ProZinc diabetes roller coaster issues

Discussion in 'Prozinc / PZI' started by MJJ, Jan 9, 2018.

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  1. MJJ

    MJJ New Member

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    Jan 9, 2018
    I’ve just registered to as hit crisis point since Christmas! I have been a pet owner of Persian pet cats for years and give them top quality care.
    My 11yr8month Persian cat was diagnosed with diabetes at half year vet check in June 2017 - via full blood diagnostics done. Had no symptoms prior to diagnosis other than slight weight loss (ie i was unaware she had a problem). Lulu been on ProZinc since - (vet advised the best insulin for cats) starting at 1 unit twice a day, then 2, then 2.5. (Had lesson on how to inject and am confident administering it).
    Went to vets twice since for in-house glucose curve test and vet dropped dose again to 2units twice per day. Vet happy with Lulu’s progress and my dealing with her. See attached pdf info
     

    Attached Files:

  2. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    Hi MJJ and Lulu!

    I am not a Prozinc user so I can't address dosage however I can address a few things and say Hi.

    You are home testing which is great! This is the best and easiest way to confirm if the insulin is truly working for her and is at the right dose. We do have a spreadsheet to help track your readings and helps everyone see the patterns. If you are looking for dose suggestions it will be required before they will be given. I will post you a link for that. If you need help with setting it up...give a shout out.

    The other issue is the food. With the ups and downs of the glucose can make Lulu feel unwell. You would feel crappy too if your blood sugar was all over the place, not sure why vets don't get that fact sometimes. There are options for that. You can add toppers to the food to entice them to eat. Parmesan cheese, forti-flora flakes, freeze dried treats. The other thing is the food itself. You are right...the best food is the one they will eat. There is some information on catinfo.org that has a list of foods and the carb content. However you are in the UK, so I know someone has a UK list just not sure who. We suggest 10% are less to help keep those numbers down. The AD is handy and Jones was on it in the beginning as well.

    DKA testing with the keytone strips is always a good thing to get into the habit of. That is all I use. There is some meters that can do both the glucose and keytone testing with the same blood sample. Not sure if that will interest you as it can be costly.

    For the vomiting - it can be pancreatitis, acidic tummy (if white and foamy) and so many other things. I am wondering if an ultrasound of the abdomen would be useful.

    Do you have copies of the latest blood work? If you can post those, we have some people here that can help read them and guide things to look at and ask the vets about. There is a lab tab on the spreadsheet as well, but if you can scan them and post that can get us started quicker.
     
    Last edited: Jan 9, 2018
  3. Tracey&Jones

    Tracey&Jones Well-Known Member

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  4. MJJ

    MJJ New Member

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  5. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hello Tracey&Jones

    Thank you so much for your positive reply, interest, and info.
    I have obtained all the blood test info and am just scanning them in. Will post the latest results when I’ve done them...

    Thanks
    MJJ
     
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  6. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Your welcome!. Plenty of knowledgeable folks here.
     
  7. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hi again Here’s the latest bloods done 22 Dec. See lab technicians summary comments too.
     

    Attached Files:

  8. Critter Mom

    Critter Mom Well-Known Member

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  9. MJJ

    MJJ New Member

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  10. Critter Mom

    Critter Mom Well-Known Member

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    If you can't organise going to the other vet for scanning services it might be worth investigating whether there are any mobile veterinary scanning services that work with vet practices in your local area. For example, there are two practices in the town where I live and a mobile ultrasound/MRI scanning service parks up at one of the practices (each week, I think). Also, sometimes specialists (e.g. opthalmologists) may offer consults at local vet practices to help people who can't travel further afield. They will happily see people from all practices in the area without the need for the clients to switch vet practices.


    Mogs
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  11. MJJ

    MJJ New Member

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    Thanks so much - will check out
     
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  12. Critter Mom

    Critter Mom Well-Known Member

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    ** FOR CONVENIENCE ** REPOSTING LULU'S HISTORY FROM THE PDF ABOVE (might be a bit more accessible as a forum post for members reading this thread :)).


    LULU diabetes thread

    Trying to condense this and hoping for help from your forum Iʼve just registered to as hit crisis point since Christmas! I have been a pet owner of Persian pet
    cats for years and give them top quality care.

    My 11yr8month Persian cat was diagnosed with diabetes at half year vet check in June 2017 - via full blood diagnostics done. Had no symptoms prior to
    diagnosis other than slight weight loss (ie i was unaware she had a problem). Lulu been on ProZinc since - (vet advised the best insulin for cats) starting at 1
    unit twice a day, then 2, then 2.5. (Had lesson on how to inject and am confident administering it).

    Went to vets twice since for in-house glucose curve test and vet dropped dose again to 2units twice per day. Vet happy with Luluʼs progress and my dealing
    with her.

