? 9y Spayed,F, DK, HHK, Hepatic Lipidosis, UTI - change insulin?

FurballAK

FurballAK

New Member
This is a long history please bear with me... I work at a vet clinic. A cat that I had used to own and returned to her original owners once their living situation changed contacted me about our cat.. She had been drinking, peeing and eating a lot for two weeks. I work for a large animal vet and we do some small animal work, but since our horse season has geared up, I advised her to take her into a different vet. She did, they suspected Diabetes, ran blood (inhouse), however, didn't give the results to her for two days. At this time, the cat stopped eating, and hadn't eaten or drank much in 3 days. They finally gave her insulin but had her come in for the first shot. At this point the cat was severely dehydrated, not eating. They gave Vetsulin at 1U AM/PM. Day 4 came, now shes still not eating and or drinking and that's where I took her. On arrival, temp. 98.6, HR 140, over 12% dehydrated, ketotic, liver values showing lipidosis, and ketones in urine off the chart and extreme UTI. So, we gave over a liter of fluids in 14 hours, began re-feeding with Royal Canin Recover and started insulin on day two when hydration improved... To cut the story short.. We have reversed DK, HHK, Lipidosis, and UTI. HOWEVER, now that shes healthy. She's never been on more than 1U BID. Her numbers are also pre-shot 230-250 on Reli-On Confirm, on AlphaTrax 260-290, sometime 320. (side note our blood machine with plasma is no more than 20 points off when using on Reli-On Confirm when plasma is used on the strips, and 60 without) On plasma, she's always under 200. but her nadirs drop to 50/60 (twice 30..long night). I've decreased dosing to 0.5 BID, same numbers. Increased to 1.25U same numbers. She drops too low and her body is compensating with the highs. She's only eating exclusively FF pate (when very sick Royal Canin Recovery).

On initial presentation, we had her on Novolin R IV every 6, she did great, tried Novolin N, didn't last more than 7 hours, back to Vetsulin which does seem to last 10/11hours. Her nadir is at the 3 hours 45 minute mark post injection. I'm unsure if we should switch or if she's showing signs of too high dosing. We have thought of doing a Fructosamine testing, however, she has been very ill and anemic that we do not want to draw more blood than necessary at this time. It requires no less than 0.5ml serum, meaning no less than 1.5mL blood. Since her hematocrit is already borderline now shes stable we do not want to stress more than needed. (FYI- hematocrit GREATLY affects glucose numbers in cats. High= false lows and Low=false highs, since she's been low we have accounted and use plasma every few days when testing liver functions to calculate an algorithm with the whole blood daily testing) Our in-house machine or require 0.5ml whole blood.

I've done countless curves and strict monitoring. Urine is not showing ketones and only very slight glucose at this time. Glucose was too high to register initially and while extremely ill. I did clean her teeth (unsedated, she's a very very easy going cat) even though she only had a grade one periodontal disease. I'm trying to sort out whether or not if when her body was not healthly if the diabetes was solely a response to the extreme stress of the UTI, DK, HHK, lipidosis and insulin is now not needed, or if I should purchase Lantus and try her on a depot. I've had her go hypo on me with Vetsulin and hit 38 and have full signs of hypo. I'm worried lantus if unneeded would be unwise for that reason. Sorry for the long story. I was hoping maybe somebody had a similar experience and advise. Since I work at a vet I have an advantage to advance/repeated testing and monitoring.


AM/PM - numbers 2 hours pre and post 230-250 on Reli-On Confirm, on AlphaTrax 260-290, sometime 320 (tried Royal Canin Glyc. dry feed caused over 130 point elevation in numbers for 24 hours duration when feed for one meal in 24 hours) . On plasma, she's always under 200. Then dives to 50-80's for 6/7 hours and then rises pre/post for the 1.5 hour. (I do not have time to do another spreadsheet. I have an app I use ( Vetsulin Pet Diabetes App) and the medical charts for work and they are ridiculously thick at this point).
 
