Newly Diabetic with Neuropathy

Hi,

My Maine Coon Cat, Mr. T, was diagnosed with diabetes on Februray 5. When I brought him to the animal hospital his medical record note said:

MM: pink
CRT: <2 sec
HR: 224
R/R 80
Temp 100.3
weight 13.5 lbs
BG 455
Urine dipstick 2000 mg

drs notes:

EENT: mm pink, moist, CRT =2 seconds. Nose/ears/eyes NSF. PLN/INTEG: NSF. GI/UG: NSF on palpation, urinary bladder is large and soft. MS/NS: Ambulatory x 4, plantagrade stance in pelvic limbs, no ambnormalities palpated. Mentally bright/alert. CV/RESP: Auscults NSF, pulses strong and synchronous.
Assessment: PU/PD, plantigrade stance; r/o diabetes mellitus
Plan: BG =455, urine diptstick = 2000 mg/dl glucose.

The dr discussed insulin options with me, glargine vs other. The glargine seemed like a very expensive process and there was an increased risk of hypoglycemia so I elected to to start Mr. T on a low dose of Humulin N at 1.5 units q 12 h. If he doesn't do well with this insulin we would try another. She said it was better for him to be a little too high for a while than too low. She said the change in diet would also help his blood sugar (I was only feeing him dry Iams before). She said it woud take some time for before his limb function would improve. She also submitted a urine test and ordered a fructosamine level.

They showed me how to give Mr. T the shot, they gave him his first shot of insulin, gave me a box of needles, a supply of canned and dry Purina DM, and a perscription for the insulin and suggested that I return in 5 days.

Discharge intructions were to feed Mr. T the canned food in meals with his insulin shot, twice daily and give him a small amount of dry food as a snack if needed during the day.

I give Mr.T his shot at 7 am and 7 pm.

On Feb 6 they called me with his test results - GLU was 477 (the ref range is 64-170). His Furctosam result was 535 micromoles (ref range is 142-450).
<500 is good regulation, 500-614 is fair and >614 is poor

On Feb 10 we returned to the vet.
Mr. T was 13.97 lbs - a gain of .47 lbs.
He was eating and urinating less but neuropathy still present.
Glu was 301 mg
Dr said to continue with 1.5 units q 12 h

On Feb 23 I started to take his BGs. At 6:13 pm his BG was 258 (gave him his 1.5 units) and at 8:33 pm it was down to 200.
On Feb 24 at 7 am I gave him his shot and at 9 am at his vet appointment his BG was 318. At 5:42 pm his BG was 369 before his 7 pm shot.

The dr called with the results of Mr. T's fructosam result which was still in the fair range and suggested that I go up to 2 units.

On Feb 25 at 6:30 pm I started Mr. T on 2 units. At 10:07 pm his BG was 148.
On Feb 26 at 7:22 am his BG was 361 before his shot. At 5:26 pm his BG was 266.
On Feb 27 at 7:35 am his BG was 325 before his shot and at 12:44 pm his BG was 200.

I am very worried about the neuropathy in his legs. The dr said he's only seen the back legs affected and not the front and he didn't think it was from the diabetes, he thought Mr. T had torn his tendons. The dr had a discussion with other vets and they said that they didn't think the neuropathy was just from the diabetes. The drs think that the diabetes caused the tendons to become weak. He said they could do surgery on the tendons but that the cat would then walk stiff legged. He said as long as the cat wasn't in pain he could live with the neuropathy.

I read about the B12 methylcobalamin and have been adding the crushed pills to Mr. T's wet food. The dr expressed concern about the quality of the B12 I bought from the health food store. He said that he could inject the vitamin instead.

Any words of wisdom would be appreciated.

Teri

 

Hi Teri & welcome!!! I don't have experience with that insulin so I can't help a lot, but wanted to say hi. The board is a little slow tonight, but I'm sure you will get more help later tonight or tomorrow.

The one thing that comes to mind to me is that the dry food is probably a little bit high carb. My cat was on DM dry and needed about 4 units of insulin - once I got him switched to low carb (LC) canned, he only needed around 1 unit. The DM canned is also higher in carbs I think than some foods you can get at the pet store. If you haven't already, head over to the Health Links forum - there are some good links there for information about diet and also Janet & Binky's food charts that identify the carb content of many foods (see the Nutrition & Diet topic). If you make food changes, please be aware that you may need to lower the insulin dose and/or monitor BG levels more closely. Sometimes the reduction in BGs from the food alone can be really dramatic.

