Will start insulin this week

I was able to do a BG curve on Sunday so I could call my vet this a.m. with the numbers. Conrad (15-yrs-old, 18 lbs.) goes to the vet today at 2. He will start insulin today (I'm assuming).

He was a such a good kitty. Here are the numbers I got (NO insulin yet & no dry food for 12 days):
7:30 am 302
Eat
9:30 am 260
11:30 am 217
1:30 pm 172
3:30 pm 186
5:30 pm 211

BTW, I used the AccuCheck Aviva. (Anybody have any comments as to how accurate it is?) It's easy to use, requires little blood and sips well.
Not so much a question, but a fear...if he drops to 172 on his own (5-6 hours after eating), I'm so afraid of him hitting hypo. I'm hoping though that, if he can get to 172 without insulin then he has enough pancreatic function that he may be one of those cats to go into remission with moist food and small doses of insulin.

 

I hope your vet starts him on a low dose and hopefully it is Lantus because with those numbers + Lantus he may very well go into remission. Please ask your vet what insulin he is going to use and the dose the vet wants to start him on. If you do not agree with the starting dose, then ask the vet to start a lower dose.

 

My vet just called me. He said that he had consulted with a vet specialist from another clinic and she is in agreement with him that Conrad is just not ready for insulin. Another vet in my vet's office agreed with them as well. (Corad has had fructosamine testing too.)
He started at 302, yes, and that might seem high, the vet said. But Conrad, without insulin, drops down into the 100s on his own. For that reason, my vet and this other vet would be leery of starting him on insulin just now.
This specialist told my vet that, in cases like this, a cat should stay on an all-moist, low carb diet for at least 3-4 weeks and see how low the numbers might get. (Conrad has been on the diet for 13 days.)
Then, Conrad would be a candidate for a pill first, rather than full-blown insulin.
I'm to keep checking for ketones (I have the strips) and do another curve this weekend. I just need to be vigililant, with both the diet and BG testing, for the next two weeks. Then, we'll take it from there.

My vet is so enthusiastic, into the newest technology and so not full of himself (he wants to hear your opinion, returns your calls, wants you to learn home testing, prints out stuff from THIS website to give out, etc.) that I feel like I should trust him.

This is such a roller coaster! :smile:

 

I'm gonna disagree again, on two fronts.

First, I disagree that 3 weeks will make any difference in seeing changes from the diet change.

Second, you do not want to pill your cat. Glypizide forces the pancreas to work and can burn it out. It is NOT a substitute for insulin.

Honestly, I don't know what else to say. Having a specialist confirm this poor advice makes it more difficult for us to give opposing ideas but I will continue to disagree with what they are saying.

Please, do not give glip.

Jen

 

I agree with Jen. The pancreas has a limited amount of time to heal; a limited time when the cat may be able to go in remission with insulin. No one knows how long that is - it varies with the cat. But if you don't start insulin within that time, you run the risk of never working with a healing pancreas.

Not to say insulin would be an easy approach. You would need to start on a very low dose and monitor often. But you are already hometesting, so you have the tools you need. I am going to pm Nicole and Baby and see if she will chime in. She started Baby on insulin at numbers about like yours or lower. It took a while of very carefully dosing and monitoring, but Baby is now off insulin and has numbers in the two digits.

I know it is hard to consider our advice over your vet and a specialist. All I can say is that there are hundreds of cats here well regulated or in remission that have followed our protocol and been successful.

 

I'm with Jen on the glip.

If you are going to try for diet control without insulin, might I suggest you break Conrad's food into several small meals during the day and night. That might take a timed feeder if you want to work outside of the home or sleep for more than 3 hours straight.

As you can see with the numbers before and after you fed Conrad, his pancreas is releasing some insulin in response to food, just not enough to get him into normal range. Frequent feedings might help.

 

This forum is so great....but it also leaves me feeling agonized.

Conrad had a physical on Sept. 14 - no glucose in his urine.
He literally starting peeing more on Oct. 14. I took him to vet less than one week later. So, he's only been mildly diabetic for 2 weeks. I am so, so, so, so torn. I want to follow the advice of three vets, one of which is an internal specialist, and just stick with the diet for another 10-14 days. If he just became diabetic two weeks ago, even if he waited to start on insulin in another 10-14 days, he hopefully would be so mildly diabetic still at that point that he'll be okay. But, I also hear what you all are saying. I just don't know what to do....this is killing me.

I truly appreciate the advice. You all are so knowledgeable. The past two weeks have a been a crash course!
No matter what I do, I will stress. Don't start him on insulin for another two weeks and worry I'm doing damage and narrowing that window.
Start him on insulin now when his body can drop to the 100s without insulin and worry that I'll come home from work (I'm single and have to work full time) and he'll be unconscious because I gave him insulin when he didn't need it.

UGH!!!!!!! :shock:

 

At this point, it is all up to you. As much as that s*cks. You need to come to a decision on what you think is best. If it is to start insulin, respectfully tell your vet that you want to start now and not wait and not use glip. If it is to wait, then that is also your choice and at least you are monitoring everything you can. Just please, do not go with the glip as there is absolutely no valid reason for you to use it and every reason not to. FYI cats can become hypoglycemic on it too..

