New member Duke

Sorry, if this is a bit choppy, but our experience with Duke so far has been very choppy. My question in a nutshell is, how often and when should I be monitoring his blood glucose level?

A partial history follows.

Duke is an 8 year old male Maine Coon mix. He has never been overweight in his life. He was never fed a high carb diet. He was diagnosed with diabetes in early February of this year. Since February he has improved and then crashed on us 3x. Most recently last week. We are having a hard time regulating his blood sugar. He was on vetsulin, but was switched over to a compounded zinc formula - 3 units 2x a day.

We initially brought him in because he had stopped eating. They found he had a gas bubble obstructing his intestines. His blood test indicated elevated glucose levels. He was kept overnight. We stopped in the next day and he looked terrible. After a few days at the vet with little visible improvement and still not eating on his own. He still perked up when he saw my wife. We took him home expecting to spend our last night with him. Orders were 1 unit vetsilin 2x. I started syringe feeding him and after a few days was eating on his own again. Eventually he gained weight and started playing with our other cats again. This was after many vet visits where they monitored his glucose levels.

Eventually we were given dip sticks to test him ourselves. The dip strips kept giving us really high readings - turned brown - and we'd take him to the vets the next morning and he'd read in the high 200's to mid 300's. Increased to 2 units.

Then he crashed again. Listless, not eating. Repeat above, many vet visits insulin increased to 3 units. After much prodding, the vet said he would order a glucometer for us and call us when it was in. We were to bring him back the next morning. Again, many vet visits - day only to monitor his glucose level. My wife called and we were told the meter was in and was told they tried to call her - highly unlikely. I had been syringe feeding him amnd he started showing signs of improvement.

Last week he crashed again. He was listless, not eating so we took him to the vet (Thursday). According to the vet, his blood sugar was 135 when he got there and 5:30 by the afternoon. He was given fluids - low potassium - and a shot of humulin (?). I asked about the meter and were told to bring him back the next day. We took him home with instructions to give him 2 units of humulin at 6:00 and again at 9:00 and bring him back in the AM. We only had urine test strips that really haven't been working for us, so I gave him the 6:00 shot, but chickened out on the 9:00.

I had a consult with another vet that afternoon and made an appointment for a second opinion the next morning. We had already reconciled with the fact that it may be our last day with him. His blood sugar the next morning at the new vet (Friday) was 335. His K level was only slightly elevated. She recommended we take him to an emergency clinic for observation over several days. We had already decided that we were not going to subject Duke to anymore extended hospital stays so we took him home - he does much better when he is around my wife and we wanted to spend our last night with him at home. Orders were for to continue 3 units 2x.

Later that morning I went out and bought a Relion meter from Walmart. I syringe fed him Friday AM and PM. Shot after each feeding. Blood glucoese was 235. I fed him Saturday AM. By Saturday afternoon, he was eating again. Blood glucose tested at 65 at 8:00 pm! He was eating well and following my wife into the kitchen and crying for food. By Saturday night, he was sitting on my wife's lap. Today (Sunday) he is eating really well, responsive and quite strong. Still vetsulin 3 units 2x after eating. He ate at 6:00 and was given his shot. I took a glucose reading at 8:00 and it read 335.

Questions:

How often and when should I be monitoring his glucose levels?

Since he is very underweight (a bit less than 7 lbs) we fed him Saturday night and today whenever he was crying for food. We feed him Wellness diet. Should we restrict his feedings to twice a day to correspond with his shots?

I have lost faith in our vet. They never trained us to test at home and always had us bringing him in for the day for observation, monitoring, etc. The cost has been staggering, with no solution found. It seems we just kept paying for the same thing over and over expecting different results.

I realize that some cats can't be regulated and have accepted Duke may be one of them, but when he pulls out of the crash and starts acting and eating normally, we hold out hope that better home monitoring may prevent the next crash.

Anyway, thanks for listening.

 

Hi and welcome. Soon you will be receiving many responses to your questions.

First, Vetsulin has been recalled. Please ask your vet to switch your insulin, most people here prefer Lantus. Harley was on Vetsulin when he was dx before the recall. There are many low cost changes you can make to help Duke yourself. Changing his diet, home testing so you won't have to pay the vet to do it and that also gives you more control (knowing what his bg #'s are before giving him insulin) so you won't risk a hypo.

