Recently Diagnosed - Cinco

My husband and I have four very spoiled indoor cats. We do not have five because one of our kitties is violently opposed to having any more housemates. Last October I noticed that an orange tabby that had been around the neighborhood for years was spending a lot of time in our yard. In fact, he was there all the time. After about a week I finally offered him food and water. He inhaled both. This became a routine. As the weather cooled and rains started, we set up a shelter in the back yard (Cinco picked the location). My husband kept referring to him as "number five", so I named him Cinco. By January, he was letting me pet and brush him, so I started using Advantage Multi on him - although he didn't like it, he never took a swipe at me or tried to bite me. I noticed that he had a very good appetite and drank a lot of water. In June I decided it was time to get him checked out and vaccinated. My plan was, if he was healthy, to contact a rescue organization and try to find him a forever home. He deserved more than I could offer him. I took him to the vet on June 22nd. He tested negative for FIV and Feline Leukemia, but they called that night to say he had a lot of sugar in his urine and wanted me to bring him back for more blood tests. Everyone at the office commented on how mellow and cooperative he was. On the evening of the 23rd, the vet called and said he was diabetic, and his mellowness was probably due to severe dehydration. We took him in on the 25th to learn how to give him insulin, and he received subq fluids. We started him on 1.0 unit of Lantus, once a day. We moved him into the garage and began feeding him moist DM twice a day and dry DM, available all day. He was peeing all over the garage - sometimes in the litter box, sometimes not. Drank a LOT of water. On June 28 we took him back for a BG test, and it was still over 500. His dose was increased to 1.0 twice a day. He was still lethargic and his back legs were weak. Sometimes he would just lie where he was and pee all over himself. On July 1st he was tested again, and still over 500. Dose was increased to 1.5 units, twice a day. There were a couple of bare areas on his hind legs, which the vet said was due to urine scald. On the morning of the 6th I took him in again, and his BG was still immeasurable. He was hospitalized and put on IV fluids and insulin. They were also giving him 2 units, twice a day. When they bathed him, fur just came off his back legs in clumps. They sent him home on the 10th, with instruction to give him 3 units, twice a day. They had also started him on Chinese tea pills to help his bladder control. We were instructed to bathe him every day. The next day, the 11th, I took him in for another BG check, and he was still off the charts. He seemed no better at all. The vet suggested it might be time to consider euthanization. I took him home and fed him and gave him his insulin, and cried over him. Then we went out for five hours. When we came home, he was standing up in his cage and meowing! We decided to give him more time. Over the next couple of days, he continued to be more alert and seemed stronger. He stopped peeing on himself, although he didn't always use the litter box. I started feeding him smaller meals of the moist DM, and no dry food at all. On the 14th we went back for another check and he was still over 500. Vet was encouraged by his improved behavior and upped the dose to 3.3 units, twice a day. I got a home meter and on the 15th took my first reading - 365 five hours after his evening shot. The vet adjusted his dose to 3.5 (too hard to do 3.3). On the 16th we left him at the vet all day so they could do a curve. I don't have the numbers yet, will get them in the next day or two. On the 17th his BG ranged from 90 to 235. I noticed he wasn't drinking as much water, nor urinating as much. Still good appetite! The vet said we could reduce dose if we wanted. Decided to drop it to 3.0. On the 18th his levels ranged from 120 to 524 (First time over 500 since the 14th). The 19th his AMPS was 417, and he was at 259 +4, 426 + 9 and at 64 four hours after his evening shot! I feed him every time I do a BG test, as that's the only way he'll stay still. He's never shown symptoms of hypo since I started testing him at home. He's still moving fine, although his back legs are a little wobbly at times, and he's more alert than he's been since before he was diagnosed. Today, (the 20th) he was at 340 AMPS, then 402 at +4 and 480 at PMPS. I don't know what to do now - do we increase the dose, leave it alone for a while longer, or decrease it? Please, Help! Here is the spreadsheet I'm keeping on him: https://spreadsheets.google.com/spreads ... c&hl=en_US[]

 

bumping you up to the top

 

Hi! You've come to the right place for help and advice - the people here have much more collective experience with diabetic cats than most vets. Sounds like Cinco, and you, have been through a lot.

