!! Vets can't stabilize glucose levels.

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Mariana.Mnez

Mariana.Mnez

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Good night everyone, I'm new to the forum and new to the feline diabetes topic. About 8 months ago I found a cat in the street and took him home with me, first vet told me he was a she, and an old one, which was why he drank so much water. He's been in and out of the vet for several other reasons (feline acne, testing, eye wound), he was skinny but vets never actually treated him for anything in particular. Last Saturday I saw he was very sick, he was hardly moving and when he did, he'd tumble, he was meowing a lot, so I took him to the vet and after some tests he was diagnosed with diabetes. He arrived with 700 of glucose and from that day on the vets have been able to get him down to 400, 300, 150, but then all the way down to 50, 80 and spiking from 400 to 80 and so on. Today my vet finally told me to put him to sleep. I have been visiting him daily at the hospital and he was very sad, hardly moving and he looked really really sick. However, today, after deciding to put him down because I don't want him to suffer, he looked like before, he was rubbing his head against me, giving me kisses and generally letting me cuddle him, walking around and stuff. So I decided to wait again, but my vets tell me there's nothing to do. I don't want to let him go, but I don't want him to suffer either, I just want to make sure I'm making everything in my hands to get him to get better before giving up.
Any advice?
 
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So sorry to hear you're having so much trouble with your dear kitty (what's kitty's name?)

What are you feeding? A low carb canned or raw diet can go a long way in helping control the diabetes. If you're feeding something high carb, it's like trying to put a fire out while continuing to pour gasoline on it.

Are you on insulin? What kind?

I wouldn't give up hope yet....most vets have very little up to date training on treating feline diabetes so they do things all wrong. The people here have lots of real life experience and can most likely help you get your "extra sweet" kitty under better control.
 
Sorry you are having problems with your cat and your vet. What treatments has the vet been giving? Do you have copies of lab work? Glucose numbers? If not, you can ask the vet for them. The more information you can give, the better.
 
Hi and welcome to the forum.
First of all, diabetes is a very treatable disease and I would not even think of having him put down. But it takes time for the body to get used to the insulin. It sounds like your kitty has had diabetes for some time so his body is used to higher numbers. He is certainly responding to the insulin. When the blood glucose drops down lower than he is used to, his body panics and dumps regulatory hormones in his blood stream to "save himself" which raises the blood glucose......and he "bounces" This is very normal behaviour and lots of cats do it, especially in the beginning, until they get used to the lower normal numbers again.
If your vet will not work with you to treat kitty I would find a vet who will,

What insulin are you using. Lantus, Levemir or ProZinz are long acting insulins and are the best for kitty. There are many experienced people here who know lots about feline diabetes and are very willing to help you.
 
Thank you for your kind responses, my kitty's name is Taro, i know that he's been taking insulin was twice a day and the vets have told me they have tried with different kinds and has not responded well to any. I feel like it's too soon to tell, as today was only his forth day after being diagnosed. He was very skinny, which is why vets are saying he will not be able to endure anymore ups and downs. I will get the names of the insulin and I will share it with you. He's currently on a wet food diet, before being diagnosed he was eating commercial food but I did share some of my own food with him.
 
I want you to see the difference between when my cat was first diagnosed and how she looked just a few months later (with the help of the people here....NOT my vet!)

Click on pictures to expand
China before diagnosis.jpg less than 8lbs...a walking skeleton
China after diagnosis.jpg with the help of the people here who know what they're doing and Lantus insulin....12+lbs

Commercial foods can be fine!! The fancy "prescription" foods are nothing special (other than being expensive!) Most of us here feed Fancy Feast Classics, Friskies pates or 9-Lives ground....they're below 10% carbs and that's the important thing. Most of the prescription foods are much higher in carbs and no good at all for a diabetic cat
 
Welcome sweet Taro.
I wonder how experienced your vets are with feline diabetes. It is not like canine diabetes. It will take more than 4 days to get the diabetes under control and if they have been using several different insulins....no wonder he is all over the place.
A lot of cats lose a lot of weight when they have undiagnosed diabetes for a while. Once the blood sugars are under control, the weight will start to go back on. That happened with my cat Sheba and she is a perfect weight now.
Let him eat all he wants as his body is not able to get all the nutrients out of the food when the blood sugars are high....but this all goes back to normal when the blood sugars regulate. Make sure he is getting plenty to drink too. If he is not drinking, you can add some warm water to his food.
 