 

Compromise and give it one more week without insulin, smaller and more frequent meals if possible and then see what the numbers are and then maybe start Lantus on a Fri. night, tiny dose and then have the weekend to see what numbers you get?

 

Jennifer,

I know that you respect your vets, and that it is your decision. But, I second the decision not to use Glip. Not only does it tend to burn out the pancreas rather than allow it to heal as insulin would, but I've seen some articles that suggest that it does liver damage.

Vinnie was on Glip in a shelter situation. I took him off as soon as he got to my house. When a blood panel was done after he was off and OTJ, his liver enzymes were elevated for a while.

A very short, very low dose of Lantus could bring Conrad into remission. A lot of vets don't have any information on Lantus because it is an off-label use of a human insulin. Lantus/Levemir reps don't call on the vets. So, we tend to have a lot more info and experience with Lantus.

ProZinc, the latest veterinary insulin for cats, hasn't been out very long. Dosing seems to be much higher than Lantus or the old PZI.

With those numbers, I would start Conrad with Lantus at .5 twice a day if he were my cat.

And you have, in my humble opinion, the best meter on the market. Been using AccuChek for me since 1980. Each of my six (opps now seven) diabetic cats has their own Aviva meter.

Questions???

Claudia

 

THANK YOU ALL! :smile:

Here's what I'll do (and this is *almost* what my vet recommended)....ONE more week with the diet change (not two), then I'll do another BG curve this Sunday (Conrad's gonna grow to hate Sundays.
I will be sure to tell my vet that I'd rather stay away from the Glip. Thanks for the head's up. I'd rather give a shot than a pill too. Better a small dose of insulin than a tablet of Glip, then.

My vet is all about Lantus, by the way. When Conrad was diagnosed, he said he'd be on a the tiniest dosage of Lantus and that he preferred this insulin because it was long-acting and had a reduced incidence of hypo. He also was up on all the studies that show a low carb diet (7% or less) and Lantus can bring many cats (up to 33%) into remission, esp. in mild cases. So, my vet is down with the Lantus. :smile:

I think I have a good vet. I don't get a bad feeling about him. (He's also a dental expert and has cleaned Conrad's teeth because, as his tech's say, "He just loves teeth!" This is completely off subject!)

 

Bo started insulin the last week in September, 2010, at 3 units twice a day then had an increase to 4 units twice a day. I learned the hard way when Bo had a seizure that I should have been listening more to the suggestions on this board. They said that we should have started low and then increased as his BG numbers indicated the need for an increase. Instead we started high, had a seizure, then after that I was scared of the high dosage and only gave him 2 units instead of 4. Along with the diet change to canned m/d, his need for insulin was quickly changing and I did not know because I was not hometesting. I was listening more to the vet and ended up more in trouble. Even though I like my vet, I am not sure that I agree with his method of treatment now that I am in the middle of this. Now I am hometesting and his numbers are indicating that he does not need insulin now. He has not had a shot in over two weeks so I think he is off the juice right now after only a few weeks. I could not get many home tests done with the AccuCheck Aviva even though it needed a small sample of .6. I bought a Reli-On meter from Walmart which only needs .3 and am getting BG tests done more often now with fewer pricks. By knowing his numbers, I feel more comfortable in making decisions about whether or not to give shots. AND I am grateful that now we are not needing injections at this point and hope that he will be in remission soon. Thankfully, Bo was put on Lantus and the information on this board showed research that many cats can go into remission if on Lantus. And maybe that is where we are heading now after only a few weeks after his diagonosis with a 561 BG level at the vet. Also after the seizure, I wanted to have Bo eat 4 small meals a day instead of two so I could feel a little better about leaving him alone during the day. I bought a timer feeder so that he could have something during the day and during the night in the hopes of warding off another seizure.

Best suggestions from this board:
***Start with a low dose and then adjust as the numbers show.
***Be ready for a hypo at all times. Learn about the symptoms of Hypo and about the "shed" in your cat's body because once it fills back up (which it did because we had so much insulin going in him so fast), the need for insulin changes. Bo had no symptoms of being hypo until he had the seizure. I was ready with Karo syrup when it happened and I followed with high carb gravy food to raise his blood sugar immediately and then took him to the emergency vet. By the time we got there his BG was back up to 74 within about 30 minutes of the seizure.
***Put your cat on canned food and get rid of the dry food. Even though the protein percentages for Hill's m/d dry and canned were about the same, the ingredients showed that more meat was used in the canned. The protein for the dry food was vegetable protein.
***Do hometesting bacause your cat's life may depend on it. We were lucky that I knew exactly when Bo has his seizure. Reli-On meter required barely a speck of blood so I am able to get BG numbers now. I will not give a shot unless I know that his BG is at a level that will require the need for insulin. Know that vet BG levels may show significantly higher than the home numbers do due to increased stress while at the vet. I think Bo's numbers are about 100 points higher at the vet due to stress and then also the vet's BG numbers are a little higher than my meter's numbers (we compared at the vet with the same blood sample.)

