Vetsulin no longer working?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Tucker's Mama CS, Jan 6, 2019.

Thread Status:
Not open for further replies.
  1. Tucker's Mama CS

    Tucker's Mama CS Member

    Joined:
    Jan 6, 2019
    Hello all!

    It was suggested to me that I should join this message board for some extra guidance. My handsome 13 and 1/2 year old boy, Tucker, has been diabetic for almost 2 years. He had been very well controlled on Vetsulin once transitioned to wet food. We even achieved remission in the late summer months of 2018.

    Unfortunately, his health has had many set-backs since that time and we have not been able to get a handle on his diabetes ever since then. In late October he had an episode of inappetence and vomiting so I took him to the emergency hospital and after many tests, he was presumed to have GI lymphoma. Despite my protesting for chemo, the IM specialist placed him on Prednisolone instead. Steroids for a diabetic? Yeah, my thoughts exactly!

    After 6 weeks on Prednisolone, he took another turn for the worst and wound up in the ICU with severe pancreatitis and diabetic ketoacidosis (DKA). Ever since that time, his glucose readings have been all over the place. In the same day, it was too high for the monitor to read in the morning, and then 72 in the evening. Most of his readings have been between 350-600. Is it possible that the Vetsulin is no longer working for him? Or is this just a product of all of his diseases? Now his kidneys are suffering and I'm sure some of that is because the diabetes is so out of control??

    Does anyone else have experience with this or advice? Thank you in advance!

    Crystal

    Edited to add: I forgot to mention that after his episode of severe pancreatitis and DKA in early December, he was taken off the Prednisolone.

    His current medications are: Vetsulin, Cerenia, Famotidine, Potassium Gluconate, and Mirtazapine.
     
    Last edited: Jan 6, 2019
    Reason for edit: forgot to mention
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! Treating feline diabetes is hard but gets even more challenging when other health issues are present.

    Sometimes steroids are necessary to keep a condition under control. If that's the case, you have to dose insulin around the steroid that will tend to raise BG. When my cat saw an IM vet for similar problems she suggested a different medication, Atopica, for IBD. It's sometimes used in cats for severe allergies as well. It doesn't affect BG like a steroid does. I didn't use it for my cat because he recovered.

    This was my experience when Teasel was very ill in May/June of 2018. His BG settled as he recovered. Vetsulin can definitely cause big spikes and dips in BG by its action. It might be time to consider a different insulin now in light of the recent crisis. Lantus or Levemir are depot insulins that have a slower, gentler action that can help to smooth things out.
     
    Tucker's Mama CS likes this.
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    BTW - Tucker is a very handsome boy! :)
     
    Tucker's Mama CS likes this.
  4. Tucker's Mama CS

    Tucker's Mama CS Member

    Joined:
    Jan 6, 2019
    Thank you! I sure think he is! :joyful:
     
  5. Tucker's Mama CS

    Tucker's Mama CS Member

    Joined:
    Jan 6, 2019
    I forgot to mention that since his episode of DKA/pancreatitis in early December 2018, he was taken off the steroid! Thank you for the welcome and the advice. Would the Lantus or Levemir be added or be in place of the Vetsulin?
     
    Last edited: Jan 6, 2019
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    It would be in place of the Vetsulin. You might want to go to the Lantus forum and do some reading of the yellow info stickies to learn more about these insulins. :)
     
    Tucker's Mama CS likes this.
  7. Lori&Scout

    Lori&Scout Member

    Joined:
    Jan 18, 2012
    From what I understand, if it is GI lymphoma, he's probably not got very long left. Its unlikely his BG will do anything that makes sense while his organs are struggling this much. Human diabetics I know say that any illness or infection makes their BG go wonky. A longer lasting insulin may help somewhat stabilize his numbers over the course of a day, but it might also be hard to start fresh with a new insulin and find the right dose because of the other disease present. It also might mean more pokes for him as you try to figure out how new insulin works for him.

    I gave my Nipper lantus during her last months, while she had cancer, and it worked well for her. I lowered the dose and cut down on the BG tests because tight regulation was no longer our main concern. But she was already regulated on lantus before she got sick, so it was a bit of a different situation.

    I'd focus on doing what you can to make him comfortable - avoid hospitalisation and make sure you manage his pain and symptoms at home as much as you can.

    Lots of hugs for this difficult situation.
     