First - great that you already have a spreadsheet but the link isn't working - please correct it as soon as you get a chance. It's much easier to give advice with organized information.

Some general info:

Lantus works best given twice a day, as close to every 12 hours as you can manage. Looks like that's what you're already doing?

If he went down to 64 on 3.0 units, I wouldn't increase. At this point you need to keep doing spot checks, and when you can do some mini-curves at home: tests every three hours - every two hours is ideal but that's a bit much for many cats and many people too. Over a little time you'll learn when his nadir (the lowest bg of the cycle) falls and you can try to test him around that time as often as possible. Lantus dosing is done by nadir values, not pre-shot values. Curves at the vet's are not very helpful since the cat is stressed and that affects bg levels.

In general, you want to decrease dose if the cat goes under 50 three times on different cycles, or if he goes under 40 once. BTW, you should have a few cans of high-carb food handy in case he goes low - any kind of canned food with sauce or gravy will do fine. At this point for Cinco, you're trying to get him under 100 every cycle, ideally into the normal 60-80 range. Be prepared - at this stage cats can require very quick dose reductions.

Expect irregularity and inconsistency at first. It can be frustrating, but in time things will settle down.

You don't need to feed prescription food. Low carb grocery store food is just as good. I feed Friskies 'pate' foods, 9-Lives, and Fancy Feast 'Classic' foods. Look for no gravy or sauce, and read the label - rice or any kind of grain or carb shouldn't appear before the 6th or 7th ingredient. You can look up Janet and Binky's food charts for more info. It's important that he gets NO dry food, not even the prescription stuff.

You can look into healthy low-carb snacks as a reward and distraction for testing - a lot of us give Halo freeze-dried chicken, aka Kitty Crack.

And you might want to look into methylcobalamin for Cinco's leg weakness, although that should improve as he gets better bgs.

Others will be along to help and give better info and advice than I can! You're a good person to take Cinco in and to do all this for him!

 

Here's the link to your post on the Health board.

You replied to my post:

I don't feed my cats fish flavors (Gabby is a female my my other cat, Gizmo is a male). Fish, if fed more than a couple of times a week, can contribute to crystals in males. (Their plumbing was poorly thought out!)

If Cinco was started at 1.0u, I wouldn't go back to that dose.We do raise doses in small increments (0.25u usually, sometimes 0.5u) based on the protocol. I would stick with your current dose.

Also, could you please make sure that you are using U100 syringes? The U100 syringes can have marks at full and half units (which is what we recommend). I've never heard of a vet recommending a dose of 3.3u. (We do "fatten" or "skinny" a dose but most vets don't do that.) There are other syringes (U40) that you can approximate like this on but they are not the syringes to use with Lantus. (Lantus is a U100 insulin and you need U100 syringes. We've had members who's vets have given them U40 syringes with Lantus and they ended up overdosing their cat.)

I couldn't get your SS to open either. Make sure you have the setting enabled so you can share the spreadsheet.

 

my cat would be one of those who had the wrong syringes! fortunately he survived!

you're doing great to start with - yes and kudos to you for taking in cinco! he's a lucky guy!

the only thing (besides welcome!) that i can add to everyone else's comments is that every time a dose gets increased the numbers get wonky. for whatever reason you have to stay with a dose for about 3 days (unless they go too low) before knowing how that dose really works on your kitty. it can even cause that inversion that you mentioned, where the check that should be the lowest number ends up being the highest number and you want to scratch your head about all of that!

so hang in there - start a daily condo tomorrow with cinco and post as often as you can. ask as many questions as you need and we'll help you through it. people here know feline diabetes inside and out after doing it 24/7 for years on end. you're in the right spot to get him healthy again. i've been amazed at how the cats with leg problems have had them resolved with help here.

btw, you can add water to cinco's food to help him stay hydrated. i add up to equal amounts of water with punkin's canned food and he eats it happily. makes for a soggy litterbox but i think it's good for him. he's returned to the "old" kitty i knew before he got sick.