That is great that you are home testing and already have so much information, great job!!! I don't know too much about neuropathy, but with my cat it has improved dramatically once his BG #s got better.

 

Hi Teri, and welcome!

I think you are suffering from too much information about some things and not enough about others.

Mt. T is diabetic for sure, the fructosamine proves that and now you should disregard the numbers in that test, the tests you are taking at home make the fructosamine unnecessary.

There is a huge difference between the Humulin N you are using and the Lantus (gargline). The fluctuation in Mt. T's preshot numbers is caused by the N wearing off long before the next shot, the Lantus does not do that. In addition, there are economical ways to buy the Lantus. Please go to the Lantus forum in the Insulin Support Groups for more detailed information.

Your vet is treating Mr. T is a way that maximizes his/her profit. Mt T does not need to go back for visits as long as you are testing at home. The results of your tests can be emailed or faxed to the vet and, because I see Mr. T higher at the vet than at home, your home tests are more accurate, Mt. T is stressed at the vet and that raises his numbers. In addition, there are far better foods than the phony "prescription" junk they are selling at a huge markup. Read www.catinfo.org for the unbiased information on nutrition for diabetics.

Your description of the neuropathy is totally consistent with diabetic neuropathy and it should disappear as Mr. T is regulated. The methyl B-12 will help, but not cure, regulation is the cure. As for the statements about tendons, your vet is not only off base, but cruel to suggest surgery before every other avenue is explored. As for the suggestion of shots v pills, while the shots are easier on you they are not better to the point where you need to pay so much more for them.

Please see my next post below.

 

(For some reason this board is limiting the length of my posts, the mods are working on the problem.)

To continue---My best advice is to set up a spreadsheet for your home tests and share that information here. Read our FAQs and look at the insulin fora for a better idea of how other cats are doing on the different insulins. Read the catinfo site a couple of times, there is a ton of information there and you will learn more with each reading, then look at the food threads here and Janet's charts to help you select better food.

Karen & Rambo have a neuropathy link in their signature that will ease your mind a bit. Karen has been out of town but I'm sure she will be checking in soon.

Please keep asking questions and learning. We are here to help you and Mr. T

Gia & Quirk (GA)

Guilt trips are a detour from life

 

Should I give Insulin at 214 BG?

Thank you all for responding to my email.

A quick question.

Mr. Ts BG at 8:59 am before feeding is 214. Should I give him the 2 units or retest in 2 hours?

 

Give him the 2 units and retest in 2 hours, 4 hours, 6 hours, and 8 hours to see how long the dose is lasting. Let us know what happens.

 

WELCOME, this forum is a great place to gain knowledge and really learn how to manage feline diabetes. By doing just a few things each day (that really won't take up much of your time at all), you won't need to worry about losing your precious cat, not where feline diabetes is concerned.

There are three key factors to managing diabetes: food/nutrition, home testing and insulin

1) Feline Nutrition: Now, as far as diet - definitely dump the dry food (if you are feeding any) and if the vet recommends purchasing prescription food like DM just say "no thank you". ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality. Most here on FDMB feed low carb/high protein canned, raw bought from a pet store or they make there own.

Here great links, one is to a food chart put together by one of our board members that breaks down the carb % and protein % of most of the commercial brand foods. You want to keep the carb % below 10% and around 7% is great. The other link is to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... there is in-depth info. there about many things, including nutrition and how to make raw food.
Nutrition/food info

The good thing with feeding your diabetic cat this way, is that it is ALSO good for any non-diabetic cat too. All your cats can safely eat the same food without worry and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.


2. Home testing: It is impossible to convey the value of testing your cat's BG (blood glucose) level at home. Some vets will "suggest" this, but most won't even mention it. They will send you home with insulin and an amount to shoot and maybe some instructions about hypoglycemia (blood sugar dropping to a dangerously low level).

Well, the thing is, human diabetics don't EVER give themselves insulin without checking there BG to make sure it is safe to do so, so why shouldn't it be the same for our kitties. Here on FDMB it is. You will notice that the vast majority of people here test their cat's BG at least 2x/day (before giving each shot to make sure the level is safe enough) and periodically at other times to see how the cat is responding to the current dose. We use a human glucometer, test strips and lancets - which are all very readily available and easy to use.