    Gradually appetite increased rapidly to begging for anything I was eating and going off her own food. Own vet away for 3 weeks over December - so saw a
    colleague at the practice as typically Luluʼs symptoms had got worse quickly and I was concerned with rapid weight loss since since she wasnʼt eating,
    refusing all cat foods, canned tinned tuna, salmon, and fresh chicken I tried to tempt her with. Vet duly concerned and advised she had no fat or muscle left
    to loose and gave her 2 months. Also found an uppper tooth infection whereby her bite had caused an ulcer in the lower bite below. Vet took bloods, gave 2
    week antibiotic injection for the tooth (which should come out but Lulu would be too weak for anaesthetic etc). Bought myself an ALphaTrak2 cat/dog
    diabetes glucose monitor (same as vet practise had used) But had struggled to take tests so had a lesson from vet nurse and mastered it! I asked if she
    could have a Vitamin B12 injection to stimulate appetite but vet not keen to give so didnt. Asked for a food I could give to get her eating (diabetic diet has
    disagreed with her tummy so prior to this been on her normal wet senior pate food and Royal Canin Persian 30 dry fro grazing) but vet said important not to
    change her diet at this stage. Went away thinking what diet, since sheʼs not eating!

    Took glucose readings over 2 days and back to same vet for recheck few days later with the readings but got feeling not deemed as helpful as readings up
    and down like a roller coaster. Inbetween Lulu had not eaten much - even taking to pinching a piece of chocolate cake off worktop - so something very wrong.
    Vet at a loss what to suggest, recommending referral to Royal Vetinerary Collage Hosp - which I was insterested in (pet insured on continuing claim albeit
    contribution costs involved) until when questioned what they would do the main focus was for a new glucoseʼs monitoring gadget fixed under the skin by
    anaesthetic - in order to obtain accurate glucose readings any time and to highlight the highs and lows. Seeing as anesthetic deemed dangerous for tooth -
    now surprised ok for this - Asked if they would remove tooth too whilst under anaesthetic but told unlikely. Asked for quote.

    Meantime Lulu had vomited with slight blood that I showed to own vet back off holiday. Things got worse since she was loosing more weight and eating
    absolutely nothing, and stopped begging for my food (last Thursday). Referral quote between £3-6000, a long way away and I do not want to put my elderly
    pet through days of stress and invasive testing pulse anesthetic and probably not her back. If she was to die I wanted her to be at home, but she would
    surely die without food. Researched all to do with ProZinc, Diets and everything in my quest to help Lulu. Obtained Hills a/d restoration palatable diet which is
    high protein and low carbs (ideal for diabetes) from another vets (mine donʼt stock the brand!) as have used this lifeline product before - just been
    apprehensive since it could increase glucose levels. A miracle as Lulu took to it. Have been feeding little and often since (4/5 times a day) building her up and
    her weight is gradually increasing. Donʼt know how long i can continue to feed her this product, but she is happier, ready to eat and looking brighter.
    Found warning on ProZinc website to ‘stop giving ProZinc if cat vomits or does not eatʼ - no vet warned me of this and I wonder if this caused the blood in
    vomit.

    Also been researching sDiabetic Ketoacidosis and Luluʼs symptoms of rapid weight loss, loss of appetite and vomiting were amongst the symptoms flagged
    up. Appears this is only diagnosed via Urine diagnostic test and doesnʼt necessarily show up in blood tests - sheʼs not had a urine test for months as always
    has a small bladder when at the surgery. I have done urine dip tests with the strips and taken a photo or the strip immediately after the test, but vets donʼt
    seem to find it helpful!

    Am at point now, where Lulu is better than she was, still eating the Hills a/d plus a little Royal Canin Gastric wet food given by my vet and she has gained a
    little weight. I have requested a simple ultrasound at my vet surgery to flag up if there is anything else going on with her organs so i at least know if there is
    another underlying condition going on (especially as ‘investigation of the liver may be consideredʼ was a comment by the lab technician on the last blood test
    reports - when the first vet had said her bloods didnʼt highlight anything else was wrong)! In readiness for ultrasound I hoped would happen on Monday I took
    glucose readings the day before and they are more balanced and between the high-low guidelines. But the first vet is apparently the only vet best qualified to
    do the ultrasound and she was away last week and training this week until Friday - or else I could be referred - guess where - the RVCH again - miles away. I
    have asked for another quote since it seems they are suggesting ultrasound of chest, kidneys, liver, etc, and possible X-rays and under sedation... not been
    forthcoming yet. I can feel the £s they want me to spend racking up. Meantime the week is progressing and I want to know where I am am with this. A good
    friend has suggested going to her good vet practise for the ultrasound and I have managed to obtain my pets records, but then I either probably have to
    switch vets long term.

    Does anyone have any info they can offer to help with the ups and downs of the glucose readings, symptoms of loss of appetite and severe weight loss,
    occasional vomited (symptoms I am now dealing with temporarily) and is it worth the ultrasound/s and at which vets!? All my pets are cared for into their old
    age but I cannot see the merit in stressful testing and days away from home for an elderly animal as they can never give her many more years. I just want to
    be able to manage Luluʼs illness as best as possible so she can remain comfortable and happy in her own home for as long as she has left. Thank you for
    reading this epic missive!