Hang in there, ask questions and read, read, read. There is a wealth of information here.

 

Thank you.

In the end we just want to do the right thing for Duke - wherever that leads us.

I forgot to mention that on Thursday and Friday, Duke was hovering over the water bowl. This stopped Saturday morning.

 

Welcome to the board.
There are many issues here and I know others will stop by.
I agree to try and get Duke off vetsulin.We started off in aand I switched to Lantus for my Max as I read that newly diagnosed cats starting on lantus have a much better chance of remission. It took us 5 months! But every cat is different.
Plus it is a longer acting and less harsh insulin. Vetsulin also has had its problems with FDA alerts and recalls.

With respect to food, an unregulated cat will want to eat a lot as the food is not being absorbed due to the high BG #s and at 7 pounds, let him eat.

Does Duke have other medical issues or take any medications?
It is great that you got the relion meter and started testing on your own. At a minimum, you eed to test him before each shot and we like to withold food 2 hours before each shot so that you have a truer number and not one that could be influenced by food.
From what I read in you rpost I do not see why you feel that you might have little me with him.
Being proactive, diabetes is managableo nOr does it require long and expesnive vets stays.
My Max was off insulin 5 months after starting Lantus and he ad not seen a vet in 4 months.

Where are you loacted?

 

Hi, I didn't offer alot of advise because when Harley was dx he was over 500 and I was lost. I thought I was loosing my buddy. We started him on Vetsulin before the recall. But I found this site within a few days and realized that the people here were treating and living with their diabetic cats 24 hours a day, 365 days a year. This is treatable and affordable. I listened to their advise about diet and home testing, I printed out Janey & Binky's food chart, I filled in my profile, I started his spreadsheet and linked it to my signature. I did my own curves instead of taking him to the vet for it.

Harley was on Insulin for only 3 weeks when he became diet controlled. We are coming up on our 1 year anniversary of 1 year OTJ (off the juice) (anti jinx) so that's why I didn't feel that I could give adivse, just incourage you to keep reading.

You have found the best place to help Duke.

 

I'm sorry you are having a rough time with Duke, but it can get better. The more you learn about feline diabetes the better you will be able to manage his treatment.

My immediate concern when reading your post is the number of hypoglycemic events - if that is what you mean when you say he crashed.
Hypos are serious and can be life-threatening.

Here is an article you need to read/print to help you recognize and treat hypos.
viewtopic.php?f=3&t=15036

I don't understand why the vet raised the dose on a cat who was going too low - so please, do not give the amount of insulin to Duke that caused him to crash. If you started at the 2u - you probably started too high. You might consider going to 1u BID and, maybe even .5 (1/2 unit) because he seems to be so sensitive to the insulin.

I would also urge you to consider switching to Lantus (glargine) insulin. Your cat is newly diagnosed and it seems you would have a better chance to get Duke into remission using Lantus.


Questions:

"How often and when should I be monitoring his glucose levels?"
Most of us test preshot - before the morning and evening shots. Whenever possible, we test mid-cycle to establish nadir (lowest point or peak of insulin). Once Duke is on a dose for a few days you can do a curve - testing every two to 3 hours to get a picture of how he is responding to the insulin.

"Since he is very underweight (a bit less than 7 lbs) we fed him Saturday night and today whenever he was crying for food. We feed him Wellness diet. Should we restrict his feedings to twice a day to correspond with his shots?"

Please do not restrict his food. You've recently had to force-feed him - you need to make sure he eats, and eats well.

"I have lost faith in our vet. They never trained us to test at home and always had us bringing him in for the day for observation, monitoring, etc. The cost has been staggering, with no solution found. It seems we just kept paying for the same thing over and over expecting different results."

There are many vets who treat diabetics in a similar manner, so, don't think it is anything your vet did wrong. It just seems it is up to you to research and take charge of the treatment. You can educate your vet and everyone will benefit.

"I realize that some cats can't be regulated and have accepted Duke may be one of them, but when he pulls out of the crash and starts acting and eating normally, we hold out hope that better home monitoring may prevent the next crash."