Mariana.Mnez said:
He arrived with 700 of glucose and from that day on the vets have been able to get him down to 400, 300, 150, but then all the way down to 50, 80 and spiking from 400 to 80 and so on. [...] he was very sad, hardly moving and he looked really really sick. However, today [...] he looked like before, he was rubbing his head against me, giving me kisses and generally letting me cuddle him, walking around and stuff. So I decided to wait again, but my vets tell me there's nothing to do.
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I'm so glad your kitty has you to love him and fight for him. I'm very sorry that you have a vet who wants to give up but it is your kitty and your decision. The first vet I took my cat to completely missed the diabetes and refused my request to do any diagnostics whatsoever. Thankfully I found FDMB and from what I learned here I was able to go back to a different vet and get her the help and treatment she needed. FDMB helped me save my cat's life.

What you describe about how your cat is behaving is essentially the same as I saw in my cat when she first started treatment. She was really lethargic and unwell for several days when she first started getting insulin but on the sixth day - and after three days in hospital - she became more alert; more herself. As her body started getting used to the insulin she she brightened up, started scent marking again (rubbing her face against the sides of her kennel) and started to be affectionate again. Progress was slow and steady at first but she kept getting better. Very, very shortly after starting insulin she started eating, drinking and peeing normally again. As her treatment continued she regained the weight she lost, her energy and behaviour returned to normal and her coat became thick, black and soft again. Four months after starting treatment she looked like she had been drinking at the Fountain of Youth (our new vet was stunned at her improvement). Shortly after that she was climbing trees!

Regulation doesn't happen overnight. Your vet can't "force" the BG back to a healthy range in a few days. The idea is to start at a SAFE insulin dose (enough to start helping the cat to use glucose properly again), test blood glucose and ketone levels (just like a human does - we can help you learn how to test) and then make small, gradual, steady changes to the insulin dose based on the individual cat's response so as to ease the cat into healthier blood glucose numbers while minimising the 'overreaction' and wild swings. As we often say here, it's more of a marathon than a sprint. :) The body needs time to 'learn' to be in a healthy blood glucose range again.

Bron and Sheba said:
But it takes time for the body to get used to the insulin.
Click to expand...

If your cat is going down as low as 50 it is possible that your vet is giving too much insulin too fast. As Bron says above, if numbers go too low too fast the body overreacts to protect itself. If your cat's blood glucose is going from 50 to 400 shortly after the wild swings in blood glucose level are very likely a lot of what might be making him feel somewhat unwell on his current insulin dose. Human diabetics who experience big BG swings like that also report that it makes them feel unwell. If your cat is going as low as 50 as measured on an animal glucometer then the dose is definitely too high. Sometimes vets give too high a starting dose and that is what can make the wide BG swings worse, as well as putting the cat at risk of a hypo.

Please can you let us know ASAP:

1. How much your cat weighs (approximately) and whether he is still underweight.

2. The type of insulin he is receiving.

3. The dose of insulin he is receiving.

4. Whether your kitty ever tested positive for ketones. (MAKE SURE THE VET TESTS FOR KETONES!!!)

If you can get this information to us then we can at the very least give you a bit of guidance on what your kitty's starting dose should be as the starting dose is typically based on the cat's weight, not their starting BG levels (assuming no ketones).

Sending lots of positive vibes to little Taro and a huge :bighug: to you for loving and fighting for him. Diabetes IS do-able. We'll do everything we can to help you both.


Mogs
.
 
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Thank you for helping this poor kitty,
Four days is not even close to the amount of time it takes to judge how a cat does on insulin. Not only that but to try out a few different insulins within four days is frankly crazy.
It doesnt sound like your vet knows much about diabetes. Can you take kitty to another vet clinic for new opinions?

For example my cat was on Lantus insulin for 10 MONTHS before we decided it wasnt right for him and to change to PZI. We tried Vetsulin briefly which was awful with extreme highs and lows, and i suspect your vet might have Taro on that. Or similar.
 
Hello everyone, I have received today's report on Taro's health, he's still around 400. I asked him the about the doses and this is the information I received.
Current weight: 5lbs
He is getting .5 units of glargine insulin every 12 hours. They tried with regular insulin before and did not work for him. He did test positive for ketones, can you explain me if this is bad or what does it mean?
 
Hi,

If your cat is positive for ketones, it would be good that you change the title of your post , and that you add a "911" as a prefix (this will alert some more people to look at your post).