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  13. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Dec 12, 2016
    @Marje and Gracie

    Tagging Marje for you to look at those tests and see if she can help you with figuring out if there is further tests needed.
     
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  14. MJJ

    MJJ New Member

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    Jan 9, 2018
    Thank you
     
  15. Critter Mom

    Critter Mom Well-Known Member

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    Hi MMJ,

    After reading the above history I was very relieved to read that you managed to find something that Lulu would eat for you and that she's regaining weight again. (Note: when Lulu was very underweight this may have caused additional wobbles in her blood glucose levels and dosing as sometimes underweight cats may swing between quite high and quite low BG levels when being treated with insulin. These swings should even out as the cat regains the weight lost and becomes more stable.)

    Once you get a spreadsheet up for Lulu we'll be able to get a better picture of what is happening with her response to Prozinc. The dodgy tooth won't be helping matters but at least we know that once Lulu's able to have the dental that is very likely to improve things (tooth issues and gum disease are notorious for elevating BG levels).

    With respect to the elevated liver values there are many things that can raise them (including diabetes) so it's tricky just looking at the bloods in isolation. An ultrasound would give you more information. In the interim, it might be worth asking your vet whether liver support with milk thistle or Hepatosyl (milk thistle and SAM-e supplement) might be beneficial. Should there prove to be a liver issue it is worth noting that the liver is a very resilient organ and it is capable of regeneration.

    With regard to the appetite issues and vomiting it would be worth asking your vet about running a Spec fPL test for pancreatitis, if only to rule it out. (We find here that often diabetes and chronic pancreatitis are fellow travellers.) If you're getting the blood test done it would be worth also ordering a B12/folate assay at the same time since cats who have digestive system disorders may be lacking in these.

    An ultrasound scan would give you more information about status of liver and pancreas. Sometimes pancreatitis, liver disorder and inflammatory bowel disease occur together; a condition referred to as triaditis. With the GI issues you've mentioned it would be worth checking whether there might be any thickening of the intestinal walls as this can give some information about whether IBD might be an issue. (Note: Formal diagnosis of IBD requires a biopsy but there's no guarantee that the person performing the procedure will actually 'hit the spot' where damaged tissue is present. Many people treat cats with suspected IBD on an 'as if' basis.)

    The blood in the vomitus is concerning. What did your vet say about what may have caused that? (Just throwing info out here: liver issues can sometimes affect blood clotting.)

    I see that Tracey has already given you the link to the spreadsheet setup instructions. Here's a companion forum sticky that explains what the column headings mean.

    Understanding the Spreadsheet Grid


    Mogs
    .
     
    Last edited: Jan 9, 2018
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  16. Critter Mom

    Critter Mom Well-Known Member

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  17. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    Thanks Tracey!

    Ketones can be measured in the blood and there are specific meters that you can even buy to test her blood ketones at home. It just appears your vet’s particular array of tests doesn’t report ketones. Most senior panels in the US do so it’s the difference between what is reported on UK tests vs US tests OR what your vet tests in-house.

    Her lymphocytes are just barely low. I will leave that to your vet to figure out why as there aren’t as many things that can cause low lymphocytes as can cause high. Because it’s borderline, I would suggest you ask her if it should be just watched for trends.

    The tT4 is low and, as remarked upon in the comments, this is what we call “euthyroid sick syndrome”. That means the tT4 appears lower than it might be due to some other concurrent disease.

    Her ALT (liver enzyme) is just mildly elevated. ALT is one of those that has to be elevated quite a bit to throw up a red flag but certainly an elevation 3x normal is a yellow flag and it would be cautious and recommended to ultrasound her. She could have pancreatitis and they could see this with an u/s. Quite often, the ALT is elevated with cats with pancreatitis and her symptoms can be attributable to pancreatitis except the weight loss ....which could just be the diabetes. Her ALP is just slightly elevated and I wouldn’t worry too much about that.

    Her PCV is ok; I wouldn’t want to see it any lower than it is. Her kidneys look absolutely fine in terms of chronic kidney disease.

    I hope this is helpful to you. BTW, I would not consider a 12 year old cat elderly......
     
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  18. MJJ

    MJJ New Member

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    Thank you - your interpretation and feedback is really helpful and gives me guidance for having just an ultrasound of her liver done. I agree Lulu isn’t really elderly at nearly 12, its just I lost one Persian at just 9 from sudden kidney failure and another at 14 also of kidney failure. Whereas my long haired handsome moggy went on to 19+ - also passing away with kidney failure - having kept him going on medication for 3 years...
     
  19. MJJ

    MJJ New Member

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  20. Critter Mom

    Critter Mom Well-Known Member

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    They should be able to do the pancreas (right next door to the liver) and check the intestinal walls in the same scan. :)


    Mogs
    .
     