 

I just wanted to welcome you to LL! You are a wonderful, amazing person to have taken Cinco in and have done an incredible job with him. It sounds like he is definitely on the road to better health. It is so important that you test him and do the curves whenever possible. The more information on the spreadsheet, the better it will be for others to give advice. The help I have received from everyone here has been amazing and the support from others has kept me sane. This is the place to ask any questions, so ask away!!

Good luck with everything and post daily so we can see how things are going on a regular basis. Welcome!!!

 

Thanks for all your kind words and helpful advice. I finally learned how to get the spreadsheet posted so it would open. I think. See below.

Cinco seems to be doing really well, as far as behavior and appearance go. He uses the litter box consistently (although he pees right at the edge and sometimes over the sides. Would like to switch to a box with higher sides but will wait till his back legs are stronger) and is starting to groom himself again. He is getting bored hanging out in my garage all day. I'm hoping to install a couple of screen doors this weekend - one on the door into the house, and one on the door to outside. On nice days or evenings, I think he'd enjoy being able to look out at the world, and smell the smells he's used to from when he was an outside cat. The indoor one would be useful to funnel cooler air out from the house, and to give my indoor cats a chance to see and smell him. I'm still hoping we can find a way to integrate him. He is really a sweet, gentle cat and loves to be petted. He's getting peach fuzz on his back legs and hips, where the urine scald burned his fur off. My husband says he looks like he had a lyon cut that went bad!

I used up the DM moist and have him on FF classic, non-fish flavors. Interesting to hear about the crystals in male cats - I have a male Abby that has had crystals, and he only eats fish flavors - he doesn't like any other flavors. I'll have to try to convince him to broaden his palate. I haven't fed Cinco dry food for over a week, except on the two occasions noted on the sheet, when his readings were low. I also give him deli-style sliced turkey as a treat when I test his BG. He loves it! I do have some FF in gravy on hand, as well as Karo syrup.

As you can see from the sheet, we dropped him to 2.0 on the 22nd and started getting lower nadirs, but really big swings. Yesterday morning we dropped him to 1.5. So far he's had much more consistent readings, but they're mosty in the 200s. We'll review after 3 days and consider going up .25.

Yes, we've been using U100 syringes. The vet had given me a script for the 1/2 size, but with all the .5 and possible .25 units, today I picked up some 3/10 which I hope will help with our accuracy. We shoot twice a day, as close to 12 hours apart as possible. The vet said the most you could vary is an hour either way and we've managed to stay well within that.

Once again, thank you all! My friend that referred me to the board was so right - you people are great!


https://spreadsheets.google.com/spr...gVSWwdEp4OWZpVXZCd05WV0taYmJRb1JmVXc&hl=en_US

 

Julie 1220, what's a condo, please? I couldn't find it in the glossary.

 

Good morning! A "condo" is what we call our discussion threads here.

Glad to hear Cinco is doing really well!

Amy

 

It looks like Cinco earned a dose reduction by dropping to 39. If you take a look at the dosing protocol we use, you would have reduced Cinco's dose at the shot after he earned the reduction, rather than waiting 2 cycles. Also, reducing a dose by 0.25u is more likely to result in Cinco holding the dose reduction than reducing by 0.5u.

I'd also suggest that you print out or bookmark this post on handling low numbers. When a cat's numbers drop below 50, you want to monitor more frequently. While those lower numbers are good and earn a dose reduction, you need to be sure that your cat isn't hanging out in lower ranges overly long. Also, as an FYI, dry food takes much longer to get into the blood stream and raise BG numbers. It also takes a long time to get out of a cat's system. This is the reason we rely on gravy from canned food -- its quick to bring numbers up and it doesn't stick around.