diabetes. Honestly concerning my cat's diabetes my vet lets me call all the shots and I get my advice here. Financially, once you start home testing your vet bills will go down so much - no more fructosamine tests or glucose curves at the vet, you can do it all at home. If you switch to a human meter (totally your choice) you'll save even more. In the US (assuming you are since Caninsulin is called Vetsulin only in the US) you can use the Relion Prime from Walmart. Strips average $0.17 each, whereas Alphatrak averages $1 each.

For the spreadsheet:

Date: self-explanatory
AMPS - AM Pre-Shot, this is the test you do right before the morning shot
U - units, your current dose that day
+1 etc - this is the number of hours since giving insulin. +1 is one hour later, +2 is two hours later, etc
PMPS - PM Pre-Shot, the test you do right before the evening shot

There is no calibration for the Relion human meter. It will read like human blood (so the numbers will read slightly lower than what they truly are), but all of our data available on FDMB is based off a human meter so no need to convert or anything.

 

Kudos to you for taking care of your diabetic kitteh for several years.

Blindness from diabetes can be caused when the cat's BG goes too low, and is untreated. For example, if Mama went to 20 or 25 and was at that very low range for awhile, then issues like blindness can occur. It is a possibility, and does not always happen.

Details: In super low BG, (if untreated), the cells of the body get starved for glucose. Some cells die, including nerve cells and brain cells - because there is no glucose to provide energy within the cell. In the very worst case of a severe hypo (such as BG 15-25), with no treatment such as sugar or carbs, a cat can die.

You indicated that Mama has not been in those low ranges. But if you missed some testing - I suppose this could be a possibility. The long term treatment is the same - just keep your sweet kitteh regulated, and avoid low numbers. Testing BG is very important.

My cat Leo went to BG = 22 once. The cause was lack of eating, and I caught it quickly. But he did have cognitive and eyesight issues for a couple of weeks. We were lucky that he recovered from that super low number.

 

Most human meters don't have any coding, and none of them would be completely appropriate for cat's blood anyway.

The human meters won't give you the same numbers as the pet meter, but as long as you know the ranges for too low (68 on a pet meter, 50 on a human), and the rough area for normal BG (69-mid-100's for pet, 50-120 for human), after that you'll just be working with relative values. That is, the main thing you want to know is, is BG going up or down, is this dose getting closer to the normal range than that dose, etc.

 

Thank you everyone. Something is definitely going on with her as far as her blood sugar, which I have tried to stabilize with the vet's help. I feel like they don't understand the dosing very well though, and Mama's can be all over the charts sometimes. So I don't know what I'm doing either. Over the past 2 days it was in the high 200's-low 300's with a low 2 thrown in here and there. This morning it was 408, so I gave her 3 units.

Again, I have been testing AFTER feeding because I thought that was the right way to see how her sugar was affected by food, and then to offset that with the Lantus. I'm sure that's what I was told way back when.

So I should be testing and administering insulin BEFORE feeding?

 

With lantus, our usual order is test-feed-shoot. Onset of insulin action is usually around 2hrs post-shot so it's not critical on this insulin to have food on-board before shooting, but you do want to make sure that the cat is willing to eat before shooting.

We test before the food because we don't want that number to be food-influenced. As long as you are testing within a half-hour or so of the meal, though, it probably won't matter too much.

I am concerned that that dose might be too high for her-- 3U is a lot for some cats, and low 200's is not that high on an AT2.

Can you get a test around +3 (3hrs post-shot) this morning? Or if it's past that already, just test now, I'd like to see where this dose is taking her.

 

We are happy to help!

That 408 could be what we call a bounce. Without actual data we can't truly say, but bouncing (scientifically known as the somogyi effect) is very common among our kitties. There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

So if Mama is say used to being in the 300s and she is getting too much insulin, it may cause her to drop to say, 100. Her body wouldn't be used to that number, even though it is technically a safe, non-diabetic number. Since her body isn't used to it, it may think it's suffering from low blood sugar, and the body dumps excess glucose in order to "protect" itself, bringing her up to 400...to us though it just looks like high blood sugar. Vets unfortunately have a habit of upping doses based on bounces and not realizing what phenomenon actually occurred.