  21. MJJ

    MJJ New Member

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    Jan 9, 2018
    Thanks Mogs - I will get them to do those and the liver.
    She is much brighter tonight and I’m about to inject. Delayed it a bit as would you believe she pinched a nibble of Xmas pudding off the worktop a couple of hours ago! She was doing this before she went down hill - even pinched a bit of choc cheesecake... all very very strange - so looks like she is back to these alarming tricks again.
     
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  22. Critter Mom

    Critter Mom Well-Known Member

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    Naughty Lulu! :eek:

    Glad to hear she's perkier in herself tonight. Is she still eating her own food OK?


    Mogs
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  23. Critter Mom

    Critter Mom Well-Known Member

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  24. Marje and Gracie

    Marje and Gracie Well-Known Member

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    As long as she’s having an ultrasound, I would have them look at all her internal organs.
     
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  25. Critter Mom

    Critter Mom Well-Known Member

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    Tip:

    For Alphatrak test strips I found them cheapest at animeddirect.co.uk. It's a while since I purchased any but Animed Direct have always tended to be the most price-competitive veterinary supplies website I've found. Delivery is prompt, too.


    Mogs
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  26. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hi Mogs
    Thanks every so for these useful links. The problem I have is that my vet only refers to RVCH, or North Downs (for diabetes) - if I go elsewhere they are then likely to not want to view the images/results for follow up and ongoing treatment.
     
  27. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hi Marjie and Gracie

    Thanks for this. I have just received the quote with breakdown of what they intend to do at my own vets on Friday. Interested in your interpretation, and do you think chest Xray is also necessary. As they want to sedate her, they want me to fast her from midnight tomorrow so as to gain better images and reduce pheonmonia risks etc. That will be tough as I’m still successfully feeding her the high protein/low calorie a/d diet to build her up, after a few days end of last week not eating at all when I nearly lost her. If you are able to comment on the attached I’d really appreciate it....
     

    Attached Files:

  28. Critter Mom

    Critter Mom Well-Known Member

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    Hi MJJ,

    Just had a look at the FD info sheet on North Downs website. According to the blurb on the website they seem to be a little bit light on the home BG testing side of things (though not averse to it), plus they missed two common FD clinical signs (poor hair coat condition, and depressed mood) but I have to give them a big thumbs-up for the fact that they warn people about the dangers of ketosis/DKA (so many vets don't do this at all). Overall they sound fairly switched on FD-wise. (But, never having used them, I could be wrong.)

    At least you're not in the Langford catchment area. They were great for my civvie's radioiodine treatment last year but I found them to be absolute pants when it comes to feline diabetes (and really backward in their overall approach to treatment of FD).


    Mogs
    .
     
    Last edited: Jan 10, 2018
  29. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hi again Mogs
    I checked out the North Downs website ... couldn’t find anything on FD on it...??? Agree about the dangers of Ketosis/DKA - no one even mentioned it to me - only leaned about it in researching myself! Also no one advised me of the warnings on the ProZinc website (under frequently asked questions!) which say if your cat is vomiting or has stopped eating, to stop giving ProZinc. Lulu had both these symptoms and I continued with the ProZinc and same doseage - no one told me to stop! These warning are also not in the leaflet enclosed with the ProZinc insulin. This could have caused her to vomit with slight blood... for starters! At the moment we are booked to have abdominal ultrasound and chest X-ray at my own vets on Friday. (See my reply to Marje for her comments)...

    So sorry to hear you experienced ignorance in your area for FD. Beginning to question things my end a bit - I guess its a bit like GP’s they know a lot of general stuff but want to refer you when things get beyond their knowledge. In my book, there is a lot that can be done or should be done locally, before you go the referral route. Depends what the problems are I guess - a brilliant referral vet saved my 2yr old Yorkie with delicate high risk spinal surgery and he lived until he was 17! I went the same route to another referral with a 14yr old Yorkie with Cushings, but came to the conclusion it was all in the name or research as my pet gained nothing except prolonged misery, with the ultimate outcome...
     
  30. Critter Mom

    Critter Mom Well-Known Member

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    I amended the post above to include a link to their diabetes info sheet. I'm posting the link again here for the sake of convenience:

    Diabetes Mellitus Info Sheet

    It's not immediately obvious to find info on the specialisms they offer. Here's a link to the index page for their pet information sheets:

    https://www.ndsr.co.uk/en-GB/specialist-referral-service/pet-health-information

    You would not believe what I've been through with vets. When Saoirse first became poster-kitty symptomatic for what I now know is feline diabetes (at age 14) the vet who saw her at the local vets we were registered to at the time point blank refused to run any diagnostic tests, gave Saoirse a Dx of 'old lady' with 'perfectly normal clinical signs for a cat her age', commented that she had 'had a good innings', gave her a steroid jab and showed us the door. I was livid but I felt absolutely helpless. (This same practice really screwed up a few years earlier when my beautiful Danú stopped eating. She was in their hospital for 6 days without appropriate treatment. Even though she was only seven they tried to write her off straight away ('probably a congenital liver disorder' and 'nothing [ I ] could have done'). I had to push for diagnostic tests and when they eventually came back they showed no underlying disease processes. Their 'cat specialist' (*cough*) announced on the Saturday that Danú needed a feeding tube but that she was off on Sunday so my girl would have to wait till Monday to have the tube placed. I lost her Sunday lunchtime. :( That vet completely ignored the fact that my cat's case was a medical emergency. I'm still sad and still angry, nearly eight years later.