Please read and print the link I posted at the beginning - you should not have a crashing cat. He is getting too much insulin, and with proper doseage, insulin, food, and monitoring, you should be good going forward.

Best,
Pam & Layla

 

Just a quick thank you for all the great advice. I'll be able to write a longer post after work.

This morning Duke looks good and is acting hungry. My wife feeds him before she leaves for work so I don't know how he is actually eating.

More later.

 

I agree with Pam & Layla - it sounds like each time Duke 'crashed' he was probably going through a hypoglycemic episode. Glucose readings at the vet can be elevated by 100-200 points or more just because of stress, so that one reading of 135 at the vet was actually a good number and a fast acting insulin like Humulin should not have been given.

I am so very glad you found us here - there is so much information here that it can be overwhelming for some. Just a few pointers for you:

* Talk to you vet about switching to another insulin like Lantus or ProZinc - much more stable and longer acting insulins.
* Hometest at the very least before each shot. If possible, get a mid cycle reading at around +6 to +8 hours after the shot to see how low he is going.
* Adjust the dose based off of when the lowest number occurs (nadir) and how low he goes.
* Make sure you are feeding a low carb WET food - never dry. Due to the manufacturing process of dry kibble, they will all have a higher starch/carb content which is required to form the kibble pieces. Prescription dry foods are no different. You can check out different foods on Janet & Binky's food charts found on the main feline diabetes page. Most here feed Fancy Feast grain free varieties, Wellness, Evo, and a few others.

 

Thank you.

Our vet has never discussed hypoglycemia as an option for Duke crashing on us.

The crash leading up to the recent episode started with a phone call from my wife saying Duke was not doing well. He was listless and had difficulty moving. When I got home he was lying on the floor and was barely responsive. I immediately thought hypoglycemic (from what I read) and fed him honey, but this was more panic mode on my part than anything else. This started his next round of vet visits and overnight stays. Where he was again diagnosed as being hyperglycemic. This started the Humulin N therapy and the switch from vetsulin to a compounded Zn PZI (? no label on vial) bought from a compounding pharmacy. This was when he tested at 135 in the AM when we brought him in to the vets where later that day he tested in the low 500s.

I can now test, but is there a way to distinguish hypo vs hyper based on behavior/symptoms?

We feed our cats Wellness, Wellness core, Wellness core pellets, Wellness Healthy Meals in pouch and Fancy Feast appetizers. The Core pellets are high in protein. Should we stop feeding this to Duke? We actually switched the cats over before Duke was diagnosed as diabetic. His sister would get inflamed ears which we think may have been caused by artificial color, gluten or beef. When we switched to wellness, this problem went away.

We've been testing Duke on the ear. I tried the lancet pen which came with the meter, but had poor luck (and poor Duke) hitting a vein. Last night I gave up and just used a lancet and manually hit the vein. This worked really well, but there was more blood than when the pen was used.

New question: Should shots be given after feeding? Before feeding? At the same time each day? Currently we give the shots after feeding.

There is so much conflicting information, it's hard to know what to do or where to turn.

 

No question but this is all confusing, Bone Daddy. It is a very steep learning curve but you are getting it fast. Here is a link for hypo: http://www.felinediabetes.com/hypogly.htm Here is the link for hyperglycemia: http://petdiabetes.wikia.com/wiki/Hyperglycemia

It sounds like you may be using the compounded PZI. Have you seen the PZI Insulin Support group? Not sure how busy it is tonight, but you might ask your insulin questions there: viewforum.php?f=24

What do the Wellness core pellets have in them? Can you goggle them to see the carb content?

You don't need to aim for the vein. You really want the small capillaries that run from the vein to the outer edge of his ear.

 

Here's a good video demonstrating testing blood glucose. It has some still shots showing how to aim between the vein and the rim of the ear.
http://www.youtube.com/watch?v=_zE12-4fVn8


Have you lowered the dose yet?

I would also suggest you establish a no-shot number. Most people, and especially someone using pzi or N insulin, use 200 as the cut-off point.

Yes, you want to make sure he eats well before giving the shot, and I would never leave the house without having food available for him.


Dry food raises glucose - even the low carb types, so, that is another factor to consider.

Best,
Pam & Layla

 

More on Duke

Thank you everyone again.