Our kitties get lots of love and treats for "putting up" with this and most of them actually come out to be tested on their own 'cause they want those treats . Here is a collection of great links that "Carolyn and Spot" pulled together about hometesting. See what you think ... it truly is the best way to not only keep Your cat safe but also really get a handle on this disease and help him to live a healthy life with FD (feline diabetes).

Home testing Links

3. Insulin: There are several types of insulin available. Many people, myself included use Lantus or Levimer both of which are great insulins. They are gentle insulin and given twice (BID) per day in 12 hour increments. Or you could also choose PZI or the new version called Prozinc.

Please read up on the insulins available, here is a link to the Insulin Support Groups:

Insulin Support Groups

However, one caveat and again this shows how these three things are inter-related:

If you are feeding dry food or even a high carb food, BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required. Again, another reason why home testing is important.

I know this all seems like a lot, and that's because it is ... there is a learning curve here. But as long as you are determined and keep at it, you will have it down before you know it and you'll be seeing the results in Your cat' overall health and happiness. Ask all the questions you can think of - that's why we are here!

Also, if you haven't done it yet, take the time and fill out your profile. It will help when others come on and read this. Also, let us know where you live - city/state as there are probably people in your area who can provide on the ground support and help you to learn home testing, etc.

Regarding the neuropathy - I used this product for Maui - http://www.vitacost.com/NSI-B12-Methylc ... 0-Capsules

I emptied one capsule per day in her food, mixed with water.

 

Anyone have the link to the Hum N primer? It might be helpful. It's so different from Pearl's I don't want to give any advice, but I bet the primer would help.

To the original poster, lantus cost can be greatly reduced by buying the cartridges. The vet just needs to make the script for cartridges. They come in a pack of five and you can just use one cart a month, bring the cost down to around 30$ per month. It'll be an easier insulin to use in the long run, especially since you hometest (yeah you!!!!!).

 

The N primer is under the links for the Insulin Support groups. Here it is:
viewtopic.php?f=19&t=303

 

Teri,
Did you say your cat has the problem in the front legs or the back legs? My maine coon has definite issues with the front legs and I have been giving him methyl b-12 for over 2 weeks now. So far I can't say that I have seen any major difference but I intend to keep up the b-12 for at least another month. Also make sure it is the Methy b-12 that because I understand there is a difference.

I would also take your cat off dry food all together because the dry food is definitely making the numbers worse but check with others on here regarding how to regulate insulin while changing foods.

 

Thanks to all for your replies to my post. I have lots of reading to do and changes to make.

I stayed home yesterday and took Mr. T.'s BGs. Below are the numbers:

Sunday, Feb 28
8:59 a.m. 214
9:50 a.m. 203 (retook it just to be sure)
10:23 a.m. gave Mr. T 2 units
1:00 p.m. 327
3:05 p.m. 296
6:20 p.m. 346
6:25 p.m. gave Mr. T. 2 units
9:04 p.m. 179
Monday, Mar 1
721 a.m. 390

So what does this all mean?

 

Harley's mom,

My Maine Coon cat, Mr. T, has neuropathy in his front and back legs. My vet said that he's never seen diabetic neuropathy in the front legs of cats. I'm hoping that when Mr. T gets regulated his walking will improve as well.

Mr. T's mom.

 

Hi Teri - you may want to start a new post and put your insulin type in the title to get eyes on your #s - something like "Humulin BG curve - need help interpreting" or whatever. I don't know anything about that insulin, so can't comment on what the #s might mean. Great job getting the data though, and hopefully others will be along soon who can shed some light on it!

 

Hi Teri!

My Rambo was a poster cat for neuropathy, but Conan had the atypical form that affected his front legs. He never seemed to be in any pain, and definitely responded to the Methyl B12. The type at the health food store is graded for humans, so should be of high quality. Just make sure you are giving 3-5 mg (3000-5000mcg) per day.

Please do read Kimber's primer on N - it's very helpful. But I am concerned about one thing :

In fact, Lantus (glargine) has a much lower risk of hypoglycemia than N. N is a fast acting and relatively harsh insulin which hits the system quickly and usually wears off well before the 12 hrs are over. And 1.5u is actually NOT a low starting dose.

The Purina DM is fine, but the quality is poor, and it's expensive. If your cat likes it, no problem. But even the vet who developed DM tells her patients to use Fancy Feast!

Patience is the key. Read as much as you can. You are already hometesting, so that is a HUGE hurdle. Keep us updated and we'll help all we can.