    Thankfully I found FDMB, measured Saoirse's fluid intake for a week or so, kept a log of her clinical signs (including her ravening hunger) marched back in and demanded diagnostic testing (from a different vet at the same practice). On initial exam they told me Saoirse very likely had fluid build-up in her abdomen and if that were so it would be due to 'nothing good'. Wrong! There was no ascites; Saoirse's bladder was full to the brim because she was drinking a litre of water a day! Thankfully they did preliminary blood and urine tests and the provisional FD Dx was made (fructosamine test came back a few days later confirming it). I got no support for home testing (positively hostile to it, refused to even give me the name of a suitable meter), they insisted that she be fed Hill's w/d Dry kibble and treated her as an in-patient for three days when she started on insulin.

    Saoirse was very lucky; her BG levels were stratospheric at time of DX (33 mmol/L!!!) and she was losing weight. I could so easily have lost her to DKA in that period between her initial presentation to the vets and the second visit where I managed to secure help for her. About the only thing that practice got right was to test Saoirse for ketones after she was admitted.

    What upsets me the most is that Saoirse was also diagnosed with pancreatitis. For several years prior to the FD Dx she had been overgrooming her tummy (after being switched to RC Urinary s/o after she had oxalate uroliths removed). At every check-up I asked about this and every time my concerns were dismissed, the clinical signs being put down to 'boredom-related stress' which was 'typical of indoor-only cats'. As soon as I switched Saoirse to a species-approriate diet her fur grew back straight away. They had been wrong about her for years. Had they been more knowledgeable she might never have developed the IBD/pancreatitis and subsequently diabetes.

    Very shortly after this we moved to a different practice. Our main vet had a diabetic cat himself. The difference in approach was like night and day.

    Our vet practice consults on FD cases with the vets at Langford. When they reviewed Saoirse's early curve data they announced that she would never achieve remission. A few months later Saoirse was in remission. (Dry w/d diet was the main problem, not Saoirse's capacity to produce any of her own insulin.) Saoirse was subsequently referred out to the vet school at Langford for specialist scans (primarily liver - as a precautionary measure). Her pancreatitis symptoms and general clinical signs had started deteriorating since she went into remission and I wanted to put her back on a once-a-day maintenance microdose of Lantus to keep her tightly regulated again (and I had reams of data showing this could be done safely). Our own vet was amenable to this approach but the feline diabetes specialist at Langford completely blocked it, leaving our own vet powerless to do anything to help Saoirse. The referral wasn't even for feline diabetes!!! I don't think I'll ever stop being angry at that specialist for denying my beloved Saoirse a treatment that had been proven to work for her; an action which led to Saoirse experiencing much unnecessary discomfort thereafter. :(

    I experienced a very visceral twinge when I read about your Yorkie with Cushing's. I'm so sorry ... :bighug:


    Mogs
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    Last edited: Jan 11, 2018
  31. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Gosh....that seems like a lot of overkill at this point. Is she difficult to handle? I’ve had numerous cats and probably every one of them has had at least one ultrasound or echocardiogram and not one has been sedated or needed an IV catheter for the procedure. I know some US vets want to sedate them (and evidently UK as well) but if she is easy to handle, why? I would ask them if you can be with her during the procedure as you will be able to have a calming effect on her (as long as you know she will lie still on her back).

    If she will not lie still with or without you, they likely will have to sedate her. But I would ask if they can do the mildest possible.

    In terms of fasting, my vet never fasts a diabetic cat more than six hours for labs, if need be. If they are giving her sedation, they are worried about her vomiting and aspirating, which is not good. Most cats clear their tummies within three hours. I would see if I could speak with the vet and explain that, if she absolutely must have sedation, can you just do a six hour fast?

    I don’t see any issue with the X-rays as long as they give you a good reason for it.....what are they looking for? Does she have symptoms of pneumonia or something else or as the X-rays just a shot in the dark trying to find what might be wrong with her. It’s up to you, what you can afford, what you want to know.

    I’m also curious why they want to do an IGF on her. Without a SS, I can’t tell if it isn’t warranted to check her for a high dose condition. True that 1 in 4 cats has a high dose condition but, unless she is at 6u twice a day and still not responding, we don’t usually recommend an IGF.

    The RVC is quite advanced in their treatment of FDs.

    The kind ladies in this forum can help you much, much more with a spreadsheet and I urge you to do that today. If you need help, please send me a private message and I’ll do it for you.
     