Duke is still doing fine. He didn't eat much for me at dinner, but when my wife came home he ate really well. She usually feeds them. He is such a momma's boy

We do not free feed our cats.

They are fed once in the morning (7:00 or so) and once in the evening (5:30 or so) and a treat (8:00 or so).

If Duke needs to have food available to him at all times, we will need to keep him separated from the other cats during the day.

I did check the ingredient list for the Core pellets and they are a problem - potatoes are an ingredient, as well cranberries, tomato paste and chickory root. It is high in protein, but I can see the potato as being an issue. I'm guessing the other fruit, root and berries are added to make it appeal to health conscious consumers as in purchasers, not eaters.

I bought scale today so we could track Duke's weight. It is a standard digital bathroom scale. The problem is it reports my weight with accuracy (hmmm maybe too accurate) but doesn't even register anything for the cats. Does anyone have a scale they can recommend?

 

Baby scales are really good to use for cats since they are calibrated for such low weights.

As for the low and then sky high numbers all in one day - if Duke is having episodes where he goes too low, or lower than his system is used to, he could be going through symogi rebound where the body tries to protect itself and secretes glucose into the system giving ultra high numbers for a few days. This could also account for the cycle of crashing and days of Duke being ok.

Most kitties do well with less than 4 units of PZI type insulins. The normal protocol is to start with 1u twice a day for 4 days or so and then re-assess the dosing and adjust accordingly. Of course, hometesting all the while

 

I don't have a seperate scale for the cats.

I weigh myself, get off the scale, pick up the cat, weigh myself again. and subtract my weight.

 

05-24 Duke's BG

Thank you for the video link. It helped a lot. Although Duke is not quite to the purring point, I did get a nice sample. Right now it is a 2 person operation. Sort of a good cop/bad cop deal. My wife does the pets I do the pokes.

I have not adjusted his insulin dose. He is getting 3 units 2x a day as prescribed.

I'd like some more information on establishing a no shot target. My guess this will come after I get a better fell for his required insulin level? Is this measured before he eats? So if he is within target range he would be fed, but would not receive a shot?

Today:

Received 3 units after breakfast approx. 7:00 am

Received 3 units after dinner approx. 5:30 pm.

BG at 9:30 pm was 112. I figured this should be timed with the onset of the insulin? As a reward he got some fancy feast tuna appetizer.

Tomorrow pm I'll take a reading before feeding and shot.

I know I should be testing in the am also. Right now one test in the PM until we get the process down seems to be less stressful on Duke and my wife. I don't know if this make any sense. Of course I'll watch Duke and monitor if things seem awry before tomorrow night. Tonight's test went really well. Hopefully we'll soon get to the point that I can test him by myself.

So my plan is to test once in the evening for the rest of this week then do a glucose curve this weekend. Please let me know if this is wholly inadequate.

Your honest input is always appreciated.

 

Thanks Rob.

I was thinking that may be the way to go. I'll give it a try.

BD

 

Hello. As a fellow vetsulin user, and who had a cat crash on this same insulin- twice, I am VERY concerned at the size of the dose you have been asked by the vet to continue to give.

I will simply add at this time, there are ways to help this insulin work more safely than your vet has instructed you and I too, had to find out the hard way.
here is a primer of info and tips just for vetsulin ( also known as Caninsulin around the world )
have a look at the food section and the rebound sections as well enclosed.

viewtopic.php?f=19&t=302

Using it safely while you research and take control of your kitty's diabetes is so important.
This insulin has a serious recall do to unstable efficacy which makes regulation beyond challenging and safe dosing even more so.

Lantus and levemir are excellent next steps.
I personally would not trust vetsulin at this time, for any of my kitties, due to the vehemency of the recalls.

Your baby is running out of reserves to save him when he crashes and continuing with the dose that caused those crashes, is dangerous.
I don't want to freak you out, but I do really want to urge you to reconsider the dose, get home testing as much as you can, and talk to another vet about a different insulin asap.

Please keep us posted, we are pulling for you guys.

 

Thank you.

This morning Duke looks great. Last night he was snuggling with his sister Tatiana on our bed.

Today marks the start of the 5th day of home testing. We are going to give 2 units this morning instead of three and test in the PM before the next shot. I have a log started. I will start a spreadsheet.

