Rascal - Round 2

Hi Everyone,
Rascal is 17 and my best little orange friend. She has been a chronic "barfer" her whole life, and I thought she just had a sensitive stomach and that this was rather normal. Unfortunately I was wrong. Just over a year ago, around the time we lost Pierre - our little tuxedo man - to oral cancer, Rascal started vomiting a lot and experiencing a lot of diarrhea. This time it had blood in it. SO scary! We got a diagnosis of inflammatory bowel disease based on clinical presentation and ultrasound. She has also had mild pancreatitis associated with this. Her symptoms declined with a switch to prescription food with novel proteins (she can't do chicken, turkey, all the normal meats), but her intestinal wall was still inflamed so we started on prednisolone. Many of you can probably guess where that led. Within three months she was diabetic. That was last November.
It's been a long, confusing year trying to treat both conditions simultaneously. A switch from pred to budesonide helped her BGs, but she is so limited as to what she can eat. Unfortunately her Royal Canin cans with rabbit and duck also contain pea flour (CARBS! Cats don't eat peas!!!!). But attempts to try other foods so far have not worked and her IBD has flared up. Right now she is tolerating a little Primal frozen raw rabbit, and I would like to gradually try a switch to homemade - either cooked or raw - but I know from past experience I would have to transition her very slowly. She is so sensitive.
Once we got the diabetes diagnosis last fall we started Lantus with dosing based only on fructosamine tests. We didn't know any better and trusted our vet, an internal medicine specialist. We started at 1 Unit but later after another fructosamine we were raised to 2 Units. Before long we had our first hypo emergency over New Year's which resulted in an overnight stay at the hospital for Rascal and an $800 bill for us!
That was it for me. I knew there had to be a better way and I found the Feline Diabetes group on Facebook. I started home testing and adjusting doses of Lantus, and by spring Rascal was mostly off the juice. Occasionally she needed insulin and it was a bit back and forth and may have been connected to mini IBD flare ups, but from early June to mid July she was holding her own, usually between 100 and 130, occasionally down to 81 or up to 148. I checked her every 5-7 days to be sure, but she stayed around 110 on average.
Then in the middle of the summer her numbers suddenly went up. It could be the fact she was fighting a UTI or that I made the stupid mistake of giving her a few small portions of her old prescription kibble with even more pea flour. Ugh. Her appetite was waning. She takes small doses of mirtazapine to increase her appetite but her interest in food is not always the best - probably due to age but also because she is sick to death of the same two cans she gets all the time. She was thrilled to have some kibble! Whatever it was that kicked her out of remission, her BGs have been in the upper 100s, 200s and now low to mid 300s from mid summer until now.
I feel terrible because I am now finding out that I have been making mistakes along the way. Since I was able to get her OTJ once before, I assumed I knew what I was doing, but I am having a terrible time getting her regulated this time. At times she seems totally unresponsive to the insulin, but then a small increase lead to another hypo event one week ago. Thankfully we were able to manage at home this time with feeding and Karo syrup.
So it turns out I have probably been making dosage changes incorrectly this time around, I have not been handling the Lantus correctly all along thanks to faulty instructions at the animal hospital, and we are still free feeding food with pea flour in it and using budesonide, both of which have helped her gut but are no doubt complicating her blood sugar patterns. I should have done a lot more reading here a long time ago. I should have started a spreadsheet and been on the FDMB more and not just the Facebook group. I should have bought a new bottle of Lantus since the one we have been using is 10 months old but at times still really seems to work (thus the hypo event!) but at other times not at all. I need to better understand the depot effect...All things I plan to take care of ASAP.
I have been so incredibly grateful for this group and IBDKitties for all the help and encouragement we have received so far, and we will definitely need more as we try to get this under control again. Time to get serious. I thought I was serious already, but apparently I need to take it to the next level. Thanks for reading and for being there for all of us and our fuzzy little diabetics!

 

Hi Melissa and Rascal, welcome to FDMB! So many knowledgeable people here to help and support you both Like you, I started in the Facebook group too, but wasn't there long before I joined here. It's much more informative here, rather than 'chatty' on FB.

It's a good idea to include some information in your signature so that everyone can see at a glance what your situation is (see mine below for an example). Also, there is a spreadsheet you can set up with Rascal's information to track his numbers, and it will help the advice-givers helping you too. I'm not sure where the link is with the instructions for the spreadsheet set-up, but I'm sure someone else will be able to link it for you.

Hypos are so scary, glad you got Rascal back up again! Please don't feel bad about things you think you may have done wrong - I'm sure we all have "shouldv'es" we regret, but you can't change that. Just this morning I gave my Ivana a fur-shot and felt like an idiot because now she will be high all day. But, things happen, you just learn from it and move on.

Also like you, I need to learn more about the depot - it's the one thing that hasn't quite gelled for me, and my task for the weekend is to read about it from different sources as one of them is bound to describe it in a way that switches on my light bulb. If you find a good explanation of it, please let me know

Wishing you both a fabulous weekend!

 

Have you checked out the raw recipe at Cat Info?
And, if it has things your cat cannot eat, do know that Dr Pierson consults for a fee. It may be possible to have a custom recipe created for your cat.

 

Welcome Melissa and Rascal. Our spreadsheet instructions are here. If you haven't been keeping a written log of your shots, dose and time, you may be able to find it on the history of your meter. It would be helpful if you could put at least two weeks of data in your new spreadsheet. Also, please put what kind of meter you have in your signature.