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  32. MJJ

    MJJ New Member

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    Jan 9, 2018
    Hi Marje and Gracie
    Many thanks for your reply/info which I only saw after my visit to the vets on Friday with Lulu. Apologies for sincere for a few days but the news results of ultrasound and X-rays were not good. Easier to list below and will attach a couple of X-ray images for any experts that may be able to give any clues!

    Feedback from own vets:
    A. Vet who did ultrasound rang when Lulu was still under sedation. Advised that ‘the ultrasound had shown there were multiple problems with her Liver, kidneys and intestine. Suspected there was a tumour somewhere. Only way to check was to do fluid withdrawal by needle into each organ, but this wasn’t without risk, and not knowing Lulu’s blood clotting capacity; also this wouldn’t be a conclusive test. Only way to be sure was to do a biopsy of each organ, but this was higher risk and also involved general anaesthetic’ and Lulu was an elderly cat’.
    B. Vet advised X-ray showed the same thing, but Heart looked good. I asked if Lulu definitely had diabetes (as her glucose levels had been and up and down and baffled the vets which is why I asked for ultrasound/X-ray investigation) and was told ‘yes’.
    C. I advised I did not want to do either of the tests as high risk, but would care for her for how every long she has being comfy and whilst eating.
    D. I asked if I could have copies of the ultrasound and X-rays. Was told the ultrasound wasn’t too clear and vet wasn’t sure how much i would understand. X-rays were clearer. Was sure they could let me see the images when I went to collect Lulu.
    E. Saw regular vet (NOT ultrasound/X-ray vet) on pick up. Was told the ultrasound images could not be printed - so I never got to see these, or discuss any of the images with vet who took them!!
    Was just shown X-ray images on computer (which I took photos of and will attach a couple below). Interestingly, this vet only pointed out the ‘white branch like structures and a few white blobs’ within this structure. She said they looked calcified. Said ‘they’ had never seen this sort of symptom before! She made no reference to it being within the Liver, or that the Liver was enlarged. Did not mention the Kidneys! Said Intestine was fine and stools stacking up could be seen.
    F. With hindsight wondering why Vet who did the ultrasound and X-rays made no mention of the white branch like structures?? I was expecting to see images of the Kidneys and Intestine that backed up the theory they are damaged as well. But I haven’t seen those/any problems I was told about on the phone not been pointed out.
    G. Vet said was not worth doing Lulu’s dental, so keeping it at bay with another 2 week antibiotic injection.

    1. Didn’t realise diabetes enlarges the Liver, but I gather it does.

    2. Not sure if Liver enzymes have been specifically tested in blood diagnostics. Liver is mentioned in lab technicians comments summary in blood results taken in Dec.

    3. Vets do not know what the white branch like structure is! Ultrasound/X-ray vet never mentioned it on phone to me. Was only thing own vet pointed out on X-ray I saw. She thought it looked calcified.

    4. Biopsy of Liver, Kidneys, Intestine was mentioned as being only conclusive way of identifying problem. But advised risky to cat due to blood clotting being unknown.

    5. Laparotomy?? (needle in Liver, Kidneys and Intestine) was also mentioned, but again advised risky in elderly cat and blood clotting unknown, and results could be inconclusive.


    Symptoms since being diagnosed with diabetes:
    Gradually lost weight since the summer. Diagnosed with diabetes in June. On ProZinc twice a day, now 2.5 units.
    Increased interest in food, primarily human food! No real increase in thirst. Occasionally sick. Home testing of glucose levels via AlphaTrak monitor - levels inconsistently up and down.
    Since Christmas, rapid increase in weight loss. Complete loss of appetite. Sick twice, once containing slight blood partials. Hills A/D food over past week has saved her and she has perked up, eating and Increased weight from below 2.43 now to 2.81 yesterday. Vet baffled, suggested diabetes referral. Opted for ultrasound and X-rays of abdomen and chest at local vets to see what else was going on.
    Her personality is normal at the moment; contented and bright eyed. Eating several small meals a day of Hills a/d restoration diet and Royal Canin Gastro (both wet food).
    ProZinc still 2.5 units twice a day.
    Have not taken further glucose readings.
    Post op check tomorrow....

    With thanks for an expert advice on this running a parallel with diabetes.
    Margaret
    View attachment 33649
     

    Attached Files:

  33. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Hello Mogs - forgive my tardy reply. Been full on here since Friday. Rather than me repeat, please view my reply to Marje and Gracie if you have the time ref Lulus ultrasound/X-rays... just posted.

    I am so very sorry to hear of all your heartbreak with Saoirse and also Danu and the total lack of urgency or it seems, expertise at the time. I echo your findings on the home testing as I think one vet has been for it, and another rather disinterested. They obviously earn more from a day at surgery testing. It is very interesting that all the knowledge and info you put forward was either dismissed, ignored or cast aside, with obvious dire consequences for your Danu - complete negligence!

    You have gained so much knowledge through research and its incredible that the Langford vet completely blocked your wishes of maintenance microdose of Lantus to help Saoirse, even with the support of your own vet. Sometimes I think one is up against the protocol of the big umbrella company that runs the local practises. Different vets have different ideas, but in the end the big boys win.