To do this:
1. Edit your message
2. At the right of the title of your message, you will see a drop list "thread tools"
3. Choose "Edit Title"
4. Change the prefix to "911".

Sophie
 
I'm sorry but I question such a large starting dose. I question whether your vet has enough experience with lantus and if my cat I would take him elsewhere. It is totally normal for a cat's glucose to bounce around. I've never dealt with ketones but the reason for that is usually not eating enough, not yet regulated, and infection. Did they check for infection? If you Pist where you live someone might be able to recommend a vet for you. I'm so sorry you are in this situation.
 
My understanding is he needs more time for the insulin to work. Glargine takes a couple weeks to really see what it can do. Its generally a good insulin, not harsh like vetsulin.
He needs fluids to keep hydrated, and he needs to eat. Ketones isnt good, that much i know, but its not a death sentence. Others here know more than me. My cat has had trace ketones in his urine, and it was only temporary. Taro has been suffering from lack of care and is going to need support and time.
Mariana.Mnez said:
Hello everyone, I have received today's report on Taro's health, he's still around 400. I asked him the about the doses and this is the information I received.
Current weight: 5lbs
He is getting .5 units of glargine insulin every 12 hours. They tried with regular insulin before and did not work for him. He did test positive for ketones, can you explain me if this is bad or what does it mean?
Click to expand...
 
tiffmaxee said:
I'm sorry but I question such a large starting dose. I question whether your vet has enough experience with lantus and if my cat I would take him elsewhere. It is totally normal for a cat's glucose to bounce around. I've never dealt with ketones but the reason for that is usually not eating enough, not yet regulated, and infection. Did they check for infection? If you Pist where you live someone might be able to recommend a vet for you. I'm so sorry you are in this situation.
Click to expand...
I dont think 1/2 unit lantus is a lot for 5 lbs. my cat started on 2 and he is 14 pounds. Are we on the same page?
 
Mariana, what did the vet say about him testing positive for ketones? Did they tell you how high or suggest any treatment? If he has more than trace ketones he needs veterinary help, the sooner the better. You can buy ketone test strips at any pharmacy, and test his urine at home.
 
Squalliesmom said:
Mariana, what did the vet say about him testing positive for ketones? Did they tell you how high or suggest any treatment? If he has more than trace ketones he needs veterinary help, the sooner the better. You can buy ketone test strips at any pharmacy, and test his urine at home.
Click to expand...

As far as I understand, Mariana's cat is at the vet for more than 5 days (since last Sunday).
 
Capoo said:
Hi,

If your cat is positive for ketones, it would be good that you change the title of your post , and that you add a "911" as a prefix (this will alert some more people to look at your post).

To do this:
1. Edit your message
2. At the right of the title of your message, you will see a drop list "thread tools"
3. Choose "Edit Title"
4. Change the prefix to "911".

Sophie
Click to expand...

Mariana,

When changing the prefix of your title to 911, you need to use the droplist so that a red box appears with 911.
 
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Mariana.Mnez said:
Hello everyone, I have received today's report on Taro's health, he's still around 400. I asked him the about the doses and this is the information I received.
Current weight: 5lbs
He is getting .5 units of glargine insulin every 12 hours. They tried with regular insulin before and did not work for him. He did test positive for ketones, can you explain me if this is bad or what does it mean?
Click to expand...
"Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter[1], may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly."
http://petdiabetes.wikia.com/wiki/Ketones

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

You can read more information about ketones here:

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/
 
tiffmaxee said:
I'm sorry but I question such a large starting dose. I question whether your vet has enough experience with lantus and if my cat I would take him elsewhere. It is totally normal for a cat's glucose to bounce around. I've never dealt with ketones but the reason for that is usually not eating enough, not yet regulated, and infection. Did they check for infection? If you Pist where you live someone might be able to recommend a vet for you. I'm so sorry you are in this situation.
Click to expand...

Glargine, which is lantus was a good decision your vet made. But it takes a much longer time for good results, which your vet does not seem to know.

Ketones are not good, and usually a cat must remain under intensive care at your vet for a week or more. Since this cat was already so thin, and in such poor shape, it may take longer.

The bouncing from a low number like 50, to a very high number is expected. Your kitty is not used to having such a low blood glucose number, and so your kitty's liver is sending out a lot of emergency insulin, because the liver "thinks" that insulin is so low they (the cat's total system) might die. Therefore, the liver provides enough insulin to be sure that death from too little insulin will not occur.

