Newcomer: neuropathy in hind legs: nothing is working...

My senior cat was diagnosed with diabetes 5 months ago: it took a while to get his glucose readings down. His hind legs (neuropathy) got worse over that time. Potassium was tried: no change. BooBoo has been on cyanocobalamin injections for six weeks now, and still no improvement. It seems that he is loosing strength more and more. I don't know what to do. My vet is away until May. Is there anything else I can try?

 

Hello and welcome. You want to try methyl B12 instead. Zobaline is one such brand specifically for neuropathy. Available through the manufacturer or Amazon. That plus getting his blood sugar numbers regulated are what will help. Is he still getting insulin?

 

Thats what we used and it started working rather quickly. GOOD LUCK you've found the right place!

 

Also are you home testing or just taking him to the vet for testing? Home testing is the best way to determine how well the insulin is controlling glucose levels. It takes a combination of controlled glucose levels and methyl b12 to reverse neuropathy. Cyanocobalam does not work for neuropathy.

Years ago when I adopted Spot, she was an uncontrolled diabetic cat with severe neuropathy. I switched her over to Lantus and immediately started her on methyl B12. When I adopted her she could barely walk. Within a few weeks of being on the right insulin and dose and also taking methyl B12, there was improvement in the neuropathy. With him three months she was walking better and started jumping on the bed. In a little over six months you would have never known her neuropathy was as severe as it was. She was running and jumping as high as she could on my furniture and cabinets. The higher the better as far as she was concerned. Not every cat will respond the same way, however once you get the glucose levels under control as start the methyl B12, you should begin to start seeing some improvement.

 

What are you cat's blood glucose readings? What insulin and what is current dose and frequency. What is typical BG before shot and lowest between shots?

 

Thanks for your quick reply. I don't think I can buy Zobaline in Canada; there is methylcobalamin human grade (like from Nat. Factors), but I don't know if it is equivalent to Zobaline... I will order it online, hoping it won't get confiscated at the boarder. My old boy is taking Lantus, 4u mornings and 3u nights ( he weighs around 15 lbs); his glucose was in the high 20s mmoles at the beginning, but now it is around 11-16; our vet prefers to see him at that level, than too low.

 

Thanks a lot. At least I don't feel alone now.

 

Thank you for sharing your experience. I will order the right B12; it seems that I have wasted a month and a half trying the Cianocobalamin. As for the glucose levels, they did come down quite a bit; they vary now between 11-16 mmoles.

 

Lantus is best dosed using the same amount for each test cycle. Number of Units should be the same, for both the AM cycle and the PM cycle. At least until you get readings that require an increase or a decrease.

You are dosing a different amount for the AM and PM cycles. Why are you doing that?

 

I took four readings yesterday: 12.1 at 11:30am, 8 at 3:30pm, 14.8 at 7:30pm and 15.7 at 11:00pm BooBoo gets 4u of Lantus mornings and 3u at night. Yesterday he got his injections at 9:00am and 9:00pm. I don't test on a regular basis; should I? How often? How many times a day? I have been testing after a dosage adjustment or every 3-4 weeks and sending the results to the vet. Thank you.

 

Ok, so if you could get some of those little bits of information in your signature and get a Spreadsheet started, You are halfway there.

New? How You Can Help Us Help You!

• Testing is a minimum of 4 times a day.
  
• Your first test should be done before every shot of insulin. Every day. AMPS is the morning test, PMPS is the evening test. So that is 2 tests.
• Then testing in the +4 to +7 hour timeframe to find the nadir. At least one test during the daytime, the second one at night.
  
• Other spot checks can fill in useful data on the SS.

• Give the same dose of insulin for both cycles. don't understand why AM dose is 4 and PM dose is 3U. That is simply lettting the "depot" drain each night cycle. You want to select a dose you can give both cycles.
  
• Lantus needs to be given as close to 12 hours apart as possible.

We have members all over the world, so 9am your time may be 6am elsewhere. We use a + based system for counting hours
0 is the start of your 12 hour cycle. So your 9 am goes in the 0 column on the SS, The AMPS reading.
11:30 is 2.5 so put that in the +2 column
3:30 pm is 6.5 hours so put that in the +6 column
7:30 pm is 10.5 hours so put that in the +10 column

9 PM is the PMPS reading
11 pm is the +2 reading

 

You can buy it direct from the manufacturer Lifelink, but the shipping cost is rather high. Check out this post for making the equivalent in Canada.

 

We encourage caregivers to test their cats on a regular basis. Unquestionably, home testing is the best way to insure your diabetic cat is in safe numbers. Even a well regulated cat can throw you a curve ball and numbers will be lower than expected. As an example, my kitty was one that liked to keep me guessing. She could start the day at 400, drop to the 40s, and be back to the 400s by her next shot time. (Obviously I'm using US numbers -- or 22 to 2.5 to 22.) If I hadn't gotten that spot check, I would have been increasing her dose versus finding out that she needed a dose reduction.