    Margaret
     
  34. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Margaret:

    Thanks for all the information.

    I am not a vet and I don’t have the ability to read or interpret X-rays. So I won’t be any help there. Perhaps there is someone else that is better able to read xrays and discuss the areas of concern in them.

    I can answer a few things, though.

    1. You were smart to elect for “no needle biopsies” as these, even ultrasound guided, can miss cells or tissues that might be what is causing any issues. So you could pay a lot for it and put her at risk and end up with inconclusive results.
    2. Diabetes, in and of itself, does not cause liver enlargement. If her liver is enlarged, there is some underlying issue causing the problem with the liver which is not diabetes. It’s possible she has a gallbladder issue, triaditis, cholangiohepatitis, pancreatitis, inflammatory bowel disease (are her intestines thickened) etc. Some of those might be associated with diabetes but non diabetic cats also get them. A competent radiologist doing an ultrasound should be able to tell you specifically what might be going on. Although, for example, IBD is usually diagnosed via endoscopy, if the intestines are thickened, one would suspect IBD or lymphoma. You should also ask if the ultrasound noted any lymph node issues. I can’t understand why they would say the ultrasound “wasn’t too clear”. That makes no sense to me unless they were using really, really old equipment.
    3. I have never had an ultrasound done on my cats that I did not receive a complete written report of findings and you should ask for that. You paid for it. A disk of the ultrasound has always been available to me but I have only taken a copy if it was needed by a specialist. For my own use, I have no clue what I’m looking at. But if they don’t provide you with the disk of the digital ultrasound, they need to give you a full, written report of all findings. I would insist upon it.
    4. Her liver enzymes were tested in the initial labs you posted and here are my comments from above:
    Her case seems complicated and, if she were mine, I’d start by getting the full written report from the radiologist of ultrasound findings and then get that to a specialist along with the X-rays and go from there.

    It would really help the folks in this ISG if you had a spreadsheet for Lulu so they can help you with the insulin dosing.

    Many vines for your sweet girl.
     
    Critter Mom likes this.
  35. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Margaret,

    I'm in the same boat as Marje in that wouldn't know where to start with X-ray and ultrasound images, so I'm sorry I can't help you with that.

    I do agree with Marje that you should request a full written report on the scan findings and ask for a referral to a specialist.

    Thank you for your kind words about my two girls. I don't know whether any corporate influences were in play re the Langford situation, but I did certainly feel that the specialist did not take into account Saoirse's specific needs, nor did she take into account the capabilities of Saoirse's caregiver. The specialist just insisted on foisting her own 'one size fits all', textbook approach on us, to the detriment of her patient.

    Our own main vet came to greatly respect me as a knowledgeable and dedicated caregiver. He asked me what I thought of my experience at Langford and I couldn't help but tell him straight up that I thought their approach to FD treatment was really backward and lacking in basic understanding of diabetes at times (e.g. declaring that Saoirse would never be a candidate for remission when she was still being fed the originally-prescribed mega-carby Hill's w/d dry diet). In particular, I highlighted to our vet the fact that the specialist was somewhat dismissive of my spreadsheet journal which provided her with all of Saoirse's blood glucose test results plus comprehensive daily observations of her clinical signs. Our vet commented that being presented with such a comprehensive case history was probably so unusual to the specialists that they probably didn't quite know what to do with it. I despair ...

    How is Lulu doing, Margaret? What's her appetite like? Has the vomiting stopped? As Marje mentions above, it would be great if you could get a spreadsheet of her BG test results going. We might be able to help you more with the FD side of things if we can get a picture of how she's doing on her insulin. (Give a shout if you'd like some help with the spreadsheet setup.)


    Mogs
    .
     
  36. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Many thanks Marje - saw vet yesterday for post op check. Lulus appetite and behaviour is back to normal - I can’t believe it. The Hills a/d food has been a life saver - albeit temporarily. I’ve got her weight up to 2.81 from well below 2.43 over a week ago. I will be running a day’s curve testing tomorrow. I’ll take another look at the FDMB spreadsheet to see if I can figure it out! I’ve not done any AlphaTrak tests for nearly a week now as just wanted to concentrate on getting Lulu eating and not stressing her out with pricking her ears. I got the medical history from the ultrasound and X-ray, so as you can see there is a lot going on. Xx
     

    Attached Files:

  37. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I’m very sorry. When you have lymph node involvement like that, it can often (but not always) be indicative of some kind of lymphoma.

    Is there a veterinary oncologist anywhere near you?
     
  38. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Hi Mogs - many thanks for replying. Yes professionals sometimes don’t take kindly to anyone with lots of knowledge! Your spreadsheet records for Saoirse were amazingly brilliant and showed what a dedicated owner and cater you were, and willing to do everything to help her.

