New from Switzerland - need help with unregulated cat

Hello all,

Firstly I want to say you are amazing, found a lot of info helping me to understand the diabetes of my Pantzel.
Indeed a forum I will rather skip, but here I am, owner of Pantzel recently found with diabetes.

Below is the long story but, in short, the problem now is that we cannot regulate him, after probably 2-3 months without treatment and one month on VETSULIN. Maybe somebody can check his SS (in my signature) and gives an advice on how to go further?

Many thanks for any input!

Pantzel long story:
His problems started this July when he suddenly stop eating / eating a lot less. He was overweight at 6.8kg back then. I didn't notice any increase in water intake or urination but he was staying a lot under the bed and playing less - I thought because of the heat wave at it's absolute maximum back then. He was also having since some time a really bad mouth odor so I suspected his teeth.

After 3 days I took him to the vet. The vet told me he is having a teeth problem and during the extraction done next day they also ran a blood test.
After the operation Pantzel was left with one incisive and one molar less and I was told that the blood tests indicate he is having a chronic renal failure (CREA 261 umol/l). The glucose level was also high (15mmol/l) but the vet suspected that was the effect of the operation stress. I was told to give him the special KD food (low protein, high carbs) and to come back in 6 months. I was given special antibiotics but was not able to force feed him with them and then the vet, at a second visit gave him an universal long acting antibiotics injection.

Immediately after the operation he started drinking / urinating a lot - had to change his sand box with a bigger one. The next 2 months there was a cycle of eating a few days (low appetite, tried/wasted a lot of food -all wet), then vomiting and not eating at all for one day and so on. He also was loosing weight at an alarming rate of 100g/week. He didn't like the special food so I was adding in his normal food a phosphor binder. I thought all these are because his CRF and that he is doomed. It was really a hell for me, trying to make him to eat and watching him slowly dying because of CRF - so I thought, given that the average life expectancy is 6-7months.

In October he suddenly decided that he likes the special KD food and ate that for one week without vomiting. Then he started vomiting and stopped drinking and eating. Two days later I called a new vet at home (old one was busy that day) and they gave him fluids and started antibiotics. The new blood test revealed that his kidneys seems at limit OK (CREA 198 umol/l) but that he is diabetic - 27 mmol/l (486 mg/l) glucose level and fructose was also very high. His urine test was mostly in the normal expectations or a little bit off. The blood test also indicated that he is having an infection.

After this first visit he gradually started to feel better, eating normally without fuss the same type of food. I've tried to switch him to special diabetic food (Purina DM canned) by mixing it with his normal food, but after a few new episodes of vomiting and low appetite he stopped to eat the mixture so he is now only on normal wet food (protein 50% fat 26% carbs 11%). He also put back some weight (from 4.7kg at the start of insulin to 4.9kg now).

After 10 days on antibiotics we started with Vetsulin but after one month he is still not regulated - his records are in my signature.

 

Hi and welcome Eugen and Pantzel! Sorry you're having trouble getting Pantzel regulated-I feel your pain, Colin and I aren't there yet either! I'm glad he's eating better for you. 11% carbs is still a little high, will he eat any of the lower carb over the counter wet foods? I don't know much about Vetsulin I'll tag @Squalliesmom to see if she can give you any dosing insight.

 

Thank you for the quick reply Sharon!
I'll try to find a lower carb normal food but he, while eating well the same type of food (Sheba fresh & fine), doesn't like anymore the other types - old ones he was eating happily months ago.
Also I noticed, before starting the insulin, that the pre-meal and after meal levels differs only by 3-4 mmol/l. I guess the food is not now the primary concern, with such high levels.

Colin's SS seems to be better than Pantzel's one, with lower overall levels - what kind of insulin is he on? Was he from the beginning on such high doses? For how long was on insulin?