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Oh dear, you and kitty have had such a rough time and I'm very sorry to read about it. I am not an experienced member with Vetsulin so I can't offer input there, however I have a couple of suggestions that are going to help advising members going forward.
First, create a signature so that Furball's pertinent information is right there with each of your posts, so they don't have to comb through successive posts or ask you again and again.
Then, set up the spreadsheet so they can see the insulin and BG testing data you have accumulated.
1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.
2. Spreadsheet info: You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
Additionally, I would suggest you copy and paste your message into a new thread in the Main Health Forum, as it's the weekend and many members who monitor the Vetsulin forum might not be online as much, and I would sure like you to get some more responses.
Your questions about trying Lantus are very valid and this may be a good option for her as it's a gentler, longer lasting insulin, many cats have transitioned to Lantus with good results. If a Lantus pen is used, syringes can be used instead of the pen needle for finer dosing, and this may help a great deal.

Thank you so much for being so diligent with this kitty's treatment, you are a real hero for taking the time and making the effort to help. I hope you are going to get lots of responses very soon.
PS, if you will use the thread tools and select the ? icon when you create your title, and be specific in your title, that will alert more members. You can copy and paste the message and not have to retype it all. :)
 
I'm sorry but I do not have time to create more spreadsheets. I dang near have a binder full at work in the medical charts. I can try to post what I have from the app.

We are in Alaska.

I tried posting in Health and I get the error "spam like or contains inappropriate material, if problem persists contact administrator". I will try again later.
 
Please do try again later, we had a long period of spam attacks and the board was tightened up some, preventing some newer members from being able to post in other forums right away. If you continue to have problems, let us know and we can forward the problem to the admin side. They may have to copy this thread directly to the Health forum for you.
If you don't have the time to set up the spreadsheet, there are members who can do that for you, then just plug in the insulin and testing data. I certainly understand that you are incredibly busy and we want very much to help.
In the meantime, I am going to tag a couple of other members who might have some input @Bron and Sheba @Lisa and Witn (GA)
 
Hi and welcome to the forum. What a time you have had but great job getting your kitty back on track and well again.
I’m sorry you have had trouble posting over on the main forum. @Idjit's mom explained why.
I am going to tag @Chris & China (GA) as she can set up a Spreadsheet that we can see here in the forum and all you will have to do is fill in the numbers. We can then help you with dosing in small amounts safely.

I would stick to just one meter. Either the human one or the alphatrak 2 one. Too confusing if you use both. Our protocols use the human meter.

I would be inclined to swap to Lantus as it is a much gentler insulin than Vetsulin and longer lasting now that your kitty is well again. . Also I think you would have a better chance of getting your kitty into remission with Lantus.
If you swap over you need to be testing for ketones daily at least until the depot fills.

If you could set up your signature that would be great. It is easy and only takes a minute.
I will also tag @Kris & Teasel and @Rachel as they are familiar with Vetsulin and DKA.
You have come to the right place for help and support.
Bron
 
I would be happy to set up your spreadsheet for you so all you have to do is plug in the numbers. We really are very data driven here so we need to see the numbers.

To send me a private message just click on my name and choose "Start Conversation" so I can get some information from you.
 
Hello! Gosh what a tough time you and that sweet kitty have had lately. I first have to give you MAJOR props for taking such great care of her and getting all those health issues resolved! That's tough when the kitty is so sick and you've done an excellent job taking care of her and truly saved her life.

It does sound like insulin is working...going from 250 to 50 is pretty extreme. You said you get the same numbers no matter what dose you give? Can I ask how often you changed the dose? Sometimes a lot of dose changes can cause some crazy numbers. It's possible that your kitty needs a consistent dose for a few days to kind of settle in some and get some good data...and then we can see if changing the dose helps or not.

Please do ask any questions you have! Working at a vet clinic gives you a major advantage, but since you said you work mostly with large animals, I imagine you might have some questions. :)
 
I second, third, fourth what the previous posters have said

want to thank you also for posting the numbers both from the Confirm and from the Alphatrak, since with your permission I would like to show that to my vet, since we are getting similar numbers on the Confirm, and she will want to know how my numbers on the Confirm compare with her Alphatrak

we have an appointment tomorrow (Monday) midmorning with the vet, for her to evaluate progress and look at the tooth/gum problem she noticed earlier

you're welcome to look at Catcat's spreadsheet if you like, know you are busy and don't have scads of free time, as I do

setting up the spreadsheet doesn't take that much, but bless you @Chris & China (GA) for volunteering to do it, easy enough to plug in the numbers once it's up
 
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