At the minimum, you want to get a test prior to each and every shot so you know numbers are in a safe range prior to giving an insulin injection. You also want to get at least one test during both the AM and PM cycles. If you look at the spreadsheets that are attached to our signatures, you'll see that people vary in how often they test. I was a testaholic. I also had a very unpredictable cat and I like data. There are times when you need to test frequently. Those are times when numbers are running low and you need to monitor to make sure that your cat is responding to your intervening with food. Then there's the rest of the time when you don't need to be testing often.

We tend to take a different approach then your vet. We want to see cats regulated so their numbers put them below renal threshold (roughly 200 or 11). Diabetes is tough on the kidneys and kidney disease is a common problem as cats age. Hence doing our best to get numbers below 200 or in normal range (50 - 120 or 2.8 - 6.7). Even better is if we can get a diabetic cat into remission. Vets get nervous with lower numbers since not that many caregivers will agree to home test. Home testing is the only way to insure your cat is safe -- something we can't say frequently enough!

As Wendy noted, Lantus does best when you give the same dose at each shot time. Lantus is a depot-type of insulin and any time your change the dose, it has an effect on the depot. Given that you're changing the dose at each shot time, the depot never has a chance to stabilize. You might want to take a look at the sticky notes on the Lantus board to get more information on Lantus and how it works.

 

Thank you for all the information: this is quite new to me. I'll have to work on the glossary, and eventually speak your language...! Why am I giving 4U mornings and 3U nights? My vet proceeded with incremental dosage adjustments: it was 2-2, then 3-2, then 3-3 and now 4-3. She is very wary of hypoglycemia

 

Thank you.

There is so much new information here that I need to process. I realize that do have to change my ways of testing BooBoo though. I"ll read up on the Lantus board; my vet increased the dosage incrementally, one unit at a time, from 2U-2U last Sept. to 4U-3U today. The readings are mainly in the 12-16mmoles. How big of an impact might it have if I did give BooBoo 4U-4U? Thank you.

 

4 units is a very high dose for most cats unless there are other medical issues that make the cat insulin resistant.

At that high of a dose your cat is at risk of becoming hypoglycemic. You vet raised the dose by too much. If a dose increase is needed, it should only be by 1/4-1/2 unit and unless you are following TR protocol, wait at least a week before increasing it again. I think you have missed the optimal dose. Too much insulin can look the same as too little. When the dose is too high the cat's body produces extra glucose to prevent hypoglycemia. The higher readings are also contributing to the neuropathy problem.

If you are not home testing I encourage you to do so. I also suggest starting over with a low dose and slowly increase it by small amounts to find your optimal dose. I think you missed it when increasing by 1 unit at a time. Most cats only need 1-2 units per shot. Once you find the best dose that keeps the glucose levels under control and with the methyl B12, you probably will see improvement in the neuropathy.

 

I'm not sure I'd suggest dropping the dose too low. Let's not get ahead of ourselves.

First, from your comments in post #10 above, it appears you're home testing. That's one big hurdle you've leapt. Can you set up a spreadsheet? That will allow us to follow along with BooBoo's progress and help you figure out next steps. Click on the dark blue "spreadsheet" and it will link you to the instructions for getting a spreadsheet (SS) set up in your signature. It would be even better if you could take readings from your records (or off of your meter) and enter them in the spreadsheet. If the shorthand for the column headings is confusing, this link provides the explanations.

Rather than increasing the lower dose, how about lowering the higher dose? In other words, what do you think of trying to shoot 3.0u twice a day? This will give the insulin depot a chance to stabilize and give you a chance to get used to how we can help you manage BooBoo's diabetes to say nothing of giving you some time to read through the sticky notes and ask questions.

I may have missed what you're feeding BooBoo. Could you let us know whether you're feeding canned food or dry and what the carbohydrate content is? We're big advocates of low carb, canned or raw food. If your kitty is a dry food addict, we can make suggestions regarding lower carb options.

One final link. This is a post on helping us to help you. It contains some of the links above along with lots of other information. You are absolutely correct -- we will overwhelm you with information. That knowledge is power and the ability to keep your kitty safe. This is also an incredible group of caregivers who are very generous with their time and their knowledge. We're all here to help.

 

Sienne and Gabby (GA) has suggested that there are many more experienced users of Lantus on the Lantus ISG. You may want to think about posting over there.
Lantus / Basaglar (glargine) and Levemir (detemir)

 

I'm doing a lot of reading; trying to figure out the spreadsheat. Getting there.... I also ordered the Zobaline. Just hope it gets here.

 

How are you trying to figure it out?
How to create it? How to link it to your signature?
What all the information means?

Would you like someone to set the spreadsheet up for you?

 

I like to get a grasp of it on my own first. I imagine I will have some questions to follow. Thank you for your concern. Appreciated.

 

These may help you to "figure it out".

• FDMB Spreadsheet Instructions
• Understanding the Spreadsheet/Grid