We are not using over the counter vetsulin. It is an insulin compounded at a local pharmacy. Does this make a difference? I will make an appointment to talk to the vet about other insulin options.

Reading other posts last night had me teary eyed. I can feel the pain and anguish of so many. It is heartening to read of the successes. This board is a blessing.

Continuing thanks for all your help.

 

Thank you for the link - Duke

Thank you for the excellent link.

I'll wean him to a 12:00 apart feeding. That would be 7:00 AM and 7:00 PM. I'll start by moving the PM feeding to 6:30 then to 7:00.

I've been so caught up in the moment that I haven't properly introduced our other cats Elmo and Tatiana. They are Duke's litter mates. My friend has his other brother and had his mother (RIP). We got our cats from him. Both Duke and Tatiana are torties. Elmo and his other brother Leopold are brown mackerel tabbies. More about them later.

Again thank you for your continued help.

 

The am and pm bg testing is to see if it is safe to give the insulin, so both are vitally important. Early on in this game, you just can't predict what might happen. It takes some cats a week or more for their body to react to the insulin and food change, and then suddenly they do. When we changed Oliver from dry food to wet, his bg levels went down 100 points from the evening shot to the morning testing. If we had just given him the regular amount, we would have sent him into a hypo situation.

The no shot number is also important. Usually, for new cats, it is 200. Once you have a record of amount of insulin given and the numbers that resulted over several weeks, you have a better idea of how he reacts. Then you might be able to lower the target. If he is at 200 at the time you would normally shoot, you usually wait an hour and test again. If he is above the no shot level, you can then give the insulin. It is tricky, but many posters here have experience with this.


4 hours after the shot is probably close to his nadir. (Every cat is different.) The nadir is the lowest point the insulin takes him. You should try to get +5 and +6 to see if he goes lower than the 112. Some cats with vetsulin do have a nadir further into the cycle. If he is going lower than 112, you need that information. Dosage is based on that nadir number, not the preshot number. If he is going low in the middle of the cycle, the higher numbers at preshot times can be a rebound from the low number. That is why people are urging you to try less insulin: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

It is hard to trust/take advice from strangers on the internet. But everyone here has/had a diabetic cat and treated them successfully. We love our vet, but she sees few diabetic cats. She started us on a dose that was too high. When we came here, everyone urged us to lower the insulin. They were right. We agree to disagree with our vet on food. She wants us to feed RX but we think the research shows the ingredients are inferior. We use our vet for shots, check ups etc. but if we have another diabetic cat, we will be on this board asking for advice from day one.

 

Just wanted to send a quick thank you for all the advice.

BD

 

Re: Thank you for the link - Duke

I'm coming in late, but I didn't spot in your thread where you were advised to move the meals to 12 hours apart. The *shots* need to be 12 hours apart, or as close as you can get, but meals can be anywhere from free-feeding to lots of mini-meals to 2 big meals. Depends on the cat and the home situation - what works well with one may not work so well with another.

How the particular cat reacts to the particular insulin also figures into the equation. It might be that 2 big meals close to shot time would provide the best cushion against overreaction to the insulin you are using. Perhaps that is the reasoning behind moving his meals?

(I'm one of the lucky ones whose cat went into diet control right away, so I haven't used any insulin at all. Don't take my musings for the voice of experience.)

 

Duke Update

Thank you.

I'm not sure where I came up meals 12 hours apart. I may have misinterpreted that if shots are 12 hours apart, then meals would follow suit.

This morning Duke received 2 units of insulin after eating. Approx. 7:00 AM.

When I came home for work he greeted me and meowed for food. He really looks good (guarded optimism).

At 5:45 tonight, Duke tested at 363. This was preshot, prefood. My stick was much better. I'm getting a feel for the sweet spot.

For dinner he had a very hearty appetite. He ate approx. 4 - 5 oz of Wilderness diet. First turkey and then chicken. I let him eat his fill. After eating he retired to the living room rug where he usually hangs out when he's well. I gave him 2 units of insulin (it is compounded PZI "vet"). I will test Duke again at 9:00 PM.

Thanks again for all your help.

 

Duke Update

Our 9:00 BG level was 285.