    Tucker's Mama CS likes this.
  8. Tucker's Mama CS

    Tucker's Mama CS Member

    Joined:
    Jan 6, 2019
    Thank you very much Lori for the words of encouragement and support. I am doing what I can to make him as comfortable as possible, I just feel so helpless right now because the wonky/ out of control sugars are killing his kidneys, and the worst his kidneys get the less of an appetite he has. I am going to struggle with putting him down but the last thing I want is for him to suffer. He has been such a sweet boy.
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Having now my third cat with GI lymphoma, :(, I will contradict what is said above. First, presuming the right tests have been done, and you have a definitive diagnosis of small cell lymphoma, it can be fairly easily be treated. Under the right chemo protocol, the vast majority of cats go into remission, some for several years. Neko did not, but she also had acromegaly, heart disease and advanced kidney disease, which is what I think took her. The heart disease and kidney disease also did not impact her blood sugar and she was well regulated on Levemir to the end.

    To break down what I said, first it’s key to get the right diagnosis. IBD and GI lymphoma can look alike even with ultrasounds. An endoscopy or full surgical biopsy is needed for a diagnosis. Having said that, my Neko’s IM vet was pretty sure she had SCL (small cell lymphoma) and due to her heart she could not undergo anesthesia required for either procedure, so we presumed the diagnosis, and treated as such. Neko also could not have pred due to her heart, so she took budesonide, which is a steroid, but it acts locally on the GI system and did not impact her blood sugar. Note, for some cats budesonide does have a BG impact, though usually less than for pred. The second part of the treatment is chemo, chlorambucil, with the most easily tolerated protocol being a once every two week pill/capsule/chew treat if compounded. Just before and after the chemo, I give an anti nausea med, ondansetron. All of my cats have tolerated the chemo fairly well.

    I would talk to the IM vet about budesonide. It reduced Neko’s inflammation by 35% and greatly improved her quality of life. That same IM vet should be putting Tucker on chlorambucil, preferably the pulsed or every two week protocol which is easier on both you and the cat. It is not to late to beat back the lymphoma, if that is what he has. It is a slow moving condition. As Kris suggested, Lantus or Levemir with their slower action may be better insulin choices.
     
  10. Tucker's Mama CS

    Tucker's Mama CS Member

    Joined:
    Jan 6, 2019
    Hi Wendy, thank you so much for your post! I'm sorry that I don't know how to reply without replying to the whole message, but I wanted to be sure to reply to you and talk to you some more. I was told the only way to definitely diagnose him was through the full surgical biopsy (endoscopy could miss things per the vet), but Tucker has been so sick and cachectic (he's lost 6 lbs) that I know he would either not make it through the surgery or it would be too difficult of a recovery. So we've been going on all of the labs, x-rays and ultrasounds that have been done up to this point and it has been presumed to be SCL by the emergency vet that first treated him in October, his regular vet, and the Internal Medicine specialist that I took him to in November and December.

    When Tuck saw the Internal Medicine specialist (one that specializes in chemo) and I requested chlorambucil, he did not want to give it to him, for reasons that are still somewhat unclear to me. I believe he was trying to say that the chlorambucil would not give me much more time with him, but that it may decrease his quality of life and so he advised against it. I had scheduled a second opinion with an oncologist in another county for the beginning of December but unfortunately Tucker was in the ICU with severe pancreatitis and DKA so I had to cancel that appt.

    Tucker's regular vet believes we need to just do palliative care at this point and make him as comfortable as possible, and while I do not want him to suffer or have any pain, if there's something I can do to give him better quality of life for the rest of his life, I will do whatever it takes. Whatever it takes! He appeared to be doing so well (great appetite, regular check-ups with normal labs) up until the end of October when he went to the emergency vet the first time. Even since then, his health has been steadily declining. I will definitely talk to the vet about budesonide, and perhaps even the ondansetron because I think there are days when the Cerenia is not controlling his nausea. I think I am also going to reschedule that consultation with the oncologist and see what she has to say. That way I know I have done everything I can to help this sweet angel.

    But that still leaves me with his uncontrollable and unpredictable glucose readings. His diet has not changed, he has been on low carb canned food ever since he became diabetic, even achieving remission at one point, but ever since he was on the Pred (he was tapered off completely by 12/3/18!) and had pancreatitis 12/7/18, his glucose readings are so out of whack. And now, his kidneys are suffering because of the uncontrolled diabetes (last creatinine was 3.4 - up from 2.4!). Do you think a change to Levemir would be better? Any other thoughts or advice? I so appreciate you taking the time to share your story and experience with me. Thank you Wendy. Neko is beautiful!
     
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    A couple comments. Endoscopy cannot diagnose all SCL, it depends where the thickening is. My last kitty was diagnosed by endoscopy, thickening in the duodenum. Ilium can be diagnosed in reverse, a colonoscopy. Next, the chlorambucil protocol is key. Many vets still prescribe every other day chlorambucil, which gives the cat no time to get over nausea. Neko started EOD and did much better on every two week which I had to fight for. Third, either Lantus or Levemir are slower, gentler insulins that can give you flatter cycles.

    Yes, my angel Neko was a beauty, in personality too.
     
Thread Status:
Not open for further replies.

Share This Page