 

Colin started on ProZinc and is now on Levemir because he is a high dose cat and Levemir last longer and gives flatter cycles. He will be tested for acromegaly and IAA this week to see if either is the reason for his high dose condition. Although it can seem like an eternity, one month is really not a long time to be on insulin. It takes many cats much longer to get regulated. Colin has been on insulin since Feb of this year. I wasn't aggressive enough in the beginning because I didn't know any better. He's been doing better since I found this site and have followed the advice I've been given. Vetsulin is sometimes not the best insulin because it doesn't seem to last very long in cats. Is Lantus available where you are? If so, ask your vet about a change.

 

Hi Eugen and Welcome to the best place you never wanted to be. So glad you found us and hopefully you can learn from this forum as there is so much information available and people you really know their insulin. I see where Sharon tagged Lucy to maybe offer some advice with the Vetsulin.

As far as food goes, as Sharon said, 11% is a little high, we recommend wet food under 10% I will link a food chart for you and hopefully it will help.
http://www.felinediabetes.com/FDMB/...for-europeans-and-international-buyers.64843/

As far as regulating: looks like you just started on Nov 3rd. It can be quite a dance with the insulin and Every Cat Is Different, ECID, you will hear that a lot around here. It takes a while for their bodies to get used to the insulin. My cat has been on insulin since June and is still not regulated. We just switched from ProZinc to Lantus on Dec. 1st so, hopefully we will see some nice changes.

While looking at your SS I noticed on 11/7 that your PMPS number was 185 and you did not shoot. When you are that close to 200 ( the cut off number for new diabetics) you could stall 20 minutes s without feeding and retest. Sometimes in anticipation of eating, their numbers will rise. With Vetsulin you want the food on board for I believe 30 minutes ahead of shooting the insulin. This is another area where maybe @Squalliesmom can help. Her name is Lucy and she is very nice.

I am glad that you are home testing as it is so important to keep our cats safe. Please ask any questions you need to and someone here can help.

 

I agree that his spreadsheet is confusing. (I don't use Vetsulin, but the insulin I am familiar with - PZI- works very similarly.) He responds well to a dose one cycle and then not the next. Two ideas:

Some of his numbers can be bounces. When a cat's body perceives a number that is lower than it is used to, it releases extra glucose. Then the next test reflects this extra glucose and can be higher than it "should" be. For example, on 11/19 the 2 units for the 344 gave you a 77 midcycle and he bounced up high for the evening shot to 533. They seem to bounce until their body gets used to lower numbers. It's something you just have to work with.

You might increasing by 0.25 rather than 0.5 and see if he settles in. I think the 2.5 makes sense on the black preshots for a few more cycles to see if it gives you flatter cycles. But when and if you increase, maybe up the scale by 0.25 rather than 0.5 (so 2.25 for the Reds and 2 for the higher pinks.).

The good news is that you are getting good duration with Vetsulin, for the first part of the cycle. Sometimes the lowest point is more in the 3-5 hour range after the shot. He is getting a lower point 6 hours (and maybe later) after the shot. He is also dropping 50% and more, which means the insulin is working. He may just need some dose finessing or he may need some more time to settle in.

The bad news may be that he has high preshot numbers not only because of bouncing, but also because the insulin is not lasting long enough. (This is a common problem with Vetsulin in some cats, though not all). A curve will give you some good data you can use. Take a test every 2-3 hours during the day or night. It should let you see when he starts to drop, how fast and when the lowest point is. Also you can find out when the insulin starts to wear off - is it a slow rise after the low point or does he jump right up in the 8-9 hour range. There are ways to use food with the insulin to help with fast drops. Duration is a harder issue.

 

We have Vetsulin/Caninsulin Guidelines to help you use it most effectively.
If it turns out that duration is a problem (glucose increase steeply at +8to+11 hours post shot(, an option is to shoot every 8 hours.

 

Thanks all for replies !
Very interesting the page with links to European food shops. Too bad that Switzerland is not in EU and I don't know why but a lot of European online shops for pets do not deliver to CH . The fact that the prices for the very same pet food (or anything related to pets) is usually double here must have a connection with this

Anyway for about two weeks since I start the insulin, Pantzel was on a mixture 50/50 of Purina DM (1% carbs) and normal food --> the carbs were then at about 6%. Unfortunately during that period he also started to go over the scale (marked as 33.3 /599 on the sheet - maximum the device I use, Bayer Contour XT, will measure).
This over the scale is freaking me up, and the main reason I'm looking for advices. Pantzel is obviously upset during these periods - asking continuously for food but having low appetite, urinating like 11-12 times per day and laying still under bed.