The "bounces", which are what we call these abrupt changes from very low blood glucose numbers to very high blood glucose numbers are normal. But it is true that it is difficult for your kitty to endure them, when in such a weakened condition. That is why a longer vet stay is necessary. I agree that a better, or rather a vet more experienced in treating diabetes might be a good idea, but I don't know your economic abilities. Intensive in house vet care is pretty expensive.

On the other hand your kitty is improving by quite a lot.
I suspect that your vet speaks truth when saying that there is nothing more she or he can do. However there is a great deal more that a vet who understands diabetes can do, including, perhaps, saving your cat's life.
 
Mariana, if the vets are not treating him for ketones/don't know how to treat for ketones, please take him to another vet, who does!
Kathy and TiTi said:
On the other hand your kitty is improving by quite a lot.
I suspect that your vet speaks truth when saying that there is nothing more she or he can do. However there is a great deal more that a vet who understands diabetes can do, including, perhaps, saving your cat's life.
Click to expand...
Kathy is absolutely right!
 
Mariana, please correct me if I'm wrong:
  • Taro is receiving 0.5 units of Lantus insulin every 12 hours.
  • He's been hospitalized for close to a week.
  • He's throwing ketones.
  • Taro weighs 5 pounds.
Questions:
  • Is he on a dextrose drip (IV)?
  • Did they try giving tiny doses of Regular insulin every 4 - 6 hours (as needed)?
  • Are they feeding him by syringe?
I'm suspect the Regular insulin "didn't work" because the dose may have been too high for such a little kitty. They may need to start with tiny, tiny doses of Regular insulin doses like this:

01unit-1.jpg


or

025unit-1.jpg
.

In other words, start with small doses of Regular insulin every 4 - 6 hours while on a glucose or dextrose drip to help bring numbers down.

Are they managing his electrolytes? Potassium and sodium should be monitored.

Here's a list of other vets in Guadalajara, Jalisco, Mexico if you find it necessary to take Taro to another vet: https://www.yelp.com/search?cflt=vet&find_loc=Guadalajara, Jalisco. Is that where you're located?

Here's more on ketones:
Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters


How can we help?
If you have questions we'll try to help answer them.

 
Hello everyone, thanks for the quick responses! We are located in Guadalajara, Mexico, he's currently at the hospital and has been hospitalized since saturday afternoon. What my vets have told me is that he is constantly being tested, he is on fluids and I have so far on my medical count being charged for 3 I.V. Fluids, along with 3 electrolyte Lyte 4 IDEXX, a glucose curve and 2 general urine EGO exams. I did find a veterinarian specialist on felines who I will be taking him to, so I need to collect all his studies and take him to her.

UPDATE: He has been treated by three different doctors, the first one was more optimistic and handled him on saturday, sunday and monday. He told me about keeping potassium and sodium levels, so I guess they are keeping that monitored. He is not being fed by syringe, he's been fed canned wet food and he's been eating well. I am at work indeed, but I have also been making phone calls trying to track down a different veterinary or hospital that can help me, that's how I came across this feline specialist I will be taking him to. I told her which hospital my cat was in and she was shocked to hear they asked me to put him down.
 
Wishing you and Taro the best of luck!
Please update when you can. We'll be thinking of you!


Edited to add:
There are several of us who are all too familiar with ketones and diabetic ketoacidosis. Don't hesitate to ask if you have any questions.
 
Mariana.Mnez said:
Hello everyone, thanks for the quick responses! We are located in Guadalajara, Mexico, he's currently at the hospital and has been hospitalized since saturday afternoon. What my vets have told me is that he is constantly being tested, he is on fluids and I have so far on my medical count being charged for 3 I.V. Fluids, along with 3 electrolyte Lyte 4 IDEXX, a glucose curve and 2 general urine EGO exams. I did find a veterinarian specialist on felines who I will be taking him to, so I need to collect all his studies and take him to her.

UPDATE: He has been treated by three different doctors, the first one was more optimistic and handled him on saturday, sunday and monday. He told me about keeping potassium and sodium levels, so I guess they are keeping that monitored. He is not being fed by syringe, he's been fed canned wet food and he's been eating well.
Click to expand...
What you are doing for Taro is wonderful, Mariana. He/she deserves to have more time with you to spoil and love him/her. I hope the recovery goes well.
 