On Lantus we test, and then feed/shoot at the same time usually, as long as they have an appetite. As Nan said, Lantus is a more gentle insulin (Vetsulin requires food a half hour PRIOR to injecting) so have food on-board isn't as big a deal.

 

I’m headed out the door right now but will be back later to see if I can add anything here. However, here are the instructions for how to use the spreadsheet. Great job getting it set up and linked in your signature block!!

 

I am at work every weekday from 7:30 to like 5. I test her when I get up, and before I have to leave, around 6:30-7. And around the same time at night.

 

I feel like this is what's happening because I don't know what I'm doing and I'm actually make her sicker. This is so stressful, especially now that she has become blind and is literally peeing all over the house. She had been confined at night with two other cats in a large size room, but she was suddenly hating it. I thought she was dying at one point so I let her roam freely in our small living room; but despite pads everywhere and a litter box, she can't seem to find the safe spots consistently. I think the blindness is making her very disoriented (understanably).

 

Gotcha. So, since daytime tests are out during the week, what you can do is to try to grab a before-bed test at night instead. A +3 or +4 is great if you stay up that late, but a +2 can be helpful too. How does that sound?

One other thing for tonight: lantus generally works best when dosed consistently morning and night. @Marje and Gracie or others may have more specific recommendations, especially once you're able to input some of your old data into the spreadsheet, but going forward I would lean towards doing the lower of the doses you've been using lately, not the 3U you did this morning, even if she's high again.

 

I can definitely do that. I understand what was explained about the bounce, so I will stay low on the insulin for now. When you say "dosed consistently", what do you mean? The same dosage or at the same time? I will work on the spreadsheet later when I get home.

Also, is it ok to switch to the human meter when I've been using the Alphatrak? The strips are so expensive, and I need to be able to manage this if she pulls through and we can figure out how to help her with the blindness.

 

Both, actually . We do change doses sometimes, but only by small amounts (0.25U, usually), and then we hold that dose for several days to assess how it's doing. There's a lot of information in the "stickies" in the Lantus+Levemir forum about the "depot" that helps explain why that's a good idea. Eventually, you'll want to start reading through all that info, and the information about the two dosing methods we use (Start Low, Go Slow and Tight Regulation).

Yes, you can definitely switch to the human meter whenever you want. The spreadsheets are coded slightly differently (not much; just the cutoff between "low but safe" and "too low"), so if you put both sets of numbers on a single spreadsheet, you'll have to adjust the coding (and of course note on the spreadsheet which meter gave which numbers). I think, since we just clicked over into a new year so everyone is putting a new "2020" tab on their spreadsheet anyway, what I would do is:

1) make a new spreadsheet using the "human meter" template
2) put the AT2 numbers into a 2019 tab, hand-coding any cells with BG<68, and (important) putting a big note at the top of that sheet that you are actually using an AT2 (like the one on your current spreadsheet).
3) start a new tab for 2020 going forward for (mostly) human meter numbers, and just make sure the couple of AT2 numbers are somehow indicated as different

The bookkeeping is a bit of a pain to set up, admittedly, but it will really help us help you figure out what's going on with Mama!

 

Thank you so much. I hope it's not too late.

 

It's also hard to see the .25 differences because I use a u-100 syringe that only has whole numbers and very short distances between the numbers.

 

You have already received great advice about the dosing so I will not add to it.

One suggestion to help your cat find the litter box is to use a litter attractants such as this https://www.petco.com/shop/en/petcostore/product/precious-cat-dr-elseys-ultra-litter-attractant

 

Thank you for that recommendation.

 

They do make insulin syringes marked in 1/2 unit increments.

 

You're here, and so is Mama, so by definition, it's not too late!

 

I just want to comment on the blindness. I had a cat (not diabetic) who went blind from high blood pressure.
Initially I had no idea she was blind as she navigated the area so well. It was not until I saw her almost fall into the pool I realised she couldn’t see.

Try not to move things and keep her LB in the same spot. And the same with the pads. Take her to them and walk her to the actual LB and pads. Hopefully she will learn the feel under her feet as to where they are. They are very clever at knowing their way around.
Ming lived to the age of 21 years and was blind for probably 4 of those years.