I followed naturally the guidelines for VETSULIN, giving food and measuring him at 6:30, then doing the injection at 7:00. Then I give him again some food to go over injection easier

I'm using a Vetpen so I can only work with 0.5 units. Even with the Vetpen it is hard to give the injection, as he doesn't cooperate and I have to hold him pretty well . I'm lucky though he tolerate well the measurements.

In the last week we tried to go for 1u but he was almost all that day over the scale.
Then we try with 1.5 a few shots but he's GB levels were raising steadily.
I tried once 2.5 but he was flat high during that day (and out of scale two hours post shot).

So I don't know what to do to keep him at at least on the scale with the highest levels.
My vet suggests to go for 1.5 even with the risk to have his pre-shot levels out of scale for a few days - and high levels in general.
I found on a vet website this info that the initial regularization can take 2 to 8 weeks, but from what you are saying it looks more like 2-8 months

 

Hi Eugen, welcome to you and Pantzel. I took a peek at your spreadsheet -wow- I see what you are talking about!

The first thing I would suggest, and very strongly, at that, is to wean Pantzel onto a low-carb, canned food diet. I know the 11% carbs he's eating now doesn't seem like enough to make a difference, and our kitties can be very resistant to changes in diet, but that is the first place I would start. Transition slowly, mixing only 15-20% or so of the low carb with his regular food each day, until he has successfully made the switch. You will need to monitor his BG closely during this transition, in case he requires a reduced dosage.

Vetsulin is comprised of two agents; one is fast-acting and will usually cause a sharp, steep drop in BG sometime around the +3 hr (give or take), and one is longer-acting to help keep levels down for the duration of the cycle. Sometimes you will also see another, gentler drop around the +7 hr. I have never had a problem with the duration of Vetsulin, it has always seemed to last 12 hours or more for my cat.

Vetsulin should be given at 12 hour intervals. It is safest to give a shot 15-30 minutes after a meal, so there is food in kitty's tummy to help with the steep BG drop. If your Pantzel seems prone to vomiting, this is especially important (we recommend "test, feed, shoot", in that order, as protocol for all insulins). It takes a while for kitty's system to adjust to insulin so it may be a bit before you start to see more "regulated" numbers.

It's good that you are home testing, and have lots of entries in your spreadsheet to provide information! Not only will this help you see patterns and trends you might not otherwise see, it also enables us to better help you when you have questions. If it's possible, you might want to run another curve; it doesn't really look like you've found Pantzel's nadir (lowest point in a curve) yet, and knowing what that is would go a long way to helping determine if he is getting the correct dose, and whether or not you are seeing "bounce", as Sue and Oliver suggested. Your vet's advice to keep him at 1.5 U for a couple of days is probably very good advice. When a bounce occurs the only thing you can do is ride it out while keeping to a low dose, even though you see high numbers. It's very frustrating, I know from personal experience!

In the meantime, since he is experiencing high numbers, you might want to get some ketone test strips for urine testing, just to keep an eye on Pantzel's ketone levels.

I hope some of this may have helped you. Always feel free to ask questions! Everybody here will do their best to assist you!

Lucy

 

@Bobbie And Bubba Thank you, Bobbie!

 

Hello Eugene. Just wanted to pop in and say hi. There is a lot of help here. My Smokey has not been regulated for 18 months since I've had him and probably the year before that. It's overwhelming, panicky, frustrating and some days I just want to give up. They are all normal feelings on your part. You have caught this early. No doubt Pantzel will make an amazing recovery. Good luck, keep asking questions. Knowledge is powerful.