Mariana.Mnez said:
Hello everyone, thanks for the quick responses! We are located in Guadalajara, Mexico, he's currently at the hospital and has been hospitalized since saturday afternoon. What my vets have told me is that he is constantly being tested, he is on fluids and I have so far on my medical count being charged for 3 I.V. Fluids, along with 3 electrolyte Lyte 4 IDEXX, a glucose curve and 2 general urine EGO exams. I did find a veterinarian specialist on felines who I will be taking him to, so I need to collect all his studies and take him to her.

UPDATE: He has been treated by three different doctors, the first one was more optimistic and handled him on saturday, sunday and monday. He told me about keeping potassium and sodium levels, so I guess they are keeping that monitored. He is not being fed by syringe, he's been fed canned wet food and he's been eating well. I am at work indeed, but I have also been making phone calls trying to track down a different veterinary or hospital that can help me, that's how I came across this feline specialist I will be taking him to. I told her which hospital my cat was in and she was shocked to hear they asked me to put him down.
Click to expand...

We were also shocked. It is wonderful that you found this new doctor. Please let us know how Taro is doing? The first doctor sounds much better. Too bad they had to switch vets.

I am so pleased that you are taking him to a specialist. Taro sounded so much better from your last visit that it seemed odd that the vet suggested putting him down.

Hugs to you and Taro!
 
Mariana, you are doing a great job seeing that Taro is properly taken care of! It's wonderful that you have found a specialist for him, and that he is eating well, on his own. Sending you prayers and healing vibes that Taro recovers quickly and you can start to get his blood glucose under control. Please DO keep us posted, and always feel free to ask questions! :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Glad you found another vet. Diabetes is so treatable. Just a little tidbit. Lantus is a depot insulin and takes a few days to fill up. Your kitty hasn't had time for that to happen yet. Give it some time those numbers will come down.

Once you get Taro home come back here for answers to all your questions. Please realise treatment isn't a quick fix and doses go up and down. And it all takes time.

One of the best ways to help is get a human glucose meter and start home testing. It will keep Taro safe and let you know when you need to give less or more insulin.

Read the informational stickies posted throughout the site. Come back you will get help here.
 
Hi Mariana I'm glad you could find a vet that knows about felines, most only treat dogs (let alone diabetes), not an easy task in Mexico, believe me I know, I live in Mexico City, so congratulations,!

You should also look what kind of canned food he is having, we don't have many good options for diabetic kitties over here and most of the hills, proplan, royan cannin, etc ( we do not get the whole line this brands have) that most vets have over here are really high in carbs that may be good if your kittie is recovering from a surgery but not for diabetes.
 
Hi Mariana, I am so glad you have found a vet who know how to treat diabetes and ketones. Sorry I haven't been around, but I just woke up.....morning here. You have been getting great help and advice.
I am going to tag @Meya14 as she knows a lot about ketones too and she will be able to give you help too.
You are doing a wonderful job saving Taro....he's a lucky boy to have you.
It is great he is eating, that is a very good sign.
:bighug::bighug:
 
Mariana - you are doing a wonderful job looking after Taro's best interests. Please let us know what the new vet says. If you have any questions or want the various lab results interrupted, please do post. The people here are very knowledgeable and wonderful.
 
Hi there, Glad you found a vet who has a more positive outlook. DKA is a very severe acute illness, but most cats who pull through and aren't any worse off after.

As far as the "insulin not working" part - When there are no fat stores left in a diabetic the liver has a very hard time compensating for insulin doses. This in humans is referred to as "brittle" diabetes. What happens is that the blood sugars go very high, then insulin is given, then you get dangerously low sugars, and back and forth. The solution is actually to increase the amount of carbs you are feeding, so that you can give larger insulin doses - this will allow her to gain weight faster and for her sugars to be less "brittle". Once she is more stable, slowly reduce the carbs in the food, and monitor weight closely. The only way she'll gain weight and be healthier is with larger insulin doses than what she's been getting and that's going to mean increasing intake.

DKA happens when the body either isn't getting enough calories (in starvation or chronic illness) or not enough insulin to allow for food to be used as energy and stored as fat. The body starts burning fat instead as an emergency fuel, but over a few days, the biproducts of this, ketones, build up in the blood and cause problems.

So, it's good that she's eating by herself and sounds like she is in good hands at the current vet. When she comes out, if it were my cat, I would aim for about 20% carb food - wet or dry (other's will disagree, I know) and increase insulin to match the intake until she gains some weight. Because she can't compensate when she goes low, you need the extra carbs from the diet to even out the blood sugar swings.

Hang in there, there are many people on this board who have DKA survivor kitties, including me. No need to PTS, just a lot of care for a bit.
 
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