 

Thank you so much. That's reassuring. Up until this episode she slept in a make shift cattery room in my house with two other cats. They did fine in there but then we noticed a lot of pee outside of the LB (there were 2 large ones). We added a lower box in case she couldn't jump up (before we realized she was blind), but the peeing continued. She did continue to poop in the low box. When this episode occurred we thought she was actually dying so we set her up in the living room and "showed" her where things were. I didn't want her trying to jump up on the perches and hurt herself either. A couple of times when I put her in the litter box she peed or pooped in it, but she doesn't seem to find her way on her own. I have pads in various spots, and sometimes she hits the spots and sometimes not. She also seems to want to go to the right when I'm trying to guide her left, and even then she won't really walk when I'm guiding her. I don't know if she's hearing me either because I call her and she doesn't always follow my voice. I put the food bowl right in front of her, and she can't seem to find it without more help. I think she's really struggling with the blindness, and my attempts to help do not seem to be hitting the mark. Scared of putting her back in the cattery because although it's familiar, I don't want her trying to jump up.

The weird thing also is that now she is eating more normally and still drinking water. No more vomiting since Dec 24th. But she still is withdrawn and sleeps most of the day/night.

 

I am working on the spreadsheet, so you should be able to see the past month. I wasn't testing regularly because I thought she was stable earlier in the month, and I was trying to work with the strips I have. When I'm writing this stuff, and the log, I clearly didn't know what I was doing and failed miserably to keep Mama stable. I think I also had some bad/inconsistent medical advice, but didn't know it until probably now.

 

I have a way that is much, much easier than the above. If you can just send me a PM, I can take care of all of this for you and you can focus on Mama. To send me a PM, just click on “Marje and Gracie” to the left and then “start a conversation”.

 

Do you recall which antibiotic was prescribed? At some doses, Baytril (fluoroquinolone) can cause blindness in cats.

 

It was Orbax for the presumed UTI. It didn't seem to stop the peeing problem though either.

 

You could try one of these (there are cheaper ones if you google). It will keep her safe and keep her from going all over the house.

Also maybe sprinkle cat attract around box so she can find it by smell.

https://www.amazon.com/Playpen-Foldable-Portable-Exercise-Outdoor/dp/B00ITX094W/ref=sr_1_7?s=pet-supplies&ie=UTF8&qid=1499885423&sr=1-7&keywords=puppy+playpen+for+small+dogs&th=1

 

That might not be a bad idea. I was thinking of an x-pen like they use for dogs outside. Thank you, Olive and Paula.

 

Don't beat yourself up. Regulating a diabetic cat is a lot of work, especially when you are working full time and can't be home to test during the day. You are doing the best you can, and you are testing and monitoring as best as you can. A lot of people don't even put in the effort that you are providing. I hope your kitteh regains her sight and you are able to find a helpful and safe dose.

 

Thank you, Jeff. That's very kind of you. I'm still working at this and a lot is happening at once. I'll keep plugging away though. Have a great day

 

How is Mama doing now, @AliOBaba ?

 

We took Mama to the vet yesterday because she appeared to be very uncomfortable and still confused. Upon examination the vey agreed that she was in pain and likely had neurological deficits. The vet could barely feel her pulses in her legs, which suggested cardiac issues as well. We couldn't bear to put Mama through more pain and suffering so we decided to let her go . We are so very sad and miss her already. Thanks to everyone for all of the guidance and support.

 

I am so sorry to hear that... You did everything you could for her, and she is free from pain now.

 

That is often the kindest thing you can ever do, and not a lot of people are willing to make that choice. So sorry Mama is gone, hope your hearts heal soon.

 

May your sweet kitteh Mama have a safe flight to the Rainbow Bridge, waiting for you there. Mama was loved.

 

It sure sounds like you gave Mama wonderful care. I hope you take comfort in that--and in the memories of purrs and snuggles and all the good cat things. Lucky kitty.

 

Thank you so much everyone

 

We cry every time a member has to put a cat to sleep. Even though it is the right thing to do, we grieve along with you.

Please be kind to yourself during this time of loss.

 

I'm so sorry for your loss.