    Lulu is bright and eating well! Saw vet yesterday for post op check. Lulus appetite and behaviour is back to normal - I can’t believe it. The Hills a/d food has been a life saver - albeit temporarily. I’ve got her weight up to 2.81 from well below 2.43 over a week ago. She is still thin and hardly any fleshy skin to put the the insulin needles in, but improving. I will be running a day’s curve testing tomorrow as home all day. Will plot it on a ProZinc graph downloaded - as vets can’t seem to understand the info when put in the AlphaTrak record book form. I’ll take another look at the FDMBspreadsheet to see if I can figure it out - must admit I couldn’t make sense how/when/where to record Info, and on this site people’s AlphaTrak numbers seem to be a whole lot different to mine. I use the large number that displays on the screen, not the small one. I’ve not done any AlphaTrak tests for nearly a week now as just wanted to concentrate on gettingLulu eating and not stressing her out with pricking her ears. I got the medical history from the ultrasound and X-ray, so as you can see there is a lot going on. I know Lulu is in borrowed time and just want her to be happy and comfy at home for as long as she’s got. Am not doing a referral as no one can make her other problems better, they would just diagnose what was wrong and at great risk with a biopsy etc.
    I took this pic yesterday as she enjoyed being out in the sunshine for a little while with me - jumped in the bbq like she always did. Look how much better she looks already. Coat beautiful again - just bald patches from the scans. They also don’t want to risk a dental so keeping her bad tooth under control with 2 week antibiotic injections at the moment. Thanks again. Mx
     

    Attached Files:

  39. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Thank Marje - I have read causes of Feline Lymphoma below. Interesting as Lulu has always had full annual boosters (which includes FIV) and additionally Feline Leukemia booster.
    CAUSES
    The incidence of lymphoma is believed to be associated with exposure to feline leukemia virus (FeLV) and the feline immunodeficiency virus (FIV). Cats that have been infected with either of these viruses have a significantly higher rate of lymphomas than the general cat population.

    I am doing her curve today - started at midday prior to first insulin dose of the day. So far her readings are 22.4, and 2 hours later after ProZinc 17.9.
    Don’t know why all readings other people take on the message board are in three figures?!
     
  40. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Here in the US our meters read differently than the rest of the world. - Like all of our measurement systems - because for whatever reason our gov't and industry think that a base-10 system would be too difficult. ;):rolleyes:o_O

    I believe the translation is your number x 18 to get the US numbers. When you set up your spreadsheet, make sure you choose the world spreadsheet and when you input your numbers it automatically calculates on the second sheet into the US numbers - that way no matter who is reading your spreadsheet they can understand it.

    Here is the link for getting it setup: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
     
    Critter Mom likes this.
  41. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Here's the link with an explanation of the spreadsheet:

    Understanding the spreadsheet grid

    I'm very glad to read that Lulu is eating better - and feeling better in herself. Sounds like she really enjoyed her time in the garden with you. :)

    In the UK we measure BG in mmol/L and in the US they use mg/dL. As Djamila advises above, multiplying the mmol/L value gives the US mg/dL equivalent value - and the World spreadsheet has a tab with mmol/L where you enter your data. There's another tab on the sheet which then automatically calculates and fills in the US equivalent values so that members on the other side of the pond will also be able to interpret the data using numbers more familiar to them.


    Mogs
    .
     
  42. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Help please! I’ve managed to go through all the hoops - opened a Google chrome a/c, downloaded Google sheets and google drive - followed FDBM instructions for worldwide spreadsheet for tablet - have now set up Lulu’s spreadsheet on Google sheets and done all the links etc. Have gone back to FDMD as requested in the las bit of the instructions which says to follow the steps to add spreadsheet to my signature block ... but where the heck is that?? Can’t find info anywhere! I’m on apple ipad. Starting to do my head in I’m afraid... Any help appreciated.
     
  43. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If you go to the upper right corner of your screen and find your name, click on it. A menu will drop down and one of the items is "Signature". Click on that and a text box will open. Copy the URL of your SS page and paste it into this text box, then save. Your SS link should appear under the text of any post you write. It's also helpful to us if you add some info about your kitty in that same text box - name, date of diagnosis, insulin used, glucose meter used , what you feed, other health issues, etc. Have a look at others' signature text , the light grey writing under a post, for what is included.
     
  44. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Many thanks for your help.
    Have tried that now. Not sure if its worked though
    Have not entered any curve info onto FDMB ss yet - need to read notes on how to understand it.
     
  45. MJJ

    MJJ New Member

    Joined:
    Jan 9, 2018
    Urhhh .... doesn’t look like its worked does it and nothing saying LULU spreadsheet on my sign off to you above!
    Giving up for today...
     
  46. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Not sure what you did but when I click on the SS link it gives me my own signature info. Make sure you clicked on your own name in the upper right area of the page you posted your thread on.
     
  47. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Here - try this video and see if it helps:


    And also, make sure you've clicked on the "share" button and selected "anyone with the link can view"
    upload_2018-1-18_18-10-31.jpeg
     
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