So listen to the people on this board. They have cats who are going through this or have gone through this. You can't beat the first -hand experience of these cat people.

 

As always, thanks!! :smile:

Conrad is already on a moist, low-carb diet and has been for the past 12 days.

I know that some vets are good and some are bad. I think I have a good one. He has echoed many of the same things you all have said. He one of those vets that loves Lantus and knows the studies, he's told me about only giving Conrad moist with 7% carbs or less and printed out the Janet & Binky list so I could take it with me to the store, he told me to hometest and said he'd show me how if I needed it; he told me about glucometers and hometesting in a way that made it sound like I could do it; he told me to do BG spot checks and curves as well as urine test results and call him back with the numbers so that we can work together; he calls when he thinks a call will do rather than make me come to the office. He had me in his office for 20 minutes, giving me advice and he didn't charge me.

I know that there are bad vets out there (and bad doctors, and lawyers, and teachers, and....). But we also have to have faith in those that are good. Using our instincts and what we learn along the way and what we know about our animals, we need to put some semblence of trust in a the knowledge that a vet has gained in vet school and by working with animals all day long. I feel like I should have even more trust in my vet because he has repeated a lot of what you all have told me.

THANKS!!!!!!!!!!! :smile:

 

Oops, sorry. One little aside I forgot to mention. My vet mentioned the Glip but did say that he's not sure how effective it is based on studies so he wasn't sure. It's just an option we could discuss, he said, because he wanted me to have all the options. But, based on what you've said, I will tell him that it's not an option I want to consider.
Have a great day, everybody.

 

Hi ;-)
I want to welcome you & share my Baby & I's story too. Baby was diagnosed in December of last year, her BG was 497.. I immediately switched her diet from dry to canned & she was down in the 200s within in 48 hours!! My Vet suggested not putting her on Insulin & of course I agreed, because the idea of insulin was sooooooo scary! However, I was really encouraged to by FDMB members, I did not want to listen.. I wanted to go by what my Vet said. Finally though, I gave in & put her on Insulin 3 weeks after diagnosis. Someone said to me, she may be in the 200s now, but if you dont get her treated now, who knows what she will be at later. I THANK God each & everyday that I went against what my Vet suggested & my feelings - I LISTENED to FDMB Members & guess what? My Baby girl was on insulin about 3 months & she is now in remission & just celebrated her 6 months OTJ!! I am blessed, she is blessed & I thank this message board & members for their expertise. Please, please, please, start insulin right now!! :mrgreen: I PROMISE it is worth it!!!

 

Wow! That's great!!! :smile:
I'm testing Conrad's BG faithfully, will stick with moist food for one more week and talk to my vet about insulin early next week.

 

UPDATE:
Well, poor Conrad has been through a lot. But there may be a light at the end of the tunnel. (Please, no stories about how you knew a cat who had this and didn't do well, steroids do this, etc. etc. :smile: My emotions are very raw from the roller coaster of the past 48 hours. I need some "ignorance is bliss" therapy about now.)

Took him to the vet early this week. The vet was still not in favor of insulin. He said Conrad was still making enough insulin on his own and dropping into the 100s. But, Conrad had a droopy day (out of the blue). The vet was confused. Something was off. He did a blood panel. Conrad's total protein was slightly elevated (indicating inflammation) and he had two bilirubin/liver numbers that were both very elevated. The vet said this, even in people, indicates pancreatitis. The reason Conrad's BGs were mildly elevated was due to this chronic inflammation.

Took him to a vet specialty clinic the next day to see a vet who specializes in feline inflammatory bowel diseases.They did an ultrasound and saw inflammation in more than just the pancreas. The specialist said Conrad looks healthy (he hasn't lost much weight and he was eating well, preening, purring, etc.) The specialist thought there was about a 70% chance that he has this autoimmune inflammatory condition. (I know all about AI conditions. I have one myself.) A 30% chance it was lymphoma. If it's inflammatory, the specialist said, Conrad will take steroids to calm the inflammation (and be weaned off of it) and, in many cats, reducing the inflammation that caused the diabetes will cause the diabetes to go into remission. (I said, "But, don't steroids cause diabetes?" In a case like Conrad's, she said, he only got diabetes because of this inflammatory condition. Hooray I didn't start insulin and listened to the my vet. He just knew something odd was going on.

Conrad stayed overnight and, today, they did 4 biopsies. The surgeon called and said it didn't look that bad and there was nothing to indicate cancer - the nodule on his liver was negative and the lymph node wasn't swollen.
I'll bring Conrad home tomorrow (possibly with a cone on his head). :smile:

 

This sounds a little better. Can I suggest that you start a NEW TOPIC and specifically ask for IBD and Pancreatitis advice? We have lots of kitties here with both issues who are being treated successfully.

 

Sorry.
Didn't want to repeat the whole story in another post and have people wondering what the heck I was talking about. :smile:

 

No worries. Go up to the top of this original post. Copy the URL. Then, when you post again, paste that URL on it. That way, people can refer to this post if they need it.

I'm afraid you are not going to get the responses you need with the title you have now. You could also change the title of this post to IBD and Pancreatitis help?