 

Thank you Squalliesmom and Woodsywife for replies!
I wasn't even aware that the ketone test can be done at home! I've just ordered 50strips of Keto Diabur and plan to try the bag over the sand method. Hope he will not prefer the rug - which ties my room together
This morning I still gave him 2u but the highs seem to slowly raise so probable I'll get back to 1.5u for 3-4days and see what happens (already tried for 2 days and they were still raising).
I really hate to see him over the scale but I understand that it might be unavoidable

I'm looking now for another low carb food as he will not touch anymore the Purina DM, even in small quantities covered by plenty of normal food.

@Woodsywife I'm sorry to see Smokey is still unregulated after 3 months of insulin. Maybe he is having another underlying condition? I often ask myself if Pantzel doesn't have something else blocking the regulation but, from what I read on this forum, it looks like it can take a lot of time - a lot more than the 2-8weeks I was expecting

@Squalliesmom - I did like 2 curves till now, and doing the third today - if that means measuring every two hours between shots, and his nadir seems to be around 6 hours after. Too bad that the BG level seems to skyrocket between +9 and next PS. Once they went from 13 to 22 in just one hour - I double measured thinking the strip might be defective.
I'm also doing 7AM/7PM shots - did a couple of times one more when he went over the scale - e.g. at +6 time.

Have a nice Sunday all of you!

 

Yes it takes time.

 

Your curve looks good - it will be interesting to see whether the number shoots up and when, at the end of the cycle. The numbers aren't awful - he drops substantially at +4 but the food you gave in the first part of the cycle may have kept him surfing along in the yellows for the hours after.

He looks to me like a cat who needs a little more insulin. You want him to get in regulated ranges first, so yellows at pre shot and blues and higher greens at nadir. Once you are there, then you can start pushing him into lower ranges, as long as you can monitor carefully and bring him up if he would drop too low.

I think I'd increase to 2.25 for the pink preshots (staying at 2 for the yellows) and see if he drops into lower ranges overall. I am not sure about your pen. If it is like Lantus users here use, they use needles to give smaller doses. On this thread, under the Syringes heading, you'll see the pictures of how it is done. (The rest of the information on the thread does not apply to Vetsulin)

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-info-proper-handling-storage.151/

If you buy U100 needles and use the U40/u100 conversion chart, you can dose in even smaller increments. Many U40 users here use this technique and increase and decrease by amounts like 0.2/0.4. Here is the chart:

http://www.felinediabetes.com/insulin-conversions.htm

 

Squallie went from 87 to 187 in 30 minutes once; sometimes it's just crazy!

Good work with the curves! I agree with Sue, it looks like Pantzel's first substantial drop is in the +4 range. I would follow her advice and see how his numbers shake out. If it doesn't work, we'll try to help you find what does.

I know some people have had issues with the duration of Vetsulin. I have never really had a problem with it unless Squallie gets caught in a bounce (ugh, I dread them) or is affected by some outside influence, e.g., stolen food from another's dish, infection, stress, just things that will make BG rise. Bounces are the worst, it takes very little for my guy to start bouncing and he can go on like that for a very long time before I can manage to get him back on track!

Keep us posted to let us know how Pantzel progresses!

 

Hi Eugene,
Are you able to buy cat food from Zooplus?
http://www.zooplus.ch/
The link to UK foods in my signature (at bottom of this post) lists foods that may well be available from Zooplus in Switzerland? (For example, Granatapet, Catz Finefood, Mac's (grain free version), Miamor 'mild meal' (certain flavours only), and others....)

I'm sorry to see that you're having trouble regulating Pantzel. His numbers look very like Bertie's numbers when he was first diagnosed. We'd get high numbers and then sudden lows, and then highs again. Some of it was due to the 'bouncing' that Sue explained above. But some of it was just....'odd'...and made no sense at all!
Things got better over time for us. And a change of insulin helped a lot. Would your vet be willing to prescribe a longer-lasting insulin if the Vetsulin isn't working well enough? (I think you may be able to get glargine (Lantus) in Switzerland?)

Edited to add: We do have another member in Switzerland. I'll tag Kim @kimouette to see if she can help with local knowledge! (She's not on the forum much at the moment though, and so may not see that she's been tagged; but if you send her a message she may receive that